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Pharmacology > 17) Psychosis > Flashcards

17) Psychosis Flashcards

1
Q

Schizophrenia

A
  • Mental illness that causespsychosis (hallucinations and delusions),and other symptoms
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2
Q

Schizophrenia is characterized by

A
  • Thoughts/experiences that seem out of touch with reality
  • Disorganized speech or behavior
  • Decreased participation in daily activities
  • Difficulty with concentration and memory may also be present
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3
Q

Bipolar disorder

A
  • Generally alternatebetweenperiods of low and high moods
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4
Q

Drugs used to treat psychosis (antipsychotics)

A
  • Classic drugs (D2 receptor affinity)

- Newer agents (5HT2 receptor affinity)

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5
Q

Antipsychotic classic drugs (D2 receptor affinity) names

A
  • Chlorpromazine
  • Fluphenazine
  • Haloperidol
  • Thioridazine
  • Triffluoperazine
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6
Q

Newer antipsychotic agents (5HT2 receptor affinity) names

A
  • Clozapine
  • Olanzapine
  • Quetiapine
  • Risperidone
  • Ziprasidone
  • Others
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7
Q

Classic bipolar drug name

A
  • Lithium
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8
Q

Newer bipolar agents

A
  • Carbamazepine
  • Clonazepam
  • Olanzapine
  • Valporic acid
  • Others
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9
Q

Hyperactivation of the dopaminergic mesolimbic pathway induces

A
  • Positive symptoms of schizophrenia

- Via increased D2 receptor stim in limbic areas

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10
Q

Hypoactivation of dopaminergic mesocortical pathway causes

A
  • Negative and cognitive symptoms of schizophrenia

- Decreased D1 receptor activation in cortical areas

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11
Q

Ideal treatment regimen

A
  • Decrease mesolimbic activation

- Increase cortical stimulation

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12
Q

Changing in other pathways’ activity (tuberoinfindibular and nigrostriatal pathways) are responsible for

A
  • Side effect of current antipsychotics
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13
Q

The antipsychotic drugs are well absorbed when given orally because they are

A
  • Lipid soluble

- Readily enter CNS and most tissues

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14
Q

Many antipsychotics are bound extensively to

A
  • Plasma proteins
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15
Q

Antipsychotics require metabolism by _____ before elimination

A
  • Liver enzymes

- Long plasma half-lives permit once-daily dosing

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16
Q

There is a correlation between blockade of D2receptors and

A
  • Extrapyramidal dysfunction
17
Q

Most of the second generation (atypical) antipsychotic agents have higher affinities for

A
  • Other receptors than for the D2receptor
18
Q

First vs. second generation antipsychotic naming

A
  • First = typical

- Second = atypical

19
Q

Most of the atypical drugs cause less _____ than the first-generation agents

A
  • Extrapyramidal dysfunction
20
Q

With the exception of haloperidol, all antipsychotic drugs block

A
  • H1receptors to some degree
21
Q

Clozapine affinity

A
  • D4and 5-HT2blocking
  • Virtually no D2affinity
22
Q

Many of the atypical drugs (eg,olanzapine, quetiapine,andrisperidone) also have high affinity for

A
  • 5-HT2Areceptors

- May also interact with D2and others

23
Q

Ziprasidoneagonist/antagonist activity

A
  • Antagonist: D2, 5-HT2A, 5-HT1D

- Agonist: 5-HT1A

24
Q

Aripiprazole agonist/antagonist activity

A
  • Partial agonist: D2, 5-HT1A
  • Strong antagonist: 5-HT2A
25
Q

Invega blocks _____ receptors

A
  • Alpha-2
26
Q

Extrapyramidal toxicity occurs most frequently with

A
  • Haloperidol

- Piperazine (more potent) side-chain phenothiazines

27
Q

Side effects of antipsychotics

A
  • Reversible neurological events (extrapyramidal toxixity)
  • Tardive dyskinesia (lips and buccal cavity)
  • Autonomic effects
  • Atropine-like effects
  • Endocrine/metabolic effects
  • Weight gain and hyperglycemia
28
Q

Autonomic side effects of antipsychotics result from blocking

A
  • Peripheral muscarinic receptors and α adrenoceptors

- Leads to postural hypotension

29
Q

Atropine-like side effects of antipsychotics

A
  • Dry mouth, constipation, urinary retention, visual problems
  • Pronounced with thioridazine and phenothiazines with aliphatic side chains (eg, chlorpromazine)
30
Q

Endocrine and metabolic side effects of antipsychotics

A
  • Hyperprolactinemia, gynecomastia, amenorrhea-galactorrhea syndrome, and infertility
  • Most are predictable manifestations of dopamine D2receptor blockade in the pituitary (dopamine is the normal inhibitory regulator of prolactin secretion)
31
Q

Significant weight gain and hyperglycemia occur as antipsychotic side effects due to

A
  • Diabetogenic action with several of the second- generation agents (especially clozapine and olanzapine)
  • Aripiprazole and ziprasidone have little or no tendency to cause hyperglycemia, hyperprolactinemia, or weight gain
32
Q

Malignant hyperthermic syndrome symptoms

A
  • Muscle rigidity
  • Impairment of
    sweating
  • Hyperpyrexia
  • Autonomic instability, which may be life threatening
33
Q

Sedation as an antipsychotic side effect is more marked with

A
  • Phenothiazines (especially chlorpromazine)
34
Q

Miscellaneous toxicities associated with antipsychotics

A
  • Visual impairment caused by retinal deposits (thioridazine)
  • Conduction defects/fatal ventricular arrhythmias (thioridazine @ high doses)
  • Prolonged QT interval (atypicals)
  • Agranulocytosis (clozapine)
  • Seizures also seen with clozapine @ high doses
35
Q

Lithium is effective in treatment of

A
  • Manic phase of bipolar disorder
36
Q

Lithium is distributed throughout the body water and cleared by

A
  • Kidneys
  • Half-life is about 20 h
  • MOA not well defined
37
Q

Plasma lithium levels should be monitored (therapeutic levels vs. maintenance)

A
  • Target therapeutic plasma concentration (for acute symptoms) = 0.8–1.2 mEq/L
  • Maintenance = 0.4–0.7 mEq/L
38
Q

Lithium side effects

A
  • Tremor, sedation, ataxia, and aphasia
  • Thyroid enlargement
  • Reversible nephrogenic diabetes insipidus (occurs commonly at therapeutic drug levels)
  • Edema
  • Acneiform skin eruptions
  • Leukocytosis
  • Teratogenic

Pharmacology (27 decks)

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