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STEP 1 - PSYCH Drugs > Anti-Psychotics > Flashcards

Anti-Psychotics Flashcards

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1
Q

According to the DA hypothesis of schizophrenia, do symptoms arise due to an excess or a lack of DA in the CNS?

A

Excess of DA

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2
Q

What characterizes the positive symptoms of schizophrenia?

A

Hallucinations; delusions; thought disorders

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3
Q

What characterizes the negative symptoms of schizophrenia?

A

Speech disorders; flat affect; amotivation; social withdrawal

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4
Q

What is the MOA of “typical” antipsychotic agents?

A

Inhibition of D2 receptors in the mesolimbic system of brain

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5
Q

What is the MOA of “atypical” antipsychotic agents?

A

Inhibition of 5-HT2 receptors (D2 receptors still involved to some extent)

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6
Q

Give examples of typical antipsychotics

A

Haloperidol; chlorpromazine; thioridazine; fluphenazine; pimozide

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7
Q

Give examples of atypical antipsychotics

A

Clozapine; risperidone; aripiprazole; olanzapine; aiprasidone; quetiapine

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8
Q

Name two typical antipsychotics commonly used in the treatment of Tourette syndrome

A
  1. Haloperidol

2. Pimozide

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9
Q

What are Extrapyramidal symptoms (EPS)?

A

Parkinsonian-like symptoms (dystonia, rigidity, tremor, and bradykinesia); akathisia; tardive dyskinesia (TD)

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10
Q

What is akathisia?

A

Motor restlessness

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11
Q

What is Tardive Dyskinesia?

A

Inappropriate movements of the tongue, neck, trunk, and limbs (associated w/ long-term DA antagonist use)

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12
Q

What is the mechanism of antipsychotic-induced TD?

A

Long-term DA receptor inhibition –> upregulation & supersensitivity of DA receptors –> DA over-stimulation (especially when antipsychotic has been discontinued)

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13
Q

Which antipsychotics are more likely to cause EPS?

A

High potency typical antipsychotics such as haloperidol and fluphenazine secondary to their weak anticholinergic activity

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14
Q

What do thioridazine and chlorpromazine have a lower EPS potential?

A

They have high anticholinergic activity

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15
Q

What medications are used to treat antipsychotic-induced EPS?

A

Benztropine; amantadine; diphenhydramine (due to anticholinergic action)

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16
Q

How do antipsychotics cause parkinsonian-like symptoms?

A

Inhibition of DA receptors in the nigrotriatal pathway

17
Q

How do antipsychotics cause orthostatic hypotension?

A

Inhibition of alpha-adrenergic receptors in vasculature

18
Q

How do antipsychotics cause prolactinemia?

A

Inhibition of DA receptors in the anterior pituitary

19
Q

Which two antipsychotics posses the highest antimuscarinic activity?

A
  1. Chlorpromazine

2. Thioridazine

20
Q

Characterize the antimuscarinic activity of chlorpromazine and thioridazine

A

Xerostomia; blurred vision; confusion; constipation; urinary retention

21
Q

Which antipsychotic agents are more effective at treating negative symptoms?

A

Atypical antipsychotics

22
Q

Which phenothiazine antipsychotic is also used to treat intractable hiccups?

A

Chlorpromazine

23
Q

Which phenothiazine antipsychotic may cause priapism, agranulocytosis, blue-gray discoloration of the skin, and lower seizure threshold?

A

Thioridazine

24
Q

Which two typical antipsychotics can be formulated as depot IM injections that may last up to 3 wks?

A
  1. Haloperidol

2. Fluphenazine

25
Q

Which atypical antipsychotic is usually reserved as a third-line agent to treat schizophrenic patients refractory to traditional therapy?

A

Clozapine

26
Q

What is the major dose-limiting side effect of clozapine?

A

Agranulocytosis

27
Q

How are patients receiving clozapine therapy monitored?

A

WBCs obtained @ baseline and weekly for the first 6 months of thearpy

28
Q

What adverse effect is more common with clozapine, agranulocytosis, or seizures?

A

Seizures

29
Q

Why is gynecomastia a common adverse effect of risperidone?

A

Risperidone induces prolactinemia (only atypical antipsychotic that significantly increases prolactin levels)

30
Q

What is a potential life-threatening adverse effect of antipsychotic medications?

A

Neuroleptic malignant syndrome (NMS)

31
Q

What characterizes NMS (Neuroleptic malignant syndrome)?

A

Hyperthermia; rigidity; altered mental status; CV instabiity

32
Q

What is the treatment for NMS?

A

Dantrolene + Bromocriptine

33
Q

What is the additional adverse effects of olanzapine?

A

Weight gain; hyperglycemia; sialorrhea

34
Q

What are the additional adverse effects of quetiapine?

A

Hypercholesterolemia; hypertriglyceridemia; weight gain; hepatotoxicity

35
Q

What is the MOA of aripiprazole?

A

Antagonist @ 5-HT2A receptors; partial agonist @ D2 & 5-HT1A receptors

36
Q

What are the additional adverse effects of aripiprazole?

A

Weight gain; rash; sialorrhea; hepatotoxicity

37
Q

Which antipsychotic has the highest incidence of sialorrhea?

A

Clozapine

STEP 1 - PSYCH Drugs (2 decks)

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