14 Questions
What is the most common use of the first-generation antipsychotics mentioned in the text?
Treating schizophrenia and acute psychosis
Which of the following is NOT a potential adverse effect of the first-generation antipsychotics?
Hypertension
What is the primary mechanism of action of the second-generation antipsychotic Clozapine?
All of the above
Which of the following is a potential drug interaction with Clozapine?
Both a and b
What is a contraindication for the use of Clozapine?
Severe renal impairment
Which of the following is a potential adverse effect of the first-generation antipsychotics that is less likely to occur with the second-generation antipsychotics like Clozapine?
Extrapyramidal symptoms
What is the primary route of administration for the first-generation antipsychotics mentioned?
All of the above
What are the main neurotransmitters blocked by Chlorpramazine in the CNS and PNS?
Dopamine, Acetylcholine, Histamine, Norepinephrine, Alpha1 and Alpha2 receptors
Which of the following conditions can be treated with Chlorpramazine besides Schizoeffective disorder?
Hiccups
What is the mechanism of action of Haloperidol in the CNS and PNS?
Blocking many receptors including dopamine and acetylcholine
Which adverse effect is associated with Chlorpramazine due to the blockade of alpha adrenergic receptors?
Tachycardia
What severe condition is characterized by 'twisting/wormlike movements of tongue/face, lip smacking, and tongue darting'?
Tardive dyskinesia
Which of the following symptoms is NOT associated with Extrapyramidal Symptoms (EPS) due to Chlorpramazine?
Uncontrollable need to move
How does Chlorpramazine affect the risk of electroshock therapy?
Reduces the risk
Study Notes
Antipsychotic Drugs
- H1, NE, Alpha 1 antagonists are used to treat schizophrenia, acute psychosis, Tourette's, and severe behavioral issues in kids.
Chlorpromazine (Thorazine)
- Low potency, first-generation antipsychotic (FGA) with conventional/neuroleptic/typical mechanism of action
- Blocks receptors in CNS and PNS: DA, AcH, H1, NE, Alpha 1, Alpha 2
- Used to reduce risk of electroshock therapy, treat schizophrenia, schizoaffective disorder, and bipolar disorder; also used for hiccups, emesis, and behavioral issues in kids
- Administered through PO, IM, IV; higher dosage required to achieve therapeutic effect
- Contraindications: CNS depression with benzodiazepines, 1st gen antihistamines, ethanol, opioids, barbiturates, and antidepressants
- Adverse effects:
- EPS: acute dystonia, parkinsonism, akathisia, tardive dyskinesia
- Anticholinergic effects: dry mouth, constipation, urinary frequency/retention, tachycardia, blurred vision
- Orthostatic hypotension due to alpha-adrenergic blockade
- Cardiac dysrhythmias
- Sedation (especially in the first week of therapy)
- Agranulocytosis (rare but serious)
- Sexual dysfunction, gynecomastia, galactorrhea, menstrual irregularity
- Increased sunlight sensitivity and risk of seizures
Haloperidol (Haldol)
- Conventional/typical/butyrophenone/nonphenothiazine neuroleptic
- Blocks multiple receptors in CNS and PNS: DA, ACH
- Mechanism of action: blocking receptors in CNS and PNS
Clozapine (Clozaril)
- Second-generation atypical antipsychotic
- Blocks DA receptors, depressing the reticular activating system, as well as serotonin and glutamate receptors; also has anticholinergic, antihistamine, and alpha-adrenergic blocking activity
- Used to treat schizophrenia, bipolar disorder, and severe behavioral problems in autistic children
- Administered through PO, IM
- Decreased drug levels with: barbiturates, rifampin, tegretol, dilantin, ethanol, and benzodiazepines
- Increased drug levels with many antifungals, erythromycin, quinidine, and SSRIs
- Adverse effects:
- HA, agitation, nervousness, anxiety, insomnia, NV, dizziness, somnolence
- EPS, orthostatic hypotension, weight gain, DM, dyslipidemia
- Acute dystonia: laryngospasm
Test your knowledge on Chlorpromazine (Thorazine), a low potency first-generation antipsychotic with various effects on neurotransmitter receptors. Learn about its mechanism of action, uses, dosage forms, drug interactions, adverse effects, and more.
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