Basic Pharmacology > SGA Classification > Flashcards

SGA Classification Flashcards

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1
Q

What are the THREE main classification systems for antipsychotics? (2 points)

A

• Chemical structure 🧪<br></br>• Typical vs atypical (EPS-based) ⚠️

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2
Q

What is the most clinically used classification today? (1 point)

A

• FGA vs SGA 🔀

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3
Q

Why is chemical classification less useful now? (2 points)

A

• Many new structures 🧬<br></br>• No clear structure–activity link ❓

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4
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A
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5
Q

What is the KEY difference between typical vs atypical antipsychotics? (2 points)

A

• Typical = High EPS ⚡<br></br>• Atypical = Low EPS ✨

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6
Q

What receptor effect defines atypicals? (1 point)

A

• 5HT2A antagonism 🎯

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7
Q

Which symptom domains do SGAs help more with? (2 points)

A

• Negative symptoms ➖<br></br>• Cognitive symptoms 🧠

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8
Q

Question

A

Answer

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9
Q

What are second-generation antipsychotics (SGAs) (2 core points)?

A

• Newer “atypical” antipsychotics 🌟.<br></br>• Designed to cause less EPS ⚠️ than FGAs.

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10
Q

What is the main pharmacological difference between SGAs and FGAs (2 core points)?

A

• SGAs block 5-HT2A + D2 receptors 🎯.<br></br>• FGAs mainly block D2 only.

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11
Q

Why were SGAs developed (2 core points)?

A

• To reduce EPS 🤝.<br></br>• To improve negative symptoms ➖.

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12
Q

What is the dual-action mechanism of SGAs (2 core points)?

A

• 5-HT2A antagonism increases dopamine in the striatum 🧠.<br></br>• This reduces EPS ⚡.

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13
Q
A
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14
Q

What is the mnemonic for SGA chemical families (2 core points)?

A

• A-B-D-T-B-A-Z 🔠.<br></br>• Groups SGAs by chemical family.

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15
Q

Which families do A and B represent in A-B-D-T-B-A-Z (2 core points)?

A

• A = Aryl piperidylindole 🤸.<br></br>• B = Benzisoxazole 🧪.

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16
Q

Which families do D and T represent in A-B-D-T-B-A-Z (2 core points)?

A

• D = Dibenzodiazepine 👑.<br></br>• T = Thienobenzodiazepine 🍔.

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17
Q

Which families do the second B and A represent in A-B-D-T-B-A-Z (2 core points)?

A

• B = Benzamide 📈.<br></br>• A = Aryl sulfonamide 🧘‍♂️.

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18
Q

What does Z represent in the SGA mnemonic (2 core points)?

A

• Z = Ziprasidone family (benzisothiazole) ⚡.<br></br>• Represents ziprasidone-type SGAs.

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19
Q
A
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20
Q

What are aryl piperidylindoles structurally (2 core points)?

A

• Contain benzene + piperidyl + indole rings 🧬.<br></br>• Flexible 3-ring structure.

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21
Q

Why does the aryl piperidylindole structure matter (2 core points)?

A

• Enables partial D2 agonism ⚖️.<br></br>• Leads to low EPS + low prolactin 🍼⬇️.

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22
Q

Which SGA is an aryl piperidylindole (1 point)?

A

• Aripiprazole 🤸.

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23
Q

What are key features of aripiprazole (2 points)?

A

• Partial D2 agonist → low EPS & low prolactin 🎯.<br></br>• Can be activating ⚡ (“A = Activating”).

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24
Q

What mnemonic summarises aripiprazole (1 point)?

A

• “Aripiprazole the Acrobat” 🤸.

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25
26
**What does benzisoxazole mean structurally (2 points)?**
• **Benzo = benzene ring** 🧬.
• **Isoxazole = 5-member ring with N + O**.
27
**Why does the benzisoxazole structure matter (2 points)?**
• Strong **D2 + 5-HT2A** binding 🎯.
• Causes **high prolactin** 🍼.
28
**Which SGAs are benzisoxazoles (2 points)?**
• **Risperidone**.
• **Paliperidone**.
29
**What is the prolactin mnemonic for benzisoxazoles (1 point)?**
• **“RISER = prolactin rises”** 🍼.
30
31
**What does dibenzodiazepine mean structurally (2 points)?**
• **Two benzene rings** + a **diazepine ring** 🧬.
• Wide, floppy multi-ring structure.
32
**Why does the dibenzodiazepine structure matter (2 points)?**
• **Broad receptor binding** → sedation + metabolic risk 😴🍔.
• **Least EPS** due to weak D2 binding.
33
**Which SGA is a dibenzodiazepine (1 point)?**
• **Clozapine** 👑.
34
**What are key features of clozapine (2 points)?**
• **Best for treatment-resistant schizophrenia** 🥇.
• **Very low EPS**, very **high metabolic/sedation** burden.
35
**What mnemonic summarises clozapine (1 point)?**
• **“Clozapine = the Big Boss”** 👑.
36
37
**What does thienobenzodiazepine mean structurally (2 points)?**
• **Thieno = sulfur-containing ring** 🧪.
• **Benzo-diazepine** core similar to clozapine.
38
**Why does this structure matter (2 points)?**
• Causes **sedation** 😴.
• Causes **major metabolic risk** 🍔.
39
**Which SGA is a thienobenzodiazepine (1 point)?**
• **Olanzapine** 🍔.
40
**Mnemonic for olanzapine weight gain (1 point)?**
• **“OLANZA-BIG / O-LARGE”** 🍔.
41
42
**What does benzamide mean structurally (2 points)?**
• **Benzo = benzene ring** 🧬.
• **Amide = C=O linked to nitrogen**.
43
**Why does the benzamide structure matter (2 points)?**
• Selective **D2/D3 blockade** 🎯.
• **Very high prolactin** 📈.
44
**Which SGAs are benzamides (2 points)?**
• **Amisulpride**.
• **Sulpiride**.
45
**What is the benzamide prolactin mnemonic (1 point)?**
• **“Ami-SU = prolactin shoots up”** 📈.
46
47
**What does aryl sulfonamide mean structurally (2 points)?**
• **Aryl = benzene ring**.
• **Sulfonamide = sulfur + oxygen + nitrogen**.
48
**Why does the aryl sulfonamide structure matter (2 points)?**
• **Low metabolic risk** 🧘‍♂️.
• **5-HT7/1A effects** → antidepressant benefit 😊.
49
**Which SGAs are aryl sulfonamides (2 points)?**
• **Lurasidone**.
• **Ziprasidone**.
50
**Mnemonic for aryl sulfonamides (1 point)?**
• **“SulfoNAM = Slim & NAMaste”** 🧘‍♂️.
51
52
**What does benzisothiazole mean structurally (2 points)?**
• **Benzo = benzene ring** 🧬.
• **Iso-thiazole = sulfur + nitrogen ring**.
53
**Why does this structure matter (2 points)?**
• **Weight-neutral** ⚖️.
• Risk of **QT prolongation** ⚡.
54
**Which SGA is a benzisothiazole (1 point)?**
• **Ziprasidone** ⚡.
55
**Mnemonic for ziprasidone (1 point)?**
• **“ZIP = Zero weight gain”** ⚖️.
56
57
**What are the two biggest advantages of SGAs (2 points)?**
• **Less EPS** ⚠️⬇️.
• Better for **negative symptoms** ➖.
58
**What is the biggest disadvantage of SGAs (2 points)?**
• **Metabolic syndrome** 🍔.
• **Weight gain** 📈.
59
**Which SGAs cause the most metabolic problems (2 points)?**
• **Olanzapine** 🍔.
• **Clozapine** 👑.
60
**Which SGAs raise prolactin the most (2 points)?**
• **Risperidone**.
• **Paliperidone** 🍼.
61
**Which SGAs spare prolactin (2 points)?**
• **Quetiapine**.
• **Aripiprazole** 🤸.
62
**Which SGA reduces suicide risk (1 point)?**
• **Clozapine** 👑.
63
**Which SGAs are best for bipolar depression (2 points)?**
• **Quetiapine** 😴.
• **Lurasidone** 🧘‍♂️.
64
**Which SGAs are most sedating (2 points)?**
• **Clozapine** 😴.
• **Quetiapine** 😴.
65
**Which SGAs have lowest metabolic risk (2 points)?**
• **Ziprasidone** ⚖️.
• **Aripiprazole** 🤸.
66
**Which SGA is a partial D2 agonist (1 point)?**
• **Aripiprazole** 🤸.
67
**Which SGAs sit between metabolic extremes (2 points)?**
• **Risperidone**.
• **Paliperidone**.
68
**Which SGAs are relatively weight-neutral (2 points)?**
• **Ziprasidone** ⚖️.
• **Lurasidone** 🧘‍♂️.
69
70
**What are the core mechanisms of SGAs (2 points)?**
• **5-HT2A antagonism**.
• **Moderate D2 blockade** 🎯.
71
**What is the most important advantage of SGAs vs FGAs (1 point)?**
• **Lower EPS** ⚠️⬇️.
72
**What is the most important disadvantage of SGAs vs FGAs (1 point)?**
• **Higher metabolic risk** 🍔.
73
**What does the mnemonic A-B-D-T-B-A-Z summarise (2 points)?**
• **Aryl piperidylindole, Benzisoxazole, Dibenzodiazepine, Thienobenzodiazepine**.
• **Benzamide, Aryl sulfonamide, Ziprasidone family**.
74
**What are the big clinical messages about SGAs (2 points)?**
• **Less EPS**, more **metabolic issues** 🍔.
• Choose based on **weight, prolactin, sedation** needs.
75
**Why do SGAs cause less EPS? (2 points)**
• **5HT2A antagonism ↑ dopamine** in striatum 🎯
• **Reduces D2 blockade load** ⚡⬇️
76
**What does D2 blockade in FGAs cause? (2 points)**
• **EPS** ⚡
• **Prolactin increase** 🍼
77
**What does strong 5HT2A blockade in SGAs cause? (2 points)**
• **Reduced EPS** ✨
• **Some weight/metabolic effects** 🍔
78
79
**Which SGAs raise prolactin the most? (2 points)**
• **Risperidone** 🍼
• **Paliperidone** 🍼
80
**Which SGAs spare prolactin? (2 points)**
• **Quetiapine** 😴
• **Aripiprazole** 🤸
81
**Why do SGAs raise prolactin less than FGAs? (2 points)**
• **5HT2A blockade ↑ dopamine** in tuberoinfundibular tract 🧠
• **Dopamine inhibits prolactin** 🍼⬇️
82
83
**Which SGAs have the highest metabolic risk? (2 points)**
• **Clozapine** 👑🍔
• **Olanzapine** 🍔
84
**Which SGAs have the lowest metabolic risk? (2 points)**
• **Ziprasidone** ⚖️
• **Lurasidone** 🧘‍♂️
85
**What mechanism explains high weight gain in some SGAs? (2 points)**
• **H1 antagonism** 😴
• **5HT2C antagonism** 🍔
86
87
**Which SGAs are partial D2 agonists? (2 points)**
• **Aripiprazole** 🤸
• **Brexpiprazole** 🤹
88
**Why do partial agonists cause low EPS? (2 points)**
• **Stabilise dopamine** rather than blocking it ⚖️
• Prevent **dopamine shutdown** 🚫🧠
89
90
**Recall the SGA mnemonic A-B-D-T-B-A-Z (2 points)**
• **Aryl piperidylindole** 🤸
• **Benzisoxazole** 🧪
91
**Continue A-B-D-T-B-A-Z (2 points)**
• **Dibenzodiazepine** 👑
• **Thienobenzodiazepine** 🍔
92
**Finish A-B-D-T-B-A-Z (2 points)**
• **Benzamide** 📈
• **Aryl sulfonamide** 🧘‍♂️
• **Ziprasidone class** ⚡
93
94
**Why does clozapine’s large ring structure matter? (2 points)**
• **Broad receptor binding** 🎯
• **Least EPS** ✨
95
**Why do benzisoxazoles raise prolactin? (2 points)**
• **Strong D2 blockade** 🎯
• **Weak 5HT1A agonism** 🧠
96
**Why are aryl sulfonamides weight-neutral? (2 points)**
• **Low H1/5HT2C activity** ⚖️
• Less appetite stimulation 🍽️
97
98
**Which SGA is best for treatment-resistant schizophrenia? (1 point)**
• **Clozapine** 👑
99
**Which SGAs are best for bipolar depression? (2 points)**
• **Quetiapine** 😴
• **Lurasidone** 🧘‍♂️
100
**Which SGAs are best when weight gain is a concern? (2 points)**
• **Ziprasidone** ⚖️
• **Aripiprazole** 🤸
101
**Which SGAs are best when prolactin elevation is a problem? (2 points)**
• **Quetiapine** 😴
• **Aripiprazole** 🤸
102
**Which SGA is best when sedation is needed? (2 points)**
• **Quetiapine** 😴
• **Clozapine** 😴👑
103
104
**Why is chemical classification outdated? (2 points)**
• **Too many new structures** 🧬
• **No consistent pharmacology link** ❓
105
**Why is EPS-based classification incomplete? (2 points)**
• Many SGAs **still cause EPS** ⚠️
• Not based on **chemistry/receptors** 🧪
106
**Why is FGA vs SGA classification preferred? (2 points)**
• Predicts **side-effects** 🎯
• Predicts **receptor profile** 🔬
107
108
**What are the TWO most important classification rules? (2 points)**
• **SGA = 5HT2A + D2** 🎯
• **FGA = D2 only**
109
**What is the MOST important risk associated with SGAs? (1 point)**
• **Metabolic syndrome** 🍔
110
**Which two SGAs define EPS extremes? (2 points)**
• **Lowest EPS = Clozapine** 👑✨
• **Highest EPS (SGAs) = Risperidone** ⚡
111
**Which two SGAs define metabolic extremes? (2 points)**
• **Highest = Clozapine/Olanzapine** 🍔
• **Lowest = Ziprasidone/Lurasidone** ⚖️
112
**What should you always recall about SGAs? (2 points)**
• **Less EPS** ✨
• **More metabolic effects** 🍔
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