NEUROLEPTICS

NEUROLEPTICS

Q. 1

Which of the following neuroleptics is not an atypical antipsychotic?

 A

Clozapine

 B

Ziprazidone

 C

Zuclopenthixol

 D

Quetiapine

Q. 1

Which of the following neuroleptics is not an atypical antipsychotic?

 A

Clozapine

 B

Ziprazidone

 C

Zuclopenthixol

 D

Quetiapine

Ans. C

Explanation:

Atypical antipsychotics are new generation anti-psychotics which are called serotonin-dopamine antagonists (SDA).

These drugs include Olanzapine, Risperidone, Quetiapine, Clozapine and Ziprazidone.

They have higher ratio of serotonin (5-HT2) receptor blockade compated to the higher dopamine receptor blockade in the old generation anti-psychotics like Haloperidol, Chlorpromazine, Zuclopenthixol etc. 

Atypical antipsychotics are a reduced risk for extra-pyramidal side effects (EPSEs) including tardive dyskinesia.

Efficasy of the atypicals are proved in Schizophrenia and acute mania. 

Ref: Kaplan & Sadock’s Synopsis of Psychiatry, By Benjamin J Sadock, M.D., Harold I. Kaplan, Virginia A Sadock, M.D, 10th Edition, Page : 1091


Q. 2

Which of the following properties distingiush Aripiprazole from atypical antipsychotics?

 A

It is a potent 5-HT2A receptor antagonist

 B

Reduced risk of extrapyramidal side effects

 C

It can be used in Schizophrenia

 D

It is not a D2 receptor antagonist

Q. 2

Which of the following properties distingiush Aripiprazole from atypical antipsychotics?

 A

It is a potent 5-HT2A receptor antagonist

 B

Reduced risk of extrapyramidal side effects

 C

It can be used in Schizophrenia

 D

It is not a D2 receptor antagonist

Ans. D

Explanation:

Aripiprazole is a potent 5-HT2A receptor antagonist like atypical antipsychotics.

It is one of the newer drugs which belongs to a class of patial D2 receptor agonists.

It is not D2 antagonists like other antipsychotics, which makes them an entirely different class.

They are used in Schizophrenia and Acute mania.

They have very low risk of extrapyramidal side effects, weight gain and diabetis.


This are also a distinguishing factors from other Atypical Antipsychotics. 

Atypical antipsychotics are new generation anti-psychotics which are called serotonin-dopamine antagonists (SDA).
These drugs include Olanzapine, Risperidone, Quetiapine, Clozapine and Ziprazidone.
They have higher ratio of serotonin (5-HT2) receptor blockade compared to the higher dopamine receptor blockade in the old generation anti-psychotics like Haloperidol, Chlorpromazine, Zuclopenthixol etc.  
Atypical antipsychotics are a reduced risk for extra-pyramidal side effects (EPSEs) including tardive dyskinesia. Efficacy of the atypicals are proved in Schizophrenia and acute mania. 
 
Ref: Kaplan & Sadock’s Synopsis of Psychiatry, By Benjamin J Sadock, M.D., Harold I. Kaplan, Virginia A Sadock, M.D, 10th Edition, Page : 1091

Q. 3

All of the following drugs are classified as atypical antipsychotics, EXCEPT:

 A

Olanzepine

 B

Clozapine

 C

Risperidone

 D

Thioridazine

Q. 3

All of the following drugs are classified as atypical antipsychotics, EXCEPT:

 A

Olanzepine

 B

Clozapine

 C

Risperidone

 D

Thioridazine

Ans. D

Explanation:

Thioridazine is a first generation antipsychotic. 
 
Commonly used atypical antipsychotics are:
  • Clozapine
  • Risperidone
  • Olanzapine
  • Quetiapine
  • Ziprasidone
  • Aripiprazole
First generation antipsychotics are:
  • Chlorpromazine
  • Trifluoperazine
  • Perphenazine
  • Loxapine
  • Haloperidol
  • Fluphenazine
  • Thiothixene
Ref: Reus V.I. (2012). Chapter 391. Mental Disorders. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison’s Principles of Internal Medicine, 18e.

Quiz In Between


Q. 4

Atypical (Second generation or newer) antipsychotics are:

 A

Aripiprazole

 B

Risperidone

 C

Olanzapine

 D

All

Q. 4

Atypical (Second generation or newer) antipsychotics are:

 A

Aripiprazole

 B

Risperidone

 C

Olanzapine

 D

All

Ans. D

Explanation:

A, B, C i.e. Aripiprazole, Risperidone, Olanzapine


Q. 5

Malignant neuroleptic syndrome is caused by:

March 2009

 A

Antidepressants

 B

Anxiolytics

 C

Antipsychotics

 D

Antiepileptics

Q. 5

Malignant neuroleptic syndrome is caused by:

March 2009

 A

Antidepressants

 B

Anxiolytics

 C

Antipsychotics

 D

Antiepileptics

Ans. C

Explanation:

Ans. C: Antipsychotics

Neuroleptic malignant syndrome (NMS) refers to the combination of hyperthermia, rigidity, and autonomic dysregulation that can occur as a serious complication of the use of antipsychotic drugs.

The list of atypical antipsychotic drugs that may cause NMS include olanzapine, risperidone, paliperidone, aripiprazole, ziprasidone, amisulpride, and quetiapine.

Clozapine may also be associated with the development of NMS, but it appears to be less likely to manifest with extrapyramidal features, including rigidity and tremor.

The most widely accepted mechanism by which antipsychotics cause neuroleptic malignant syndrome is that of dopamine D2 receptor antagonism.

Central D2 receptor blockade in the hypothalamus, nigrostriatal pathways, and spinal cord leads to increased muscle rigidity and tremor via extrapyramidal pathways. Hypothalamic D2 receptor blockade results in an elevated temperature set point and impairment of heat-dissipating mechanisms.

Peripherally, antipsychotics lead to increased calcium release from the sarcoplasmic reticulum, resulting in increased contractility, which can contribute to hyperthermia, rigidity, and muscle cell breakdown.


Q. 6

Most common receptor for typical antipsychotics is ‑

 A

D1

 B

D2

 C

D3

 D

D4

Q. 6

Most common receptor for typical antipsychotics is ‑

 A

D1

 B

D2

 C

D3

 D

D4

Ans. B

Explanation:

Ans. is ‘b’ i.e., D2

ANTIPSYCHOTICS

  • Antipsychotic (neuroleptic) drugs can be divided into typical and atypical.

Typical

  • Block D2 receptors
  • Have significant extrapyramidal symptoms (except for thioridazine) – Parkinsonism, Acute muscular dystonia, Akathisia, Malignant neuroleptic syndrome, Tardive dyskinesia.

Drugs are

  1. Phenothiazines – Chlorpromazine, Thioridazine, Trifluperazine, Fluphenazine.
  2. Thioxanthenes – Thiothixene, Flupenthixol.
  3. Butyrophenones – Haloperidol, Trifluperidol, Penfluridol.
  4. Other heterocyclics – Pimozide, Loxapine, sulpiride

Atypical

  • These are newer generation (second generation) antipsychotics that have weak D2 blocking but potent 5-HT2 antagonistic activity.
  • Called atypical because they have no D2 blocking property (except resperidone).
  • Extrapyramidal side effects are minimal (Resperidone can cause some extrapyramidal effects).
  • Have no antiemetic effect.
  • Examples are → Clozapine, Risperidone, Olanzapine, Quetiapine, Aripiprazole, Ziprasidone.

Quiz In Between



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