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pharmacology year 3.1 > anti-psychotic drugs > Flashcards

anti-psychotic drugs Flashcards

1
Q

what is schizo?

A
  • thinking, behavior, perception disorder
  • onset at early adult life
  • fluctuation
  • 50% attempt suicide
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2
Q

positive symptoms of schizo

A
  • delusions
  • hallucinations
  • speech
  • thought disorder
  • catatonia (mental numbness)
  • mesolimbic too MUCH dopamine
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3
Q

negative symptoms of schizo

A
  • alogia (inability to speak)
  • affect flat
  • anhedonia (absence of pleasure)
  • avolition (lack of motivation to goals)
  • mesocortical too LITTLE dopamine
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4
Q

aetiology of schizophrenia

A
  • genetic
  • environment (virus infection and cannabis use)
  • social dysfunction
  • inflammation
  • oxidative stress
  • neuroplasticity
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5
Q

explain genetic factor

A
  • 50% monozygotic twins
  • 10% siblings
  • NMDA receptor dysfunction
  • glutamergic transmission
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6
Q

expain social dysfunction factor

A
  1. cognition social neuro
  2. positive symptoms
  3. negative symptoms
  4. mood disorder
  5. substance abuse
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7
Q

differential psychotic behaviour

A
  • delirium (temporary mental confusion)
  • dementia
  • autism
  • depression
  • personality disorder
  • encephalitis
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8
Q

what is the dopamine hypothesis?

A
  • amphetamine reproduce positive symptoms
  • L dopa and agonists increase symptoms
  • reserpine decrease symptoms
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9
Q

what is the glutamate hypothesis?

A
  • decrease NMDA receptor function

- ketamine, phencyclidine reproduce positive and negative symptoms

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10
Q

what is the GABA hypothesis?

A

decrease GABAnergic inhibition

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11
Q

what is the serotonin hypothesis?

A

5HT 2 antagonism help negative symptoms

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12
Q

what nigrostriate pathway for?

A

motor function

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13
Q

what mesocortical pathway for?

A

emotion and reward

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14
Q

what mesolimbic pathway for?

A

emotion and reward (positive symptoms)

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15
Q

what tuberoinfundibular pathway for?

A

endocrine function

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16
Q

old terms for anti-psychotic drugs

A
  • neuroleptics
  • major tranquillisers
  • antischizoprenics
17
Q

what CAPS (conventional) do?

A
  • first generation
  • block D2 mesolimbic
  • block MUSCARINIC receptors
  • block ADRENERGIC receptors
  • histamine 1 give sedation
18
Q

what AAPS (atypical) do?

A
  • 2nd generation
  • block D2 mesolimbic
  • block MUSCARINIC receptors
  • block ADRENERGIC receptors
  • 5HT2 antagonists
  • 5HT1 agonists
19
Q

what are the initial treatment?

A
  1. orally at lowest dose
  2. treat as early as diagnosis
  3. increase after 2 weeks if poor response
  4. treat at least 4-6 weeks
  5. avoid combinations
  6. treat at least 1 year
  7. watch for tolerance
20
Q

general characteristics of CAPS

A
  • oral absorption
  • depot IM
  • variable efficacy
  • lipophilic
  • large volume distribution
  • first pass metabolism
21
Q

examples of butyrophenones (CAPS)

A
  • haloperidol

- benperidol

22
Q

examples of thioxanthines (CAPS)

A
  • flupenthixol

- zuclopenthixol

23
Q

example of benzamides (CAPS)

A

sulpiride (reduce EPS)

24
Q

example of butylpiperidines (CAPS)

A

pimozide (reduce EPS)

25
Q

characteristics of aliphatic 1 (phenothiazine) and examples of drugs

A
  • low potency
  • sedating
  • moderate EPD
  • CHLORPROMAZINE and PROMAZINE
26
Q

characteristics of piperidine 2 (phenothiazine) and examples of drugs

A
  • moderate potency
  • moderate sedating
  • low EPD
  • PIPOTIAZINE and PERICYAZINE
27
Q

characteristics of piperizine 3 (phenothizine) and examples of drugs

A
  • most potent
  • least sedating
  • high EPD
  • FLUPHENAZINE and PERPHENAZINE
28
Q

CAPS motor side effects

A
  • dystonia (reversible)
  • parkinsonism (reversible)
  • dyskinesia (irreversible)
  • akathisia (inability to remain motionless)
  • neuroleptic malignant syndrome
29
Q

what 5HT 2A antagonism AAP do?

A
  • indirectly increases dopamine transmission

- negative symptoms improve

30
Q

what 5HT 2C antagonism AAP results?

A
  • weight gain

- eg: CLOZAPINE and OLANZEPINE

31
Q

examples of drugs of AAP

A
  • aripiprazole
  • risperidone (oral, liquid, long IV)
  • olanzepine (oral, short, long IV)
  • ziprasidone (short- acting IV)
32
Q

benefits of AAP

A
  • better tolerated (1st line)
  • less EPD
  • better for negative symptoms
33
Q

concerns when giving AAP

A
  • cardiac disease
  • parkinson’s disease
  • epilepsy
  • elderly
  • liver disease
34
Q

side effects of AAP

A
  • severe weight gain
  • metabolic syndrome
  • hyperglycemia
  • postural hypotension prolonged QTs
  • sexual dysfunction
35
Q

drugs to treat neuroleptic malignant syndrome

A

bromocriptine or dantrolene

36
Q

main drugs for AAP

A

clozapine

37
Q

diagnostic criteria of neuroleptic malignant syndrome

A

at least 2 of the following

  • diaphoresis (sweating)
  • dysphagia
  • tremor
  • incontinence
  • mutism
  • tachycardia

pharmacology year 3.1 (8 decks)

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