Psych

Antidepressant

SSRI

• expreSS tRIps: selective serotonin reuptake inhibitors (SSRIs)

• Fly out: fluoxetine (SSRI)

• Parrot: paroxetine (SSRI)

• Desert Airline: sertraline (SSRI)

• City: citalopram (SSRI)

• Smiley face: serotonin (5-HT)

• Keeping post-it out of the drawer: SSRIs inhibit the presynaptic reuptake of serotonin (5-HT)

• Fax machine: venlafaxine (SNRI)

• Dual copier/scanner: duloxetine (SNRI)

• North and South: SNRIs (e.g. venlafaxine, duloxetine) inhibit the presynaptic reuptake of norepinephrine and serotonin

• 2 month calendar: SSRIs and SNRIs (take 1-2 months to achieve maximum effect (not for acute treatment)

• Happy and sad masks: SSRIs and SNRIs are first line agents for the treatment of depression

• 5H-TV: serotonin (5-hydroxytryptamine, 5-HT). SSRI and SNRI treat depression by increase serotonin

• Anxious coworker: SSRIs and SNRIs are first line agents for the treatment of generalized anxiety disorder (GAD)

• The Scream: SSRIs and SNRIs treat panic disorder

• Dog tags: SSRIs and SNRIs treat PTSD

• Obsessively neat: SSRIs are useful in the management of obsessive compulsive disorder (OCD)

• Binge drawer: SSRIs are useful in the management of bulimia, not anorexia

• Shy guy: SSRIs are useful in the management of social anxiety disorder

• Chronically frayed wire: SNRIs treat chronic pain (e.g. neuropathic pain)

• Pain in the Diasweetes machine: SNRIs (e.g. venlafaxine, duloxetine) treat diabetic neuropathy (both NE and 5HT)

• Fiber bars: SNRIs (e.g. venlafaxine, duloxetine) treat fibromyalgia

• Inappropriately wet head: SSRIs may cause hyponatremia (SIADH)

• Rejected advances: SSRIs can cause sexual dysfunction

• Fat belly: SSRIs can cause weight gain

• Sleeping on the job: SSRIs can cause drowsiness

• Excessive smiley faces: SSRIs and SNRIs can serotonin syndrome

• Hot and hypertensive: serotonin syndrome is characterized by hyperthermia and hypertension (autonomic instability)

• Hyperactive foot tap: serotonin syndrome is characterized by neuromuscular hyperactivity (e.g. hyperreflexia, clonus) NMS: rigidity

• Tricycle and mouse traps: serotonin syndrome can occur if SSRIs or SNRIs are combined with other drugs that increase serotonin levels (e.g. TCAs, MAO inhibitors)

• “Silly pranks prohibited”: cyproheptadine (5HT-2 blocker) treats serotonin syndrome

• Hypertensive coworker: SNRIs can cause hypertension

• Withdrawn with the flu: withdrawal symptoms from SSRIs and SNRIs include flu-like symptoms (dizziness, fatigue, headache, nausea), taper off the drug

TCA

• Tricycle: tricyclic antidepressants (TCAs)

• Imprint: imipramine (and derivatives desipramine, clomipramine - TCAs)

• Tripping: amitriptyline, nortriptyline

• Prevented from picking up smiley face and compass balls: TCAs inhibit presynaptic uptake of serotonin and norepinephrine (NET, SERT)

• Treat depression by up monoamines (S, D, NE)

• Happy and sad masks: TCAs can be useful in treatment resistant depression (SSRI first line)

• Resistant door: TCAs can be useful in treatment resistant depression (SSRI first line)

• Pain from Diasweeties machine: TCAs treat diabetic neuropathy

• Chronically frayed wire: TCAs treat chronic pain (e.g. neuropathic pain)

• Pounding head bell: TCAs can be used for migraine prophylaxis (amitryptyline)

• Obsessively neat: clomipramine (TCA) treats OCD (SSRIs first line)

• Northside Prep: nortriptyline and desipramine (secondary amines)

• Protected by secondary sign: secondary amines (e.g. nortriptyline and desipramine) are associated with less cholinergic effects (good for elderly)

• Rejected advances: TCAs can cause sexual dysfunction

• Anti-muscarinic tea party: TCAs inhibit muscarinic acetylcholine receptors → dry mouth, constipation, blurred vision, urinary retention

• Confused elderly: TCAs are relatively contraindicated in elderly patients due to severe anticholinergic and antihistamine effects (use secondary amines)

• Bee swatter: TCAs block H1 histamine receptors

• Hefty kid: TCAs can cause increased appetite and weight gain

• Sleeping kid: TCAs can cause sedation

• Extinguished alpha flame: TCAs block alpha-1 receptors

• Passed out: TCAs can cause orthostatic hypotension

• Broken hearts: TCAs induced cardiotoxicity (e.g. fatal cardiac arrhythmias) is the most common cause of death in overdose

• Inactivated peanut butter jar: TCAs block the cardiac fast Na+ channels, decreased contractility, QRS, QT propagation

• Wide QRS crack: TCAs can widen the QRS complex on ECG

• Twisted torsades streamer: TCAs can induce torsades

• Baking soda: sodium bicarb teats widened QRS and ventricular arrhythmia caused by TCA overdose (increase serum pH, favor nonionized drug version, also increase Na in serum)

• Shaking kid: TCAs can induce seizures (cardiac, coma, convulsion)

• Stack of smiley faces: TCAs can cause serotonin syndrome

MAO I

• Albino mouse: monoamine oxidase A (MAO-A)

• Albino mouse eating smiley face: MAO-A breaks down serotonin

• Albino mouse eating north compass: MAO-A breaks down norepinephrine

• Albino mouse eating rope: MAO-A breaks down dopamine

• Black mouse: MAO-B

• Black mouse eating rope: MAO-B breaks down dopamine

• Mouse trap: MAO inhibitors

• Irreversible trap: MAO inhibitors are irreversible

• “Try a sip of wine”: tranylcypromine (MAO inhibitor)

• Funnel: phenelzine (MAO inhibitor)

• Boxed wine: isocarboxazid (MAO inhibitor)

• Sledge hammer: selegiline (selective MAO-B inhibitor)

• Brain tied with rope: selegiline (selective MAO-B inhibitor) increases dopamine levels in the CNS

• Happy and sad masks: MAO inhibitors can treat depression (not first line)

• “Not typical”: MAO inhibitors may be useful in atypical depression

• Resistant wine bottle: MAO inhibitors can be useful in treatment resistant depression

• Cog wheels: selegiline is useful in the management of Parkinson's disease (increases dopamine levels in the CNS)

• Aged meats, wine, cheese: MAO inhibitors should be avoided with these tyramine

  containing foods

• Albino mouse eating GI meat: tyramine is normally broken down by MAO-A in the GI tract

• Trap releasing north compass cheeses: in the presence of MAO inhibitors, tyramine enters the circulation and acts as a sympathomimetic agent

• Hypertensive and sweaty: tyramine toxicity can precipitate a hypertensive crisis (e.g. hypertension, blurry vision, diaphoresis)

• Also blocks H1, a1: orthostatic hypotension, weight gain

• Pile of smiley faces: MAO inhibitors can cause serotonin syndrome

• Tricycle: MAO inhibitors should be avoided with other drugs that increase serotonin levels

  (e.g. TCAs, SSRIs, SNRIs → cause serotonin syndrome)

• Phantom of the alpha: phentolamine (alpha-1 and alpha-2 blocker) can be used to manage

  hypertensive symptoms of tyramine toxicity

Bupropion

• “NET DAT ball”: bupropion inhibits the norepinephrine transporter (NET) and the dopamine transporter (DAT) (work like amphetamines). No effect on serotonin

• Pro ball player: bupropion (atypical antidepressant)

• Aroused from sleep: bupropion exerts CNS activating effects

• Happy and sad masks: atypical antidepressants can be used as first line agents to treat depression

• “Pros don’t smoke”: bupropion can be used to treat tobacco dependence

• Shaking: bupropion can induce seizures, avoid in seizure patients

• Shaking binge snacker: bupropion is contraindicated in bulimia (may induce seizures)

• Shaking skinny player: bupropion is contraindicated in anorexia nervosa (may induce seizures)

• Kissing couple: bupropion does not cause sexual dysfunction

• “Lose weight”: bupropion is less likely to cause weight gain

• “Mirth and Misery”: mirtazapine (atypical antidepressant)

• Happy and sad masks: atypical antidepressants can be used as first line agents to treat depression

• Extinguished double alpha light: mirtazapine blocks alpha-2 receptors

• Released smiley faces and north compasses: alpha-2 inhibition increases presynaptic release of serotonin and norepinephrine

• Retired 52 and 53: mirtazapine blocks 5HT-2 and 5HT-3 receptors

• Bee swatter: mirtazapine inhibits H1 histamine receptors

• Sleeping fan: mirtazapine can cause sedation

• Hefty fan: mirtazapine can cause weight gain

• Kissing couple: mirtazapine does not cause sexual dysfunction

• Trombone: trazodone (serotonin modulator)

• Smiley face drummer: trazodone is a serotonin modulator (antagonizes 5-HT receptors and inhibits 5-HT reuptake)

• Retired 52: trazodone inhibits 5HT-2 receptors

• Happy and sad masks: atypical antidepressants can be used as first line agents to treat depression

• Extinguished alpha lighter: trazodone antagonizes alpha-1 receptors

• Erect trombone: trazodone can cause priapism (trazobone)

• Fainting: trazodone can cause orthostatic hypotension

• Sleeping players: trazodone can cause sedation

• Bee swatter: trazodone blocks H1 histamine receptors

• Rejected advances: trazodone can cause sexual dysfunction

• Pile of smiley faces: trazodone can cause serotonin syndrome

Mood Stabilizers

Lithium

• Polar setting: bipolar

• 2 Stabilizing poles: mood stabilizers (e.g. lithium, valproate, carbamazepine, lamotrigine, antipsychotics)

• “Winter festiVAL”: valproate treats bipolar disorder (acute mania and maintenance)

• Classic car carving: carbamazepine treats bipolar disorder (acute mania and maintenance)

• Llama: lamotrigine treats bipolar disorder (maintenance only)

• Psychotic painting on the high peak: first generation (e.g. haloperidol) and second generation (e.g. quetiapine) antipsychotics treat acute mania

• Stabilizing chair lift: lithium treats bipolar disorder (acute mania and maintenance)

• Narrow window: lithium has a very narrow therapeutic index

• Early nausea: acute lithium toxicity causes GI symptoms (e.g. nausea, vomiting, diarrhea)

• Late trembling: chronic lithium toxicity causes neurologic symptoms (e.g. tremor)

• Late falling: chronic lithium toxicity causes neurologic symptoms (e.g. ataxia, confusion)

• Undone bowtie: lithium therapy can cause hypothyroid

• Hefty snowboarder: signs of lithium induced hypothyroidism include weight gain, dry skin, hair loss, and constipation

• Insipidus fountain: lithium can cause nephrogenic diabetes insipidus

• Tarantula hat: lithium is teratogenic (Ebstein’s anomaly)

• Large right head: atrialization of the right ventricle (seen in Ebstein’s anomaly with ASD and malformed tricuspid (regurge))

• Thighs on high dive: thiazide diuretics (increase lithium levels)

• “Low clearance”: diuretics (e.g. thiazides) and NSAIDs decrease clearance of lithium (decrease GFR)

• Elevated “lift-ium” balloons: NSAIDs can increase serum lithium concentrations

• "Lift"ium balloons: thiazide diuretics can cause increased lithium levels (bipolar disorder treatment)

• Falling lift-ium balloon man: amiloride treats lithium induced DI (blocks Li+ entry into collecting duct cells → increased Li+ clearance)

• insipidus fountain: amiloride is useful in the treatment of Li+ induced nephrogenic diabetes insipidus, block Li reabsorption

Valproate

• “Seize the land”: broad spectrum antiepileptic agents (e.g. valproate, topiramate, lamotrigine, levetiracetam)

• Welcome festiVAL: valproate (broad spectrum anti epileptic drug)

• Toupee: topiramate (broad spectrum antiepileptic drug)

• Llama: lamotrigine (broad spectrum antiepileptic drug

• Elevator: levetiracetam (broad spectrum antiepileptic drug)

• Focal arm shaking: broad spectrum antiepileptic agents (e.g. valproate) treat focal seizures

• Generalized body shaking: broad spectrum antiepileptic agents (e.g. valproate) treat generalized seizures

• Juvenile shaking arms: broad spectrum antiepileptic agents (e.g. valproate) treat juvenile myoclonic epilepsy (a type of generalized seizure disorder)

• Chrome CYP450 cannon: many antiepileptic drugs are metabolized by the hepatic cytochrome P450 system

• Welcome festiVAL: valproate (broad spectrum anti epileptic drug)

• Inactivated baskets of salty peanuts: valproate increases Na+ channel inactivation

• Elevated cab design: valproate increases GABA levels in the CNS

• Nauseated: valproate can cause GI distress (e.g. nausea, vomiting)

• Fat belly: valproate can cause increased appetite and weight gain

• Trembling weapon: valproate can cause tremor

• Liver spot: valproate can cause fatal hepatotoxicity

• Squeezed pancreas sponge: valproate can cause pancreatitis

• Tarantula: valproate is teratogenic

• Tubes: valproate therapy during pregnancy can cause neural tube defects (e.g. spina bifida)

• Bald head: Alopecia (valopecia)

• Toupee: topiramate (broad spectrum antiepileptic drug)

• Inactivated baskets of salty peanuts: topiramate increases Na+ channel inactivation

• Binding to cab driver: topiramate directly, allosterically binds to the GABA-A receptor

• Fatigued soldiers: topiramate can cause somnolence and fatigue

• Scratching head: topiramate can cause confusion and cognitive slowing

• Thin arm: topiramate can cause weight loss

• Kidney cannon and cannon balls: topiramate can cause urolithiasis (kidney stones)

• High pressure eye kettle: topiramate can cause acute angle closure glaucoma

• Llama: lamotrigine (broad spectrum antiepileptic drug

• Inactivated baskets of salty peanuts: lamotrigine increases Na+ channel inactivation

• Sloughed off red mask: lamotrigine can cause Stevens-Johnson syndrome (SJS/TEN)

• Cross-eyed: lamotrigine can cause diplopia

• Elevator: levetiracetam (broad spectrum antiepileptic drug)

• Sleeping on the job: levetiracetam can cause somnolence

• levetiracetam acts downstream by disrupting vesicle fusion

Carbamazepine

• “Seize the Night”: narrow spectrum antiepileptic agents (e.g. carbamazepine, phenytoin, phenobarbital, gabapentin)

• Classic car: carbamazepine (narrow spectrum antiepileptic drug)

• Classic tow truck: phenytoin (narrow spectrum antiepileptic drug)

• “Grab a pint”: gabapentin (narrow spectrum antiepileptic drug)

• Focal arm shaking: narrow spectrum antiepileptic agents (e.g. carbamazepine, phenytoin) treat focal seizures (and generalized tonic-clonic), can sometimes exacerbate other seizures like JME

• Classic car: carbamazepine (narrow spectrum antiepileptic drug)

• Inactivated salty sodium chip bags: carbamazepine increases Na+ channel inactivation

• Focal arm shaking: narrow spectrum antiepileptic agents (e.g. carbamazepine, phenytoin) treat focal seizures (and generalized tonic-clonic), can sometimes exacerbate other seizures like JME

• Three gems: carbamazepine is a first line therapy for trigeminal neuralgia

• Unbalanced stack: carbamazepine can cause ataxia (esp for elderly)

• Misaligned headlights: carbamazepine can cause diplopia

• Inappropriate wet head: carbamazepine can cause syndrome of inappropriate ADH (SIADH)

• Sand timer: carbamazepine can cause agranulocytosis

• Activated chrome bumper: carbamazepine induces cytochrome P450

• Eosinophilic dress: carbamazepine can cause drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome

• Tarantula: carbamazepine is teratogenic

• Neural exhaust tube: carbamazepine therapy during pregnancy can cause neural tube defects (e.g. spina bifida)

• Sloughed off red mask asian: carbamazepine can cause Stevens-Johnson syndrome (SJS/TEN), HLA B1502 allele, Asians

• Classic tow truck: phenytoin (narrow spectrum antiepileptic drug)

• Inactivated salty sodium chip bags: phenytoin increases Na+ channel inactivation

• Focal arm shaking: narrow spectrum antiepileptic agents (e.g. carbamazepine, phenytoin) treat focal seizures (and generalized tonic-clonic), can sometimes exacerbate other seizures like JME

• “Status”: status epilepticus (treat acutely with benzodiazepines and phenytoin for maintenance

• Unbalanced stack: phenytoin can cause ataxia

• Misaligned headlights: phenytoin can cause diplopia

• Spilled salad: phenytoin can cause folate deficiency → megaloblastic anemia

• Expanding gum: phenytoin can cause gingival hyperplasia

• Big bushy beard: phenytoin can cause hirsutism

• Lupus wolf: phenytoin and carbamazepine can drug-induced lupus

• Eosinophilic dress: phenytoin can cause drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome

• Sloughed off red mask: phenytoin can cause Stevens-Johnson syndrome (SJS/TEN)

• Tarantula: phenytoin is teratogenic

• Cleft trucker hat: phenytoin therapy during pregnancy can cause cleft palate

• Activated chrome bumper: phenytoin induces cytochrome P450

• Fractured osteoporotic axle: phenytoin can decrease bone density (P450 and increase vit D catabolism)

• Pseudolymphadenopathy

• “Status”: status epilepticus (treat acutely with benzodiazepines and phenytoin for maintenance

• Ben’s Diner: IV benzodiazepines (e.g. diazepam, lorazepam) acutely treat status epilepticus (give phenytoin for maintenance

• Barbershop: IV phenobarbital (barbiturate) can be used in treatment refractory seizures

• “Grab a pint”: gabapentin (narrow spectrum antiepileptic drug)

• Closed Calci-Yum ice cream cooler: gabapentin blocks voltage gated Ca2+ channels, block inward Ca

• Chronically frayed wire: gabapentin treats chronic pain (e.g. neuropathic pain)

• Diasweetes: gabapentin treats painful diabetic nephropathy

• Fiber bars: gabapentin treats fibromyalgia

• Zeus: gabapentin treats postherpetic neuralgia (reactivated varicella-zoster virus - VZV)

• Unbalanced scoops: gabapentin and pregabalin can cause CNS side effects (e.g. ataxia, dizziness, sedation)

• Raised CAB: vigabatrin and tiagabine (narrow spectrum antiepileptic drugs) increase GABA

• V cab transmission: vigabatrin irreversibly inhibits GABA transaminase (decrease GABA degradation)

• Tied up cab driver, prevent cab from taken up: tiagabine inhibits GABA reuptake

Ethosuximide

• “Seize the day”: antiepileptic therapy for absence seizures (e.g. ethosuximide)

• “Absences”: absence seizure (a type of generalized seizure)

• Inattentive student: absence seizures are characterized by sudden momentary lapse in awareness accompanied by staring, blinking, or clonic jerks

• “3 spikes”: absence seizure manifest as 3 Hz spike wave complexes on EEG

• “Ethos”: ethosuximide (a narrow spectrum anti-epileptic drug used to treat absence seizures)

• Closed Calci-Yum chocolate: ethosuximide blocks Ca2+ channels

• Closed T-thermos: ethosuximide blocks T-type Ca2+ channels in the thalamus

• Punched in stomach: ethosuximide can cause GI distress (e.g. pain, nausea, vomiting)

• Sleeping student: ethosuximide can cause lethargy or fatigue

• FestiVAL banner: valproate is effective against absence seizures

• Llama: lamotrigine is effective against absence seizures

Antipsychotics

Antipsychotics I

• Typical post-impressionist: first generation (typical) antipsychotics (FGAs)

• Halo: haloperidol (high potency FGA)

• “Gazing”: “-azine” suffix of FGAs (e.g. trifluoperazine, fluphenazine, chlorpromazine, thioridazine, phenothiazine)

• Trying to fly: trifluoperazine, fluphenazine (high potency FGAs) (greater D2 binding)

• “Color theory”: thioridazine (low potency FGA)

• “Color-Pro”: chlorpromazine (low potency FGA)

• Snapping double rope: FGAs block D2 receptors in the CNS

• Extinguished alpha flame: FGAs (low potency>high potency) block alpha-1 receptors

• Bee swatter: FGAs (low potency>high potency) block H1 histamine receptors

• Blocking positive voices: FGAs treat the positive symptoms of schizophrenia (hallucination, delusion, disorganized thoughts/behavior)

• Crazy peak: antipsychotics treat acute psychosis in many conditions (e.g. bipolar)

• Agitated peak: antipsychotics (e.g. haloperidol) treat acute agitation or aggression/violence

• Marionette: FGAs can be useful for the management of Tourette syndrome

• Twisted streamer: FGAs can cause torsades de pointes

• Shaking: FGAs can cause lower the seizure threshold

• Long tapering flag: FGAs have a long half life (highly lipophilic)

low potency specific:

• Antimuscarinic tea party: FGAs (low potency>high potency) block muscarinic receptors → dry mouth, constipation, blurred vision, urinary retention

• Passed out: FGAs (low potency>high potency) can cause orthostatic hypotension (a blockade)

• Van Gogh’s bed: FGAs (low potency>high potency) can cause sedation (h1 blockade)

• Corn Yellow paint: chlorpromazine can cause corneal deposits

• Deposits on retinal palette: thioridazine can cause retinal deposits (browning of vision)

• Twisted streamer: FGAs can cause torsades de pointes

• Shaking: FGAs can cause lower the seizure threshold

• Long tapering flag: FGAs have a long half life (highly lipophilic)

high potency specific:

• EXTRA pyramid hat on the roof: FGAs (high potency>low potency) cause extrapyramidal symptoms (EPS) (cholinergic dopaminergic unbalance treated with benztropine)

• Cocked head: acute dystonia (EPS seen within minutes), sudden onset sustained muscle contraction. Torticolis, ocular gyri crisis (forced elevation of eye), arching of back and neck

• Uncomfortable in chair: akathisia (EPS seen within days), restlessness, can't sit still

• Cog wheels: drug induced Parkinsonism (EPS seen within weeks), bradykinesia, tremor, masked facies (treat with anti-M)

• Sticking out tongue: FGAs (high potency>low potency) can cause tardive dyskinesia (oralfacial dyskinesia)

• Elevated milk production: FGAs (high potency>low potency) can cause hyperprolactinemia → galactorrhea, amenorrhea, impotence

• “Now More Spicy”: FGAs (high potency>low potency) can cause neuroleptic malignant syndrome (NMS)

• Rigidly holding pipe: NMS is characterized by generalized “lead-pipe” rigidity (generalized rigidity)

• Crazy, sweaty, and tachycardic: NMS is characterized by altered mental status, fever, autonomic instability

• Eaten chicken: NMS is characterized by rhabdomyolysis

Antipsychotics II

• Atypical surrealist: second generation (atypical) antipsychotics (SGAs)

• “Quiet please, only whispering is appropriate”: quetiapine, olanzapine, risperidone, aripiprazole (SGAs)

• Zipper: ziprasidone (SGA)

• closet: clozapine (SGA)

• Snapping double rope: SGAs block D2 receptors in the CNS (weak)

• Cut smiley cake: SGAs block serotonin receptors (5-HT 2A), lead to release of other NTs (dopamine, NE, Glut, GABA, Ach)

• Hearing positive and negative voices: SGAs treat schizophrenia (positive AND negative symptoms)

• Happy and sad masks: SGAs can treat depression (treatment resistant)

• Resisting opening: treatment resistant depression (not to antidepressant monotherapy)

• Obsessively neat: SGAs (e.g. risperidone) can help manage OCD (adjunctive with SSRIs)

• Marionette: risperidone can help manage Tourette syndrome

• less CNS/extrapyramidal effects, more metabolic effects

• Bee swatter: SGAs block H1 histamine receptors→ sedation

• Extinguished alpha candle: SGAs block alpha-1 receptors→ orthostatic hypotension (tachycardia)

• Antimuscarinic tea party: SGAs (especially clozapine) block muscarinic receptors→ dry mouth, constipation, blurred vision, urinary retention

• Obscured tea party: SGAs have lower affinity for muscarinic receptors than FGAs (less antimuscarinic symptoms)

• Passed out: SGAs can cause sedation and orthostatic hypotension (block H1 and alpha-1)

• Fat face: SGAs (e.g. olanzapine, clozapine) can cause weight gain

• Elevated butter: SGAs (e.g. olanzapine, clozapine) can cause dyslipidemia

• Bunch of candy: SGAs (e.g. olanzapine, clozapine) can cause hyperglycemia

• Melting sand timers: clozapine can cause agranulocytosis

• Surreal heart: clozapine can cause myocarditis or cardiomyopathy

• Shaking clock: clozapine reduces seizure threshold

• EXTRA pyramid hat asked to leave: extrapyramidal symptoms (e.g. acute dystonia, akathisia, parkinsonism) due to D2 blockade (FGA>SGA). Less than 1st gen

• Whispering to EXTRA hat: risperidone has the highest risk of causing EPS among the SGAs

• Elevated milk release: elevated prolactin levels due to D2 blockade (FGA>SGA)

• “Now more spicy”: neuroleptic malignant syndrome (e.g. mental status changes, rigidity, autonomic instability, fever) (FGA>SGA)

• Bite out of chicken leg: NMS is associated with rhabdomyolysis

• Twisted torsades streamer: SGAs can cause torsade de pointes