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Pharm Test 2 > Anti-Psychotics > Flashcards

Anti-Psychotics Flashcards

1
Q

Main neurotransmitters in schizophrenia

A

Serotonin

Dopamine

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2
Q

Psychosis

A

Inability to think or comprehend reality

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3
Q

Schizophrenia

A

Withdrawal, disordered thought process, delusions, auditory hallucinations

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4
Q

Schiz positive s/s

A

Hallucinations
Delusions
Behavioral disorg
Thought disorder

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5
Q

Schiz neg s/s

A 
Alogia
Affective blunting
Avolition
Asociality
Anhedonia
Attention impairment
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6
Q

Schiz

DA hypothesis

A
  • All antipsycs block D2 receptor
  • up synaptic DA= psychosis (amphetamine, L-DOPA)
  • DA receptor changes
  • successful Tx increases DA metablites
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7
Q

Amphetamine DA release

A

Up via reversal of transporter

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8
Q

Serotonin

A
  • new Rx block 5HT recepotor

* clin correlation poor

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9
Q

Glutamate

A
  • NMDA receptor
  • can induce psychosis with this
  • no Rxs
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10
Q

Acute psychotic episode

A

Antispyc in ER (haloperidol?)

*long term tx 4-6 weeks (depolarization inactivation)

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11
Q

Depolarization Inactivation

A

After overfiring DA neuron due to presynaptic receptor stimulation, whole neuron wears out in 4-6 weeks

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12
Q

Acute tx

A

Block post synaptic receptor

Presynaptic sees less, fires more

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13
Q

Frontal cortex in Schiz

A

Too LITTLE DA = negative symptoms

VTA to cortex degraded (prefrontal neurons),
no feedback mech to Accumbens,
Accumbens ramps up dopamine release

W too much acivity in accumbens

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14
Q

D2 blockers = blocking in nigrostriatal pathway

A

Parkinson’s s/s

EPS symptoms = extra-pyramidal

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15
Q

Prolonged treatment w/ D2 blockers

A

D2 post synaptic receptors up regulate =

Tardive Dyskinesia (activity)

  • Short-term = movement poverty (EPS)
  • Long-term = too much movement
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16
Q

Where = Endocrinological S.E.

A

Arcuate nucleus (hypothalamus) –> pituitary

DA suppresses PRL release
UP PRoLactin = gynecomastia

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17
Q

Neuroleptic

A

“Clamp the neuron” = EPS s/s

Don’t say this, old term

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18
Q

Schiz tx

1st generation

A

Butyrophenones (haloperidol)

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19
Q

2nd gen

Rxs

A 
Clozapine
Risperidone
Olanzapine
Ziprasidone
Aripiprazole
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20
Q

Clorpromazine (thorazine)

A
  • anethesia
  • d2 blocker
  • sometimes in acute
21
Q

Butyrophenones

Haloperidol

A

Lower sedation + less alpha block than phenothiazines

22
Q

Atypical Rxs/ 2nd gen

A

More 5HT receptor blocking (serotonin)

23
Q

2nd gen

Clozapine

A
  • 1st
  • NO EPS
  • DPI ONLY in mesolimbic pathway (NOT striatum, NOT frontal cortex)= no neg/ EPS symptoms
24
Q

2nd Gen

Clozapine

S.E.

A

*Agranulocytosis risk (bone marrow/blood)
(Compliancy/cost)

**DM risk

25
Q

Blocking serotonin

A

Facilitate Dopamine release in FRONTAL CORTEX

*serotinin blocking dopa neuron ONLY in FRONTAL CORTEX

26
Q

2nd gen

Risperidone

A

*low dose = low EPS
(Dose-dependent atypical)
*NO agranulocytosis risk

27
Q

2nd gen

Olanzepine

A
  • NO agranulocytosis
  • *DM risk/weight gain risk
  • LESS serum prolactin release than haloperidol
28
Q

2nd gen

Ziprasidone

A

*QT interval widening

29
Q

2nd gen

Aripiprazole

A
  • partial agonist at D2 receptor (block where high, increase where low)
  • modest 5HT2 block
  • partial 5HT1A agonist
  • no DM
30
Q

Partial D2 agonist

A
  • down dopa in accumbens

* UP dopa in frontal cortex

31
Q

Anti-psych

Neuro S.E. Early

A
  • ACUTE DYSTONIA = Spastic retrocollis/torticollis
  • AKATHISIA = reduce rx/benzo/propanolol
  • EPS. = bradykinesia, rigidity, gait
  • NMS Neuroleptic Malignant Syndrome
  • can be fatal, stop Rx NOW
  • Sedation
  • Lower seizure threshold (older Rx, clozapine, epileptic)

REVIEW SLIDE

32
Q

Anti-psych

Neuro S.E. Later

A
  • Perioral syndrome (rabbit syndrome)
    • D2 blocked
    • give anti-Parkison Rx - anticholinergic
  • ***Tarditive dyskinesia
  • D2 super-sensitivity
  • NO ANTICHOLINGERGICs

MUST PREVENT THESE

33
Q

Anti-Psycs : Autonomic S.E.

A
  • Ortho HypoHTN (a1 block)
  • Altered sexual function
  • Anticholinergic
34
Q

Anti-psych. S.E.

Endocrine

A

*Up prolactin (D2 block in pituitary)

35
Q

Other Anti-psych S.E.

A
  • Blood dyscrasias (clozapine-agranulocytosis)
  • Metabolic - up weight gain, DM/Hyperlipid

*Skin
*Cardio toxicity
Thioridazine - T wave
Ziprasidone QT prolong

36
Q

Anti-psychs

ADME

A

A = erratic, down w/ food , antacid, anticholinergic

  • goes in fat (brain)
  • hepatic metab, glucuronic acid conjugation
37
Q

Anti-psychs

Rx interaction

A
  • up CNS depressants
  • Quinidine-effect bad w/ Digitalis
  • no w/ antiHTN
  • barbituates = up metab
  • Musc block = confusion
38
Q

DM risk

A

Olanzapine

Clozapine

39
Q

Where = Weight gain S.E.

A

Motor nucleus (vagus) –> area around ventricles

D2 block = hunger

40
Q

Where = anti-emetic S.E.

A

Chemotrigger zone (CTZ)

41
Q

1st gen S.E.

A

ASK teacher

42
Q

2nd gen

DM risk

A
  • Clozapine
  • Olanzapine
  • Risperidone
  • Ziprasidone
43
Q

2nd gen

EPS s/s

A

Risperidone

44
Q

2nd Gen

QT prolongation

A

Ziprasidone

45
Q

2nd gen

PRL s/s

A

Risperidone

46
Q

2nd gen

Weight gain S/s

A

Clozapine
Olanzapine
Risperidone

47
Q

Ach block

A

Clozapine

Olanzapine

48
Q

Anti-psycs

Other uses

A
  • Organic brain syndrome
  • Acute mania
  • Tourette’s Syndrome
  • Bipolar
  • NO DEMENTIA in ELDERLY

Pharm Test 2 (13 decks)

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