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PHAC II > 7. Antipsychotics & Bipolar > Flashcards

7. Antipsychotics & Bipolar Flashcards

1
Q

When does the onset of schizophrenia occur in each gender?

Which gender if affected more?

A

Males 15-24
Females 25-34

Males have 1.4x the risk

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2
Q

What are the positive sx of schizophrenia?

A

Hallucinations
Delusions
Disorganized speech

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3
Q

What are the negative sx of schizophrenia?

A

Avolition (lack of drive, motivation)
Alogia (poverty of speech)
Anhedonia (inability to feel pleasure)
Blunted affect (reduced emotional responses)

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4
Q

Describe the cognitive sx associated with schizophrenia.

A
  • declined attention, language, memory, executive function.

- probably present from birth

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5
Q

Describe the affective sx associated with schizophrenia.

A
  • blunted, inappropriate, odd expression

- often leads to social stigmatization

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6
Q

How are the positive and negative sx related to dopamine levels?

A
  • too much mesolimbic dopamine leads to positive sx

- low mesocortical dopamine leads to negative sx

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7
Q

What are the effects of dopamine on the nucleus accumbens?

A
  • motivation
  • reward
  • addiction
  • reinforcing behavior
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8
Q

What are the effects of dopamine on the prefrontal cortex?

A
  • cognition
  • communication
  • social function
  • stress response
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9
Q

Which receptors due most antipsychotics strongly block?

A

D2 dopamine receptors

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10
Q

What is the mechanism of action for typical antipsychotics?

A

It is antagonism of D2 receptors in the mesolimbic pathway.

This causes relief from positive sx

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11
Q

What are the adverse effects of typical antipsychotics related to?

A
  1. receptor non-selectivity

2. block of non-mesolimbic D2 dopaminergic pathways

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12
Q

With respect to receptor non-selectivity, what side effects are due to the antimuscarinic effects?

A
  • toxic confused state
  • dry mouth
  • urinary retention
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13
Q

With respect to receptor non-selectivity, what side effects are due to the blocked alpha-1 adrenergic effects?

A
  • orthostatic hypotension
  • dizziness
  • tachycardia
  • impotence
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14
Q

With respect to receptor non-selectivity, what side effects are due to the histamine H1 blockade?

A
  • weight gain

- sedation

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15
Q

When you block D2 receptors in the ___________ pathway, this can cause extrapyramidal side effects (EPS). What are some examples?

A

Nigrostriatal

  • Parkinson’s
  • akathisia (state of agitation, distress, restlessness)
  • acute dystonic reactions (muscles contract uncontrollably)
  • tardive dyskinesia (involuntary face and jaw movement)
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16
Q

Why should antipsychotics and anticholinergics drugs not be given together?

A

Because antipsychotics already cause anticholinergic effects.
If given together, the effects will add together.

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17
Q

When you block D2 receptors in the ___________ pathway , there will be an increase in prolactin production. What are the side effects of this in males and females?

A

Tuberoinfundibular

Males:

  • lactation
  • impotence
  • decreased libido
  • gynecomastia

Females:

  • lactation
  • amenorrhea
  • infertility
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18
Q

What are some other side effects of antipsychotics?

A
  • pseudodepression (related to drowsiness, restlessness and autonomic effects)
  • corneal and lens deposits
  • retinal deposits
  • cardiac arrhythmias in OD
  • neuroleptic malignant syndrome
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19
Q

What is neuroleptic malignant syndrome? (antipsychotic SE)

A
  • severe muscle rigidity
  • impaired sweating
  • fever
  • autonomic instability
  • severe agitation
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20
Q

What are the advantages of atypical antipsychotics?

A
  • they block D2 in the NAcc which decreases positive sx
    BUT ALSO:
  • have reduced D2 affinity (lower EPS)
  • block serotonin receptors –> decreases negative sx
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21
Q

How does increased serotonin affinity in atypical antipsychotics help reduce negative sx?

A

When serotonin receptors are blocked, mesocortical dopamine will be increased.
This will decrease the negative sx

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22
Q

What are the side effects of atypical antipsychotics?

A
  • same as typical, but lower risk (esp. with EPS)
  • seizures
  • weight gain, hyperlipidemia, hyperglycemia (due to 5HT block)
  • agranulocytosis
  • higher death rate in elderly dementia pts
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23
Q

Which atypical antipsychotics has a large risk of seizures?

A

Clozapine

24
Q

What substances will cause a decrease in metabolism of CYP 3A4?

A

fluoxetine

grapefruit juice

25
Q

What substances will cause an increase in metabolism of CYP 3A4?

A

St. John’s Wort

26
Q

What substance will cause a decrease in metabolism of CYP 1A2?

A

ciprofloxacin

27
Q

What substance will cause an increase in metabolism of CYP 1A2?

A

Smoking (nicotine?)

28
Q

What substance will cause a decrease in the metabolism of CYP 2D6?

A

paroxetine

29
Q

What kind of drugs/substances will cause excess sedation when combined with antipsychotics?

A
  • anxiolytics
  • alcohol
  • antidepressants
  • antihistamines
30
Q

Why should antipsychotics and metoclopramide not be combined?

A

Metoclopramide is a D2 antagonist

The combination of these two drugs will lead to higher risks of EPS

31
Q

Why should antipsychotics and SSRI antidepressants not be combined?

A

The SSRIs will increase serotonin levels which will cause dopamine suppression in nigrostriatal pathway, leading to higher EPS

32
Q

Describe bipolar “mania”.

What are the associated sx?

A
  • distinct period of dramatically elevated, irritable mood lasting one week or more and impairing social functioning

Sx:

  • inflated self-esteem
  • reduced need for sleep
  • verbosity
  • racing thoughts
  • distractability
  • risky behavior
33
Q

What is hypomania?

A
  • a briefer duration of mania sx

- less severe

34
Q

What is the difference between bipolar I and bipolar II?

A

Bipolar I
- episodes of sustained mania, usually with intervening depressive episodes

Bipolar II
- major depressive episodes with at least ONE manic episode

35
Q

Why are antidepressants not helpful with bipolar disorder?

A

Because they just push a pt towards a manic episode.

36
Q

What are the non-pharmacological treatments for bipolar disorder?

A
  • adjust sleep
  • nutrition
  • exercise
  • control stress levels
37
Q

What are the pharmacological treatment of bipolar disorders/

A
  • mood stabilizers
  • atypical antipsychotics
  • adjunct therapy with benzos
38
Q

What 3 components do you need to control when treating bipolar disease?

A
  • mania/mixed episodes
  • depression episodes
  • mood maintenance
39
Q

Which components of bipolar treatment do atypical antipsychotics not help with?

A 
Depression episodes (only small amounts) and mood maintenance
(good for mania)
40
Q

What drugs/drug classes are used to control manic episodes?

A
  • lithium
  • carbamazepine
  • valproate
  • antipsychotics
  • benzos
41
Q

What are lithium’s percentages of effectiveness for the manic phase? Mood maintenance?

A 
mania = 60-80%
maintenance = ~60%
42
Q

What are the early SE of lithium?

A
  • GI
  • muscle weakness, lethargy
  • polydipsia with polyuria
  • headache, confusion, tremor
  • nephrogenic diabetes insipidus
43
Q

What are the long term SE of lithium?

A
  • renal damage
  • hypothyroidism, goiter
  • weight gain (>20 kg)
  • reduced libido, sexual dysfunction
  • edema
  • severe acne
  • cardiovascular problems
44
Q

What causes lithium to have so many side effects?

A

Its low therapeutic index

45
Q

What medical condition is contraindicated with the use of lithium?

A

Any renal issues

46
Q

What drug interactions occur with lithium?

A
  1. thiazides, NSAIDS, ACEIs –> increase Li
  2. K+ sparing diuretics –> decrease Li
  3. loops, CCB –> can increase or decrease Li
47
Q

What components of bipolar therapy does carbamazepine control?

A
  • mania, depression and maintenance
48
Q

What are the side effects of carbamazepine?

A
  • GI
  • hyponatremia
  • rash
  • leukopenia
  • fluid retention
  • drowsiness, lethargy
  • dizziness
  • headache
49
Q

Which component of bipolar therapy is valproate good for?

A

Good for anti-mania effects

Effective in pts not responding to lithium

50
Q

What are the side effects of valproate?

A
  • Generally well-tolerated

Higher doses lead to:

  • GI
  • weight gain
  • hair loss
  • tremor
51
Q

Which drugs/drug classes are used for depression episodes?

A
  • lithium
  • lamotrigine
  • antipsychotics
  • antidepressants
52
Q

What component of bipolar therapy is lamotrigine good for?

A
  • good depression control

- limited mania control

53
Q

Why is lamotrigine a good alternative to lithium?

A

because lamotrigine is weight neutral

54
Q

What drugs are used to for mood maintenance in bipolar therapy?

A
  • lithium
  • lamotrigine
  • valproate
  • carbamazepine

Also with psychotherapy

55
Q

When does a pt require lifetime mood maintenance therapy?

A

If they have 3 or more manic episode

Or if they have 1 moderate to severe manic episode

PHAC II (9 decks)

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