A 24-year-old man is hospitalized after a violent episode in which he destroyed his television with a baseball bat. Over the past year, the patient was convinced that people on television were monitoring his thoughts and movements and that certain newscasters were laughing at him. At night, he was unable to sleep and reported hearing the voices of demons threatening to kill him. The patient was diagnosed with schizophrenia and initially treated with chlorpromazine. He now is reluctant to take the medication, saying, "I don't like how it makes me feel." His medication is subsequently changed to fluphenazine. Compared to the patient's initial treatment, fluphenazine is more likely to cause which of the following?

Question

A 24-year-old man is hospitalized after a violent episode in which he destroyed his television with a baseball bat.  Over the past year, the patient was convinced that people on television were monitoring his thoughts and movements and that certain newscasters were laughing at him.  At night, he was unable to sleep and reported hearing the voices of demons threatening to kill him.  The patient was diagnosed with schizophrenia and initially treated with chlorpromazine.  He now is reluctant to take the medication, saying, "I don't like how it makes me feel."  His medication is subsequently changed to fluphenazine.  Compared to the patient's initial treatment, fluphenazine is more likely to cause which of the following?

Quizplus · Accepted Answer

11ec160b_3c4d_b733_9249_dfefb826cf4a_MD0001_00 First-generation antipsychotics (FGAs), also known as typical or conventional antipsychotics, are effective in treating schizophrenia and psychosis due to other causes. FGAs are classified according to potency, which refers to the dose required to produce an effect. Low-potency FGAs primarily cause histaminergic, cholinergic, and noradrenergic blockade side effects. These drugs are highly sedating and often cause anticholinergic side effects and orthostatic hypotension. High-potency FGAs are associated primarily with extrapyramidal symptoms (eg, dystonia, akathisia, parkinsonism) due to potent D2 dopamine receptor antagonism in the nigrostriatal pathway. This patient's medication was changed from a low-potency FGA (chlorpromazine) to a high-potency FGA (fluphenazine). Muscular rigidity, an extrapyramidal side effect, is seen in drug-induced parkinsonism; it is more likely to occur with a high-potency agent. (Choices A, C, and G) Constipation, dry mouth, and urinary retention are anticholinergic side effects due to cholinergic receptor blockade. They are more common with low-potency antipsychotics. Other anticholinergic side effects include blurred vision and impaired cognitive function. (Choice B) Dizziness and orthostatic hypotension are due to alpha-1 adrenergic blockade and are more common with low-potency FGAs. Orthostatic hypotension is particularly problematic in the elderly due to the risk of falls. (Choice D) Hyperglycemia is a metabolic side effect seen more commonly with second-generation antipsychotics. (Choice F) Sedation is due to histamine receptor blockade that is more common with low-potency antipsychotics. Educational objective: First-generation antipsychotics can be classified according to high or low potency and have characteristic side effect profiles. Low-potency antipsychotics are more likely to cause sedation, anticholinergic side effects, and orthostatic hypotension. High-potency antipsychotics are more likely to cause extrapyramidal symptoms (eg, dystonia, akathisia, parkinsonism). __________ References: Fluphenazine versus low-potency first-generation antipsychotic drugs for schizophrenia. (http://www.ncbi.nlm.nih.gov/pubmed/25087165) Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. (http://www.ncbi.nlm.nih.gov/pubmed/23810019)

A 24-Year-Old Man Is Hospitalized After a Violent Episode in Which