Anti-Psychotic Drugs and Mood Stabilizers

Question 1

Brain scan of a schizophrenic pt shows

Answer 1

Progressive gray matter loss

Question 2

Hypothesis of schizophrenia

Answer 2

1. Greater amount of DA receptors, 2. Serotonin receptors (–>DA transmission) altered, 3. Glutamate

Question 3

Positive symptoms

Answer 3

Hallucination (auditory and visual) & delusions, catatonic behavior, disorganized speech and thinking

Question 4

Cause of positive sxs

Answer 4

Over-active dopamine pathway in limbic system (mesolimbic)

Question 5

Negative sxs

Answer 5

Affective behavior, apathetic, withdrawn, anti-social, lack of motivation, depressed

Question 6

Cause of negative sxs

Answer 6

Under-active dopamine pathways in frontal cortex (Mesocortical)

Question 7

Mesolimbic

Answer 7

VTA to limbic (emotion)

Question 8

Mesocortical

Answer 8

VTA to frontal cortex (cognition; emotion)

Question 9

Nigrostraital

Answer 9

SN to striatum (motor)

Question 10

Tuberoinfundibular

Answer 10

Hypothalamus to pituitary (Prolactin)

Question 11

DA D2 receptors distrubtion

Answer 11

Mesolimbic region

Question 12

DA D4 receptors distribution

Answer 12

Mesocortical area

Question 13

Classical antipsychotic

Answer 13

Block DA D2 receptors; target the mesolimbic system; alleviate positive sxs

Question 14

Atypical antipsychotic

Answer 14

Block 5HT2A & DA receptor; target mesocortical and mesolimbic system; alleviate both negative and positive sxs; DOC!!

Question 15

In addiction to their primary receptor blocking mechanism, what else do they block?

Answer 15

Muscarinic, alpha-adrenergic, and histamine receptors in brain and periphery

Question 16

Antipsychotic with antiemetic property

Answer 16

Prochloroperazine

Question 17

Antipsychotic side effects

Answer 17

Decrease seizure threshold; endocrine (wt gain, increased prolactin); autonomic (anticholinergic, alpha-adrenergic, histamine); dental (xerostomia and bruxism); EPS; Tardive dyskinesia, neuroleptic malignant syndrome

Question 18

Antipsychotic EPS

Answer 18

Parkinson’s like, imbalance of striatal DA and ACh

Question 19

Degree of EPS depend on

Answer 19

Anticholinergic activity (more anticholinergic, less EPS)

Question 20

How to restore ACh/DA balance

Answer 20

Treat w/ anticholinergic (Benztropine)

Question 21

More EPS: Classical vs. Atypical

Answer 21

Classical

Question 22

Drugs least likely to cause tardive dyskinesia

Answer 22

Clozpine and olanzapine

Question 23

Antipsychotic drug interactions

Answer 23

Anticholinergic, sedative-hypnotics, TCAs, drugs that induce CYP450s

Question 24

Classical antipsychotic drugs (4)

Answer 24

Chloropromazine, Prochlorperazine, Fluphenazine, Haperidol

Question 25

Classical antipsych with high anticholinergic effects (low EPS)

Answer 25

Chloropromazine

Question 26

SE: retinal deposits "browning of vision"

Answer 26

Chloropromazine

Question 27

"Vitamin H"

Answer 27

Haloperidol

Question 28

Antipysch that works right away!!

Answer 28

Haloperidol (may be injected)

Question 29

Antipsych with no anticholinergic activity (high risk of EPS)

Answer 29

Haloperidol

Question 30

Antipsychotic: drug of last choice due to agranulocytosis

Answer 30

Clozapine

Question 31

SE: Hyperglycemia, type II DM

Answer 31

Olanzapine

Question 32

DOC for psychosis

Answer 32

Risperidone

Question 33

No significant effect on DA neurotransmission in NS pathway

Answer 33

Risperidone

Question 34

SE: prolongs QT interval

Answer 34

Ziprasidone

Question 35

Do not give ziprasidone to pts w/

Answer 35

hx of seizure

Question 36

Antipsych with some antidepressant activity

Answer 36

Ziprasidone

Question 37

Antipsych that does not elevate prolactin

Answer 37

Quetiapine

Question 38

Dopamine system stabilizer

Answer 38

Arpiprazole

Question 39

SE: decreases esophageal motility

Answer 39

Arpiprazole

Question 40

Used in treatment of depression associated with bipolar disorder

Answer 40

Olanzapine, Lurasidone

Question 41

Bipolar affective disorder caused by

Answer 41

a lack of GABAergic activity

Question 42

DOC of bipolar disorder

Answer 42

Lithium

Question 43

Lithium absorption

Answer 43

by proximal tubule in kidney

Question 44

Li competes w/ ___ for reabsorption

Answer 44

Na+ (must monitor!)

Question 45

Li increases results in

Answer 45

Hyponatremia

Question 46

Na+ decreases results in

Answer 46

Li toxicity

Question 47

SE: Diabetes insipidus (by inhibiting ADH --> increase thirst and UO)

Answer 47

Lithium

Question 48

Tx for diabetse insipidus

Answer 48

amiloride

Question 49

Lithium therapeutic window

Answer 49

small

Question 50

Lithium can cause mania if added with

Answer 50

antidepressants

Question 51

Li clearance increases w/

Answer 51

diuretics

Question 52

NSAIDs + Lithium

Answer 52

increase Li toxicity (decrease clearance, increase uptake)

Question 53

LIthium + benzos & antipsychotics

Answer 53

SAFE

Question 54

Used for rapid cycling manic/depressive phases

Answer 54

Valproic acid, gabapentin

Question 55

SI: surgical bleeding (dental)

Answer 55

Valproic acid

Question 56

Drugs NOT given to pregnant ladies with bipolar (teratogenic

Answer 56

Valproic acid, Lithium

Question 57

Used for refractory bipolar disorder

Answer 57

Carbamazepine

Question 58

Tardive dyskinease

Answer 58

Choreiform; uncontrollable, jerky movements of face and limits

Question 59

Neuroletpic malignant syndrome

Answer 59

muscle rigidity, hyperprexia, changes in BP and heart rate