Anti-psychotic drugs

Question 1

what is Schizophrenia charctersied by?

Answer 1

Excessive DA activity

Question 2

MoA of Anti-Psychotic drugs?

Answer 2

1) Blocks DA receptors (D2>D1) in the brain
2) Blocks 5HT2A receptors

Question 3

Symptoms of Schizophrenia

Answer 3

1) positive symptoms–> delusion, hallucination, paranoia, agitated behaviour
2) Negative symptoms –> Amotivation, socail withdrawel, anhedonia
3) + cognitive impairments –> Attention and memory

Question 4

SCZ –> increased level of dopamine in the brain

Changes in the mesolimbic pathways ( ? D2 activity) associated with (?) ve symptoms.

Answer 4

Increases D2 Activity, +ve

Question 5

Changes in the meso-cortical pathway ( ? D1 activity) associated with ———– and ———— impairment symptoms.

Answer 5

Decreases D1 activity,
Negative and, Cognitive

Question 6

MoA of 5HT2A receptors in the nigrostriatal pathway?

Answer 6

They control the release of DA

Question 7

The drug classes of Anti-psychotics + their MoA

Answer 7

1) Typical –> ↓ +ve symptoms (hyperactivity, bizarre ideation, hallucinations, and delusions)
2) Atypical –> ↓ +ve and -ve symptoms.

Question 8

What mediates the extrapyramidal side effects (EPSs) of the anti-psychotic agents?

Answer 8

Antagonist activity at dopamine receptors in the basal ganglia and other dopamine receptor sites in the CNS

Question 9

Which autonomic nervous system receptors are antagonized by anti-psychotic agents?

Answer 9

α-adrenoceptors and muscarinic cholinoreceptors

Question 10

Typical Anti-psychotic drugs

Answer 10

1) Haloperidol,
2) Chlorpromazine
3) Thiothixene
4) Procyclidine

Question 11

MoA of Haloperidol

Answer 11

Block of D2 receptors > D1 > 5HT2A receptors

Question 12

Adverse effects of Haloperidol

Answer 12

Extrapyramidal toxicity

Question 13

Indication of Haloperidol

Answer 13

1. Schizophrenia.
2. Acute psychotic
   illness

Question 14

MoA of typical Anti-psychotics

Answer 14

1. Block brain DA receptors (D2 > D1) in the mesolimbic pathway.
2. Block 5-HT2A receptors.

D2> D1> 5HT2A

Question 15

first line treatment for Schizophrenia?

Answer 15

Typical anti-psychotics (e.g., Haloperidol)

*Atypical anti-psychotic drugs are used if pateint in unresponsive to, or intolerant of, typical anti-psychotic drugs

Question 16

Indication of Chlorpromazine

Answer 16

1. SCZ.
2. Bipolar disorder
   (manic phase)

Question 17

AE of Chlorpromazine

Answer 17

Postural Hypotension –> beacuse of α blocaked

*Less sever EPS compared to Haloperidol

Question 18

Adverse effects of Typical Anti-psychotics

Answer 18

Neurological Effects:
1) Dose-dependent extrapyramidal effects
2) Acute dystonia –> involuntary movements (restlessness, muscle spasms, protruding tongue) –
3)** Parkinson-like syndrome**
4)** tardive dyskinesia**

Question 19

MoA of Atypical anti-psychotic drugs

Answer 19

Block of 5HT2A > D2 >D1

Question 20

Atypical Anti-psychotic drugs

Answer 20

1) Clozapine
2) Olanzapine
3) Risperidone
4) Aripiprazole

Question 21

Indication of Clozapine

Answer 21

SCZ (+ve & -ve symptoms)

Question 22

MoA of Clozapine

Answer 22

Block of 5-HT2 receptors > D2 > D1.

Question 23

AE of Clozapine

Answer 23

1. Agranulocytosis; causes severe
   neutropenia –> monitor of WBC & absolute neutrophil counts.
2. Diabetogenic weight gain.

Question 24

Indication of Olanzapine and Risperidone

Answer 24

1. SCZ (+ve & -ve symptoms).
2. Schizoaffective.
3. Tourette’s Syndrome.
4. Toxic psychosis.

Question 25

AE of Olanzapine

Answer 25

1. Diabetogenic.
2. weight gain.

Question 26

AE of Risperidone

Answer 26

Hyperprolactinemia ( ↑prolactin levels in blood)

Question 27

Indication of Aripiprazole

Answer 27

1. Major depression
2. Maintenance treatment for biopolar disorder –> in combo with Olanzapine.

Question 28

Clinical syndrome casued by Atypical anti-psychotic drugs

Answer 28

Malignant hyperthermia

–> Management: Dantrolene, diazepam, and dopamine agonists.

Question 29

What drug is used to treat Bipolar disorders ?

Answer 29

1) Lithium
2) valporic acid
3) Carbamazepine

Question 30

Bipolar affective disorder is chracterized by?

Answer 30

Depression and mania

Question 31

Since Lithium has a slow onset of action, it is normally used in combination of what type of drugs to intitiate the treatment of bipolar disorder ?

Answer 31

1) Anti-psychotics
2) Benozodiazepines –> Carbamazepine or Valproic acid

Question 32

Drugs used to maintain the tretment of biopolar disroders along with Lithium

Answer 32

Lithium+ Anti-depressant
–> Aripiprazole (Atypical) in combo with Olanzapine (Atypical)

*Aripiprazole –> indicated for major depression and Maintance treatment for BD

Question 33

AE of Lithium?

Answer 33

Neurologic effects:
1) Ataxia
2) tremor
3) sedation
4) Aphasia
5) Edema
6) others: thyroid enlargment, diapetes insipidus (reversable)