# Psych

## Antidepressant

### SSRI

![](https://i.imgur.com/XJjY3dg.jpg)

* expreSS tRIps: selective serotonin reuptake inhibitors (SSRIs)
* Fly out: fluoxetine (SSRI)
* Parrot: paroxetine (SSRI)
* De**sert** Airline: **sert**raline (SSRI)
* City: **cita**lopram (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)

![](https://i.imgur.com/XJjY3dg.jpg)

* 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   &#x20;
* 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

![](https://i.imgur.com/XJjY3dg.jpg)

* 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

![](https://i.imgur.com/Q2GCXrM.jpg)

* 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)

![](https://i.imgur.com/Q2GCXrM.jpg)

* 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)

![](https://i.imgur.com/Q2GCXrM.jpg)

* 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)

![](https://i.imgur.com/Q2GCXrM.jpg)

* 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

![](https://i.imgur.com/mcpYKNq.jpg)

* 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

![](https://i.imgur.com/mcpYKNq.jpg)

* 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

![](https://i.imgur.com/mcpYKNq.jpg)

* 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)

![](https://i.imgur.com/mcpYKNq.jpg)

*   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

![](https://i.imgur.com/taool8j.jpg)

* “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

![](https://i.imgur.com/taool8j.jpg)

* “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

![](https://i.imgur.com/taool8j.jpg)

* 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

![](https://f001.backblazeb2.com/file/wikiFiles/k3ldjGn.jpg)

* 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

![](https://f001.backblazeb2.com/file/wikiFiles/k3ldjGn.jpg)

* 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))

![](https://f001.backblazeb2.com/file/wikiFiles/k3ldjGn.jpg)

* Thighs on high dive: thiazide diuretics (increase lithium levels)
* “Low clearance”: diuretics (e.g. thiazides) and NSAIDs decrease clearance of lithium (decrease GFR)

![](https://i.imgur.com/t7MSOYP.jpg)

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

![](https://f001.backblazeb2.com/file/wikiFiles/QqQxFuX.jpg)

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

![](https://i.imgur.com/7ASE8z9.jpg)

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

![](https://f001.backblazeb2.com/file/wikiFiles/e65ouNz.jpg)

* insipidus fountain: amiloride is useful in the treatment of Li+ induced nephrogenic diabetes insipidus, block Li reabsorption&#x20;

### Valproate

![](https://i.imgur.com/jsOYG4z.jpg)

* “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

![](https://i.imgur.com/jsOYG4z.jpg)

* 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)

![](https://i.imgur.com/jsOYG4z.jpg)

* 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

![](https://i.imgur.com/jsOYG4z.jpg)

* 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

![](https://i.imgur.com/jsOYG4z.jpg)

* Elevator: levetiracetam (broad spectrum antiepileptic drug)
* Sleeping on the job: levetiracetam can cause somnolence
* levetiracetam acts downstream by disrupting vesicle fusion

### Carbamazepine

![](https://i.imgur.com/Azzuus7.jpg)

* “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

![](https://i.imgur.com/Azzuus7.jpg)

* 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

![](https://i.imgur.com/Azzuus7.jpg)

* 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

![](https://i.imgur.com/Azzuus7.jpg)

* “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

![](https://i.imgur.com/Azzuus7.jpg)

* “Grab a pint”: gabapentin (narrow spectrum antiepileptic drug)
* Closed Calci-Yum ice cream cooler: gabapentin blocks voltage gated Ca2+ channels, block inward Ca&#x20;
* 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)

![](https://i.imgur.com/Azzuus7.jpg)

* Raised CAB: vigabatrin and tiagabine (narrow spectrum antiepileptic drugs) increase GABA&#x20;
* 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

![](https://i.imgur.com/NV6f6MV.jpg)

* “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

![](https://i.imgur.com/NV6f6MV.jpg)

* “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

![](https://i.imgur.com/z0iaNLl.jpg)

* 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)

![](https://i.imgur.com/z0iaNLl.jpg)

* 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

![](https://i.imgur.com/z0iaNLl.jpg)

* 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

![](https://i.imgur.com/z0iaNLl.jpg)

* 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)

![](https://i.imgur.com/z0iaNLl.jpg)

* 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

![](https://i.imgur.com/z0iaNLl.jpg)

* “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

![](https://i.imgur.com/uNLbBan.jpg)

* Atypical surrealist: second generation (atypical) antipsychotics (SGAs)
* “Quiet please, only whispering is appropriate”: quetiapine, olanzapine, risperidone, aripiprazole (SGAs)
* Zipper: ziprasidone (SGA)
* closet: clozapine (SGA)

![](https://i.imgur.com/uNLbBan.jpg)

* 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)

![](https://i.imgur.com/uNLbBan.jpg)

* 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

![](https://i.imgur.com/uNLbBan.jpg)

* 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
