Anti-psychotics Flashcards

1
Q

What is schizophrenia and how is it charecterized?

A

A psychotic disorder that at a miniumum consitists of dellusions and hallucinations

Charecterised by distortions of thinking and perception. It affects the emotionial response to stimuli/situations, becoming inapproprite or blunted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 5 diensions of symptoms shown by Schizophrenic sufferers?

A

Posititve symptoms

Negitive symptoms

Cognitive symptoms

Agressive symptoms

Depression and anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is required for a diagnosis of Schizophrenia to be reached?

A

Disturbance lasting for 6 months or longer with at least one of the classical symptoms, delusions, hallucinations, disorganised or catatonic behavior or negitive symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Name 5 classical symptoms of Schizophrenia

A

Thought echo/instertion/withdrawal

Delusional perception and control

Hallucinatory voices that comment or discuss the patient in the third person

Though disorders

Influence or passivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Give 4 ‘negitive’ symptoms of Schozophrenia

A

Affective blunting = reduced emotional reactivity

Ahedonia = loss of enjoyment or intrest in previously enjoyed activites

Alogia = Loss of the ability to speak

Apathy = Absence or supression of emotion feeling, concern or passion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Give 5 positive symptoms of Schizophrenia

A

Delusions

Hallucinations

Agitation

Exaggerated/disorganised speech

Exaggerated/disorganised bizzare behavior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What anatomical alreations can be see in Schizophrenia?

A

Imbalance in transmitter levels are thought to underpin schizophrena (dopamine)

Degeneration occurs within the grey matter - particularly within the medial temporal lobes

Enlarged ventricles and sulci are apparent on scanning as a result

Cerebral blood flow is reduced in the basal ganglia and frontal lobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the target for antipsycotics?

A

Dopamine receptors

Dopamine antagonists have been proven to calm Schizophrenic patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the major problem with antipsychotics?

A

Less effect on negitive symptoms

60% of patients still suffer these even when the negitive symptoms are under control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the two groups of antipsychotics?

A

First generation - Classical

Second generation - Atypical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What receptors do first generation antipsychotics act on?

A

Primarily potent antagonists at the D2 receptor

Also act on Muscaranic, Histamine, and Adrengic receptors

Low efficacy and 30% of patients are non-responders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the 4 main groups of first generation antipsychotics?

A

Phenothiazines

Butyrophenones

Thioxanthines

Dibenzoiazenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Second generation antipsychotics were initially delveloped to around 5HT and dopamine antagonism, however they have been found to act on other receptors. What are these receptors?

A

Multiple receptor subtypes of 5HT and Dopamine

Muscarinic, histminergic and aderenergic receptors

May also inhibit reuptake mechanisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the gold standard second generation Antipsychotic?

A

Clozapine

High efficancy but has the most associated side effects (cardiovascular)

Also causes Agranulocytosis

Generally only used after at least 2 second generation antipsychotics have been shown to be ineffective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which two second generation antipsychotic drugs are the most effective at tacking negitive symptoms?

A

Risperidone and Olanzapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Risaperidone can be classed as both a first and second generation antipsychotic. Why is this?

What other uses/benfits does this drug have?

A

Shows biphasic activity. Atypical at low doses and more conventional at higher doses.

Used to treat dementia

Can be used in children and adolescents

17
Q

Name first (2), second (3) and third generation (1) antipsychotics

A

1st = Chlorpromazine, Haloperidol

2nd = Amisulpride, Risperidone, Clozapine

3rd = Aripiprazole

18
Q

What are the majority of side effects seen with antipsychotics called?

What are they a result of?

A

Extrapyramidal symptoms

As a result of altering activity within the nigrostrital pathway

19
Q

Give examples of 3 extrapyramidal symptoms caused as a side effect of antipsychotics

A

Dystonias

Akathisia

Parkinsonisms

20
Q

What are the side effects of antipsychotics?

A

Extrapyramidal symptoms

Sedation

Seizures

Hypotension

Hypothermia

Hypersensitvity

Weight gain

21
Q

Why are second generation antipsychotics associated with seeing reduced side effects?

A

2nd generation antipsychotics have a higher affinity for the mesolimbic and cortical pathways than the nigrostriatal dopaminergic pathways.

22
Q

What is neuroleptic malignant syndrome?

A

Describes the side effects associated with the use of antipsychotics in patients with a genetic polymorphism of the D2 receptor

High fever, autonomic problems, and altered consciousness

23
Q

Where a patient presents with neuroleptic malignant syndrome, how can the side effects caused by the use of antipsychotics be treated?

A

Dopamine agonists and benzodiazepines can be used following immedate withdrawal of the antipsychotic

24
Q

What is Tardive dyskinesia?

A

Disabling invoulentary movements of the face and limbs: tounge protruding, grimacing and twisting of the face and limbs

Only side effect that is irrevesible - spontanelously remitts in 30% of presentations

25
What causes Tardive dyskinesia?
A result of oxidative neurodegneration caused by increased glutamatergic transmission wich results from a down-regulation of the dopamine system Caused by prolonged use of classical antipsychotics
26
What would be the action you would take on presentation of Tardive dyskinesia?
Withdraw the classical antipsychotic Switch to a atypical antipsychotic Immediately stop any anticholinergics being used
27
What dopamine pathway is involved in the pathogenesis of schizophrenia?
Mesolimbic and Mesocortical
28
Which of the dopamine pathways are used in parkinsonism?
Striatongral
29
What substances can induce iatrogenic parkinsonism?
Antiemetics Antiepileptics Cardiovascular agents Vestibular Seditives