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MT 6314 2nd Shift > 7.3: Antipsychology Drugs (Lithium) > Flashcards

7.3: Antipsychology Drugs (Lithium) Flashcards

1
Q

What are the two types of drugs for psychoses and bipolar disorders?

A
  1. Antipsychotics
  2. Bipolar drugs
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2
Q

The antipsychotic drugs have two types, what are those?

A
  1. Classic drugs (D2 receptor affinity)
  2. Newer agents (5HT2 receptor affinity)
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3
Q

What are the main class of first generation antipsychotic drugs (D2 receptor affinity)?

A
  • Chlorpromazine
  • Haloperidol
  • Fluphenazine
  • Thioridazine
  • Trifluoperazine

CHeaF TT

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4
Q

What are the main class of second generation antipsychotic drugs (5HT2 receptor affinity)?

A
  • Clozapine
  • Risperidone
  • Olanzapine
  • Quetiapine
  • Ziprasidone

CROQ Z

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5
Q

Identify this medication:

  • Used to treat schizophrenia, other psychoses and agitated states
  • Protracted therapy (years)
  • Severe toxicity
A

Neuroleptics

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6
Q

Enumerate the symptoms of schizophrenia:

A
  • Disorganized speech
  • Catatonic or disorganized behavior
  • Hallucinations
  • Delusions
  • Negative symptoms
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7
Q

True or False:

In schizophrenia, impairment in major areas of functioning at work or interpersonal relationship or self care, schizoaffective and bipolar disorder are ruled out, and the disturbance is not due to other substance abuse.

A

True

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8
Q

What are the other associated features in Schizophrenia?

A
  • Inappropriate laughing
  • Disturbed sleep pattern
  • Dysphoric mood (depression, anger, anxiety
  • Anxiety and phobia
  • Cognitive deficits impacting language processing, executive function or memory
  • Hostility and aggression
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9
Q

Identify if manic or hypomanic in Bipolar Disorder:

Distinct episode of abnormally and persistently elevated expansive or irritable mood for 1 week

A

Manic episode

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10
Q

Identify if manic or hypomanic in Bipolar Disorder:

During the period of mood disturbance, three (or more) of the following have persisted (4 if mood is only irritable)
- Inflated self esteem or grandiosity
- Decrease need for sleep (3 hrs still feels rested)
- More talkative than usual or pressure to keep talking
- Insomnia or hypersomnia everyday
- Psychomotor agitation or retardation
- Flight of ideas or subjective experience that thoughts are racing
- Increase in goal-directed activity or psychomotor agitation
- Excessive involvement in pleasurable activities that have high potential for painful consequences (e.g buying sprees, sexual indiscretions, foolish)

A

Manic episode

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11
Q

Identify if manic or hypomanic in Bipolar Disorder:

  • During the mood disturbance is sufficiently severe to cause impairment in occupational functioning or in usual social activities or relationships or necessitates hospitalizations
  • Not due to physical substance abuse
A

Manic episode

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12
Q

Identify if manic or hypomanic in Bipolar Disorder:

  • Low mood
  • Lack of interest or pleasure in activities once enjoyed
  • Slowed down behavior
  • Fatigue or loss of energy
A

Hypomanic episode

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13
Q

Identify if manic or hypomanic in Bipolar Disorder:

  • Thinking of death or suicide
  • Feeling guilty
  • Sleeping problems
  • Problems concentrating
A

Hypomanic episode

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14
Q

What are the four major chemical subgroups of antipsychotic drugs and lithium?

A
  1. Phenothiazines
  2. Thioxanthenes
  3. Butyrophenones
  4. Atypical Antipsychotics
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15
Q

Identify this major chemical subgroup:

Aliphatic (Chlorpromazine)
Advantage: Generic, inexpensive
Disadvantage: Many adverse effects, especially autonomic

A

Phenothiazines

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16
Q

Identify this major chemical subgroup:

Piperidine (Thioridazine)
Advantage: Slight extrapyramidal syndrome, generic
Disadvantage: 800 mg/d limit; no parenteral form; cardiotoxicity

A

Phenothiazines

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17
Q

Identify this major chemical subgroups:

Piperazine (Fluphenazine)
Advantage: Depot form also available (enanthate, decanoate)
Disadvantage: Possible increased tardive dyskinesia

A

Phenothiazines

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18
Q

Identify this major chemical subgroups:

Thiothixene
Advantage: Parenteral form also available; possible decreased tardive dyskinesia
Disadvantage: Uncertain

A

Thioxanthenes

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19
Q

Identify this major chemical subgroups:

Haloperidol
Advantage: Parenteral form also available; generic
Disadvantage: Severe extrapyramidal syndrome

A

Butyrophenones

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20
Q

Identify this major chemical subgroup:

Clozapine
Advantage: May benefit treatment-resistant patients; little extrapyramidal toxicity
Disadvantage: May cause agranulocytosis in up to 2% of patients

A

Atypical Antipsychotic

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21
Q

Identify this major chemical subgroups:

Loxapine
Advantage: Possible no weight gain
Disadvantage: Uncertain

A

Atypical Antipsychotic

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22
Q

Identify this major chemical subgroup:

  • More effective
  • Less toxic
  • More costly
  • Prescribed generically
A

Atypical Antipsychotic

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23
Q

What are the pharmacokinetics of antipsychotic drugs and lithium?

A
  • Well absorbed when given orally
  • Lipid soluble
  • Bound extensively to plasma proteins
  • Require metabolism by liver enzymes before elimination
  • Long plasma half-lives
  • IV forms
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24
Q

Whats the IV forms in pharmacokinetics of Antipsychotic Drugs and Lithium?

A
  • Rapid initiation
  • Depot treatment
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25
Q

Identify this mechanism of action:

Relative excess of functional activity of dopamine

A

The Dopamine Hypothesis

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26
Q

Identify this mechanism of action:

  • Not fully satisfactory
  • Antipsychotic drugs are only partly effective in most patients
  • Many effective drugs have a much higher affinity for other receptors than D2 receptors
A

The Dopamine Hypothesis

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27
Q

Identify this mechanism of action:

Many antipsychotic drugs block brain dopamine receptors (especially D2 receptors)

A

The Dopamine Hypothesis

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28
Q

What are the dopamine-agonist drugs that exacerbate schizophrenia?

A
  • Amphetamine
  • Levodopa
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29
Q

Identify this mechanism of action:

Increased density of dopamine receptors has been detected in certain brain regions of untreated schizophrenia.

A

Dopamine hypothesis

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30
Q

Identify this mechanism of action:

  • Has 5 different dopamine receptors
  • Therapeutic efficacy of most older antipsychotic drugs correlate with relative affinity to D2 receptors
A

Dopamine Receptors

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31
Q

Identify this mechanism of action:

Correlation between blocking of D2 receptors and extrapyramidal dysfunction

A

Dopamine Receptors

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32
Q

Identify this mechanism of action:

Newer atypical antipsychotic agents
have higher affinities for other
receptors than for the D2 receptor

A

Other receptors

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33
Q

Identify this mechanism of action:

Table on relative receptor blocking
actions of neuroleptic drugs (Katzung)

A

Other receptors

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34
Q

Identify this mechanism of action:

Alpha adrenoceptor blockade- antipsychotic effect of most drugs

A

Other receptors

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35
Q

Enumerate the receptor based on this mechanism of actions:

  • Newer atypical drugs
  • High affinity for 5-HT2A
  • May also interact with D2 and other receptors
A
  • Olanzapine
  • Quetiapine
  • Risperidone
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36
Q

Enumerate the receptor based on this mechanism of actions:

  • Significant D4 and 5-HT2 receptor blocking actions
  • Low affinity for D2 receptors
A

Clozapine

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37
Q

Identify this mechanism of action:

Causes less extrapyramidal dysfunction than standard drugs

A

OTHER RECEPTORS

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38
Q

All antipsychotic drugs have H1 receptor blockade to some degree, except:

A

Haloperidol

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39
Q

True or False:

In Dopaminergic receptor blockade, it has major effect for older antipsychotics.

A

True

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40
Q

What are the Dopaminergic tracts in the brain?

A
  • Mesocortical-mesolimbic
  • Nigrostriatal tract
  • Tuberoinfundibular pathways
  • Chemoreceptor trigger zone

Mintis (MNTC)

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41
Q

Identify what Dopaminergic tracts:

Menstruation and mood

A

Mesocortical-mesolimbic pathway

42
Q

Identify what Dopaminergic tracts:

Extrapyramidal function

A

Nigrostriatal tract

43
Q

Identify what Dopaminergic tracts:

Prolactin release

A

Tuberoinfundibular pathways

44
Q

Identify what Dopaminergic tracts:

Emesis

A

Chemoreceptor trigger zone

45
Q

Identify what blockade:

Blockade of Antipsychotic effect of the drug

A

Blockade #1

46
Q

Identify what blockade:

Blockade of Antiemetic properties

A

Blockade of #4

47
Q

Identify what blockade:

Blockade of Adverse effects like extrapyramidal dysfunction and hyperprolactinemia respectively

A

Blockade #2 and#3

48
Q

Treatment of schizophrenia includes reducing some of the positive symptoms, what are these positive symptoms?

A
  • Hyperactivity
  • Bizarre ideation
  • Hallucinations and delusions
49
Q

Facilitate functioning in both out and inpatient environments

A

Treatment of schizophrenia

50
Q

Negative symptoms of Treatment of schizophrenia

A
  • Older drugs do not have much effect
  • Newer atypical drugs improve some
    1. Emotional blunting
    2. Social withdrawal
51
Q

Other psychiatric and neurologic indications:

A

Mania

Used together with lithium.

52
Q

Drug that is sole agent in the manic phase

A

Olanzapine

53
Q

Drug that is mood stabilizer in bipolar disorders

A

Olanzapine

54
Q

What is the drug treated for Tourette’s syndrome?

A

Molindone

55
Q

What is the treatment for Alzheimer’s and Parkinsonism?

A

Newer drugs

56
Q

What are the effects of nonpsychiatric indications?

A
  • Antiemetic action
  • Antipruritics
57
Q

Identify this nonpsychiatric indication:

H1 receptor blockade basis for use.

A

Antipruritics

58
Q

Identify this nonpsychiatric indication:

  • Phenothiazines except thioridazine
  • Prochlorperazine
A

Antiemetic action

59
Q

Parkinson-like syndrome

A
  • Rigidity
  • Akinesia
  • Flat facies
  • Tremor
60
Q

Identify this toxicity:

Dose dependent extrapyramidal effects

A

Reversible neurologic effects

61
Q

Identify this toxicity:

Decrease in dose and antagonized with
muscarinic blocking agents

A

Reversible neurologic effects

62
Q

What are the drugs that occurs most frequently in reversible neurologic effects?

A
  • Haloperidol
  • Fluphenazine
  • Trifluoperazine
63
Q

Identify this toxicity:

Less frequent with clozapine
Less common with the newer drug

A

Reversible neurologic effects

64
Q

Identify this toxicity:

Other neurologic dysfunction in Reversible neurologic effects

A
  • Akathisia
  • Dystonia
  • Respond to diphenhydramine and muscarinic blocking agents
65
Q

Identify this toxicity:

Choreoathetoid movements of the muscle of the lips and buccal cavity

A

Tardive dyskinesia

66
Q

Identify this toxicity:

  • Tend to develop after years of therapy
  • May appear as early as 6 months
  • Maybe irreversible
A

Tardive dyskinesia

67
Q

Identify this toxicity:

Antimuscarinic drugs that improve extrapyramidal effects increase the severity of symptoms.

A

Tardive dyskinesia

68
Q

Identify this disorder:

  • No effective drug for treatment
  • Switching to clozapine does not exacerbate the condition
A

Tardive dyskinesia

69
Q

Identify this toxicity:

  • Improved temporarily by increasing neuroleptic dosage
  • Maybe caused by dopamine receptor sensitization
A

Tardive dyskinesia

70
Q

Identify this toxicity:

Result from blockade of peripheral muscarinic receptors and alpha adrenoceptors

A

Autonomic effects

71
Q

Drug:

Strongest autonomic effects

A

Thioridazine

72
Q

Drug:

Weakest autonomic effects

A

Haloperidol

73
Q

Toxicity:

Intermediate autonomic effects

A

Clozapine and most atypical antipyschotics

74
Q

Toxicity:

Atropine-like effects

A
  • Dry mouth
  • Constipation
  • Urinary retention
  • Visual problems
  • Not with ziprasidone and aripiprazol
75
Q

Toxicity:

Alpha receptor blockade

A
  • Postural hypotension
  • All atypical drugs
76
Q

Drug:

Failure to ejaculate

A

Phenothiazines

77
Q

Endocrine and metabolic effects:

Dopamine D2 receptor blockade in the pituitary

A
  • Hyperprolactinemia
  • Gynecomastia
  • Amenorrhea-galactorrhea syndrome
  • Infertility
78
Q

Endocrine and metabolic effects

A
  • Dopamine D2 receptor blockade in the pituitary
  • Weight gain and hyperglycemia
79
Q

Drug:

Weight gain and hyperglycemia

A
  • Clozapine
  • Olanzapine
80
Q

Toxicity:

Neuroleptic malignant syndrome (NMS) signs and symptoms

A
  • Muscle rigidity
  • Impairment of sweating
  • Hyperpyrexia
  • Autonomic instability
81
Q

Toxicity:

  • Patients who are sensitive to the extrapyramidal effects are prone to develop NMS
  • Life threatening
A

Neuroleptic malignant syndrome

82
Q

What are the treatment used for Neuroleptic malignant syndrome (NMS)?

A
  • Dantrolene
  • Dopamine agonist
83
Q

Sedation (toxicity):

More marked sedation

A

Phenothiazines (chlorpromazine)

84
Q

Sedation (toxicity):

Less sedating among the older drugs

A

Fluphenazine and haloperidol

85
Q

Sedation (toxicity):

Least sedating among newer drugs

A

Aripiprazole

86
Q

Miscellaneous (toxicity):

Visual impairment due to retinal deposits

A

Thioridazine

87
Q

Miscellaneous (toxicity):

At high doses, fatal ventricular arrhythmias

A

Thioridazine

88
Q

Miscellaneous (toxicity):

Arrhythmias

A

Ziprasidone

89
Q

Miscellaneous (toxicity):

Agranulocytosis, seizure at high doses

A

Clozapine

90
Q

Miscellaneous toxicities

A
  • Arrhythmias
  • Agranulocytosis, seizure at high doses
  • At high doses, fatal ventricular arrhythmias
  • Visual impairment due to retinal deposits
91
Q

Overdosage toxicity:

Drug for seizures:

A
  • Diazepam
  • Phenytoin
92
Q

This is absorbed rapidly and completely from the gut and distributed throughout the body water.

A

Lithium

93
Q

Lithium is cleared by the kidney at a rate of __ of creatinine.

A

1/5

94
Q

Half-life of Lithium:

A

20 hours

95
Q

What week of therapy for Lithium:

  • Plasma levels monitored
  • Effective and safe dosage regimen
A

1st week of therapy

96
Q

Lithium may increase to toxic levels by:

A
  • Dehydration
  • Treatment with thiazide diuretics
97
Q

Drug that increases renal clearance in lithium:

A

Theophylline

98
Q

MOA of lithium

A
  • Recycling of neuronal membrane phosphoinosotides (IP3 & DAG - neurotransmission)
99
Q

Alternative drugs for lithium:

A
  • Olanzapine
  • Valproic acid
  • Carbamazepine
  • Clonazepam
  • Gabapentin
  • Lamotrigine
100
Q

Toxicity of Lithium:

Increase congentical cardiac anomalies

A

Ebstein’s anomaly

101
Q

T or F:

The toxicity of Lithium has containdicated in nursing mothers.

A

True

MT 6314 2nd Shift (8 decks)

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