38: Antipsychotic Drugs

Question 1

describe schizophrenia

Answer 1

severe type of psychosis

• considered neurodevelopmental disorder
• develops during childhood and adolescence
• genetic disorder with high heritability

Question 2

positive v. negative symptom of schizophrenia

Answer 2

positive = manifestation of abnormal behavior
negative = absence of normal behavior

Question 3

delusions, hallucinations, paranoia, agitation =

Answer 3

positive symptoms of schizophrenia

Question 4

emotional apathy, inattentiveness, socially withdrawn =

Answer 4

negative symptoms of schizophrenia

Question 5

dopamine hypothesis

Answer 5

hyperactivity of the mesolimbic/mesocortical DA system

excessive limbic DA activty –> psychosis

Question 6

serotonin hypothesis

Answer 6

blockade of 5HT2A receptor is key MOA of the main class of atypical antipsychotic drugs

Question 7

glutamate hypothesis

Answer 7

hypofunction of NMDA receptors located on GABAergic interneurons can lead to hyperstimulation of cortical neurons

Question 8

subtype of antipsychotic drugs that produce high incidence of extrapyramidal side effects EPS

Answer 8

neuroleptics

Question 9

therapeutic indications for antipsychotic agents

Answer 9

• schizophrenia
• psychotic behavior
• severe mania
• antiemetic (prochlorperazine, phenergan)

Question 10

best treatment =

Answer 10

drug and social therapy

Question 11

chlorpromazine

Answer 11

typical

Question 12

thioridazine

Answer 12

typical

Question 13

clozapine

Answer 13

atypical

Question 14

olanzapine

Answer 14

atypical

Question 15

fluphenazine

Answer 15

typical

Question 16

risperidone

Answer 16

atypical

Question 17

aripiprazole

Answer 17

atypical

Question 18

haloperidol

Answer 18

typical

Question 19

quetiapine

Answer 19

atypical

Question 20

ziprasidone

Answer 20

atypical

Question 21

describe the pharmokinetics of antipsychotics

Answer 21

• large Vd (lipophilic)

- metabolized by liver

Question 22

MOA of typical antipsychotic agents

Answer 22

antagonist of post-synaptic D2 receptors

Question 23

MOA atypical antipsychotic agents

Answer 23

antagonist at 5HT2a receptors AND D2 receptors

Question 24

blockade of _____ is responsible for EPS

Answer 24

D2 receptor

Question 25

describe EPS extrapyramidal syndrome

Answer 25

- parkinson like syndrome - akathesia - dystonia - tardive dyskinesia

Question 26

what are the endocrine side effects of antipsychotics?

Answer 26

hyperprolactinemia - gynecomastia - infertility - galactorrhea - menstrual irregularities

Question 27

side effect more common of atypicals than typicals

Answer 27

weight gain

Question 28

besides 5HT and D receptors - what can antipsychotics bind to and what are the effects?

Answer 28

anticholinergic - urinary retention, dry mouth, blurred vision, constipation, mental confusion antihistaminic - sedation, weight gain anti-adrenergic (a1) - postural hypotension, reflex tachycardia, erectile dysfunction

Question 29

what is neuroleptic malignant syndrome?

Answer 29

hypertension and hyperthermia adverse effect of antipsychotics

Question 30

which atypical agent is most strongly associated with EPS?

Answer 30

risperidone clozapine and quetiapine are least strongly associated with EPS

Question 31

_____ age increases risk for tardive dyskinesia

Answer 31

increasing cumulative years of treatment also increases risk

Question 32

risk of development of parkinsonism with antipsychotics increases with _____

Answer 32

potency and dosage

Question 33

which atypical antipsychotics pose diabetes risks due to weight gain side effects?

Answer 33

clozapine and olanzapine