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Neuro drugs > Anti-psychotics > Flashcards

Anti-psychotics Flashcards

1
Q

What is schizophrenia?

A
  • Emotionally flat, no display of emotions happiness, sadness
  • Positive and negative symptoms exist in phases, acute positive → interphase period negative symptom
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2
Q

Causes of schizophrenia?

A
  1. Hereditary (strong)
  2. Environmental
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3
Q

Positive symptoms of schizophrenia

A
  1. Delusions (often paranoid).
  2. Hallucinations (e.g. exhortatory voices).
  3. Thought disorder including feeling that thoughts are controlled by an outside agency.
  4. Abnormal behaviours (e.g. stereotypical or aggressive behaviours).
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4
Q

Negative symptoms of schizophrenia

A
  1. Withdrawal from social contacts
  2. Flattening of emotional responses

more negative symptoms as disease progresses

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5
Q

Cognitive dysfunction of schizophrenic patient

A
  1. Impairment of selective attention
  2. Impairment of working memory
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6
Q

Pathophysiology of schizophrenia

A
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7
Q

4 pathways of dopamine in the brain

A
  1. Nigrostriatal (EPS motor system)
  2. Tuberoinfundibular (hypothalamus to anterior pit. for secretion of prolactin)
  3. Mesolimbic (Reward & emotion)
  4. Mesocortical (cognition and attention)

Only 3 and 4 are targets of interests for treatment of schizophrenia but drugs can affect 1 and 2 causing undesired side effects

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8
Q

What are the typical (1st gen) antipsychotic drugs?

A
  1. Chlorpromazine
  2. Haloperidol
  3. Fluphenazine
  4. Trifluoperazine
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9
Q

Mechanism of typical antipsychotics

A

D2 antagonism (Indirect pathway) on the mesolimbic pathway, alleviating the symptoms

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10
Q

What are the side effects of chlorpromazine

A

Anti-cholinergic effects:
1. Dry mouth
2. Constipation
3. Blurred vision

A1 sympatholytic side effects
1. Postural hypotension
2. Diziness

H1 histaminergic effects:
1. Sedation
2. Weight gain

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11
Q

What are the side effects of haloperidol?

A

Haloperidol less EPS than chlorpromazine due to lack of M1 and H1 receptor binding but still hav A1 so → sympatholytic side effects (postural hypotension etc.)

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12
Q

What are Extrapyramidal side-effects?

A

Pathway involving the basal ganglia, including the striatum and substantia nigra.

  1. Parkinsonism-like syndrome
  2. Acute dystonia
  3. Tardive dyskinesia and akathisia
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13
Q

What is Parkinsonism-like syndrome?

A
  1. Cogwheel/Leadpipe rigidity
  2. Bradykinesia
  3. Resting tremor
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14
Q

What is the cause of Parkinsonism-like syndrome?

A

D2 antagonism of the nigrostriatal pathway because reduce D2 inhibition of the nigrostriatal pathway (basal ganglia) leading to increased stimulation of motor cortex giving rise to these symptoms (tremors and bradykinesia)

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15
Q

What is tardive dyskinesia?

A

Involuntary movements of the mouth, tongue, limbs, face and respiratory muscles (eg: uncontrolled lip smacking and chewing)

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16
Q

What is akathisia?

A

Restlessness, compelling urge to move, inability to sit still

17
Q

What is acute dystonia?

A

Painful and long-lasting (house to days) of muscle spams and stiffness

18
Q

What causes tardive dyskinesia and akathisia over time?

A

blockade of receptors in the nigrostriatal pathway -> up-regulation of receptors -> lead to tardive dyskinesia

19
Q

What are some examples of atypical 2nd gen antipsychotic drugs?

A
  1. Clozapine (initial)
  2. Olanzapine
  3. Risperidone
  4. Amisulpride
  5. Aripiprazole
20
Q

What improvements are in atypical compared to typical antipsychotics?

A
  1. Less EPS
  2. Serotonin-dopamine antagonism (SDA)

Complex mixtures of actions

21
Q

Adverse effects of clozapine

A

Clozapine induced agranulocytosis (olanzapine dh this effect)

Anti-cholinergic effects:
1. Dry mouth
2. Constipation
3. Blurred vision

A1 sympatholytic side effects
1. Postural hypotension
2. Diziness

H1 histaminergic effects:
1. Sedation
2. Weight gain

22
Q

Adverse effects of amisulpride

A
  1. Increase prolactin secretion due to block of D2/3 receptors in anterior pituitary, breast pain, swelling, lactation, gynaecomastia
    (TUBEROINFUNDIBULAR PATHWAY)
  2. NO A1, H1, M1 side effects
  3. selective for d2/d3 receptors
23
Q

What is a common adverse effects of all atypical antipsychotics?

A

Metabolic effects
1. diabetes (clozapine, olanzapine, risperidone)
2. weight gain
3. dyslipidemia

Less EPS

24
Q

Why are there less EPS in atypical antipsychotics?

A

(in general less blockade of D2)
1. More D3 to D2 antagonism
2. More D4 to D2 antagonism
3. More D2 to D1 (D2 antagonism will increase dopamine release due to autoreceptors)

25
Q

Selectivity of individual atypical antipsychotics?

A

More effective against negative symptoms
Clozapine, olanzapine, risperidone

More effective for ameliorating cognitive dysfunction
Clozapine, risperidone

Better mood stabilisation
clozapine, olanzapine, risperidone

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