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Pharmacology: CNS Drugs > Anti-psychotics and Lithium > Flashcards

Anti-psychotics and Lithium Flashcards

1
Q

Presence of delusions, hallucinations, and grossly disorganized thinking in a clear sensorium (i.e grandiosity and paranoia)

A

Psychosis

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2
Q

States that stimulation of 5-HT receptors cause hallucinogenic effects

A

Serotonin hypothesis of schizophrenia

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3
Q

States that there is increased dopamine in schizophrenic patients

A

Dopamine Hypothesis of Schizophrenia

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4
Q

States that hypofunction of NMDA receptors on GABAergic interneurons leads to diminished inhibitory influences on neuronal function, inducing disinhibition of downstream glutamatergic activity and hyperstimulation of cortical neurons through non-NMDA receptors

A

Glutamate hypothesis of schizophrenia

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5
Q

T/F Antipsychotics are specific for schizophrenia

A

False

Antipsychotics are NOT specific for schizophrenia

They are also effective in conditions where psychosis is present, such as schizoaffective disorder, mood disorder, dementia, personality disorder.

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6
Q

Three main psychopathological dimensions of Schizophrenia and examples of each

A

Positive Sx: psychosis (delusion, hallucination)
Negative Sx: social withdrawal, anhedonia, apathy
Cognitive Sx: attention, memory, executive function

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7
Q

Enumerate the four main dopamine pathways important in schizophrenia and their role

A

– The mesolimbic pathway (positive symptoms)
– The mesocortical pathway (negative symptoms and cognitive symptoms)
– The nigrostriatal pathway (extrapyramidal symptoms and tardive dyskinesia)
– The tuberoinfundibular pathway (hyperprolactinemia)

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8
Q

Dopamine pathway relevant to positive symptoms of schizophrenia

A

mesolimbic pathway

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9
Q

T/F: All antipsychotic drugs have the ability to reduce dopaminergic neurotransmission.

A

True. All antipsychotics are dopamine antagonists and therefore address positive Sx of schizophrenia

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10
Q

Negative and cognitive symptoms of schizophrenia are associated with hypofunction of the

A

mesocortical pathway

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11
Q

This pathway is related to neurological effects caused by D2 antagonists, such as EPS.

A

nigrostriatal pathway

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12
Q

Dopaminergic projections in the this pathway influence prolactin release.

A

tuberoinfundibular pathway

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13
Q

T/F First generation AP affects positive and negative symptoms

A

F; It only affects positive symptoms

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14
Q

T/F Second generation AP affects positive, negative and cognitive symptoms

A

T

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15
Q

SE of First generation AP

A

EPS

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16
Q

First generation AP is aka

A

Typical
Conventional
Neuroleptic

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17
Q

Second generation AP is aka

A

Atypical

Serotonin-dopamine antagonists

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18
Q

SE Second generation AP

A

Less EPS; but more metabolic SE (hyperglycemia, weight gain, dyslipidemia)

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19
Q

MOA of First Gen AP

A

D2 antagonist

But they can also block H1, M1, and alpha-1 receptors

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20
Q

MOA of Second Gen AP

A

D2 antagonist
5-HT2A antagonist
5-HT1A agonits

Some are 5-HT1A agonists (ziprasidone, quetiapine, clozapine): causes release in dopamine thereby reducing glutamate release

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21
Q

Acute SE of first gen anti-psychotics

A

Akathisia
Dystonia
Parkinsonism

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22
Q

Inability to sit still

A

akathisia

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23
Q

Management of akathisia

A

beta blockers (propranolol)

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24
Q

sustained contraction of tongue, face, back

A

acute dystonia

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25
Q

Management of dystonia

A

antiparkinsonian medication

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26
Q

Clinical features of parkinsonism

A

Masklike facies, resting tremor, bradykinesia, cogwheel rigidity, shuffling gait, psychomotor retardation

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27
Q

Management of anti-psychotic induced parkinsonsism

A

Anticholinergic agents

benztropine, biperiden, trihexyphenidyl

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28
Q

Give examples of first generation AP classified based on potency (high, mid, low)

A

High-potency: haloperidol, fluphenazine
Mid-potency: perphenazine, loxapine
Low-potency: chlorpromazine

29
Q

Most widely used typical AP

A

haloperidol

30
Q

Used for emergency psychotic patients

A

haloperidol

31
Q

Prototype atypical AP

A

clozapine

32
Q

T/F AP are highly lipid soluble and protein bound

A

T (able to traverse BBB)

33
Q

Metabolism of AP

A

CYP (hepatic) metabolism

34
Q

SE of AP due to blockade of alpha receptors

A

orhostatic hypotension

tachycardia

35
Q

SE of AP due to blockade of muscarinic receptors

A

mouth dryness
blurring of vision
constipation
urinary retention

36
Q

SE of AP due to blockade of histamine receptors

A

sedation

37
Q

Only drug that is Partial agonist of D2 receptor

A

aripiprazole

38
Q

Typical AP Must be given in sufficient doses to achieve at least ___% occupancy of D2 receptors

A

60%

39
Q

EPS expected when occupancy reaches ____% or higher

A

80%

Aripiprazole achieves 80% occupancy but DOES NOT cause EPS (Why?)
** Because it is a partial agonist of your dopamine receptor (D2) not capable of achieving of maximum effect.

40
Q

Endocrine SE of typical AP

A

Hyperprolactinemia: amenorrhea, galactorrhea, infertility, impotence

41
Q

QT prolongation is seen in use of

A

thioridazine

ziprasidone

42
Q

SE due to chronic use of AP

A

Tardive dyskinesia

43
Q

most important unwanted effect of antipsychotic drugs

A

tardive dyskinesia

44
Q

Mx of tardive dyskinesia

A

discontinue medication, reduce dose or switch to antipsychotics which are least likely to cause this syndrome (quetiapine or clozapine)

45
Q

Impaired Ejaculation is seen in use of

A

chlorpromazine or mesoridazine

46
Q

Metabolic SE of Second gen AP

A

Weight gain
Hyperglycemia
Hyperlipidemia

47
Q

Weight gain is seen in use of which second gen AP?

A

clozapine

olanzapine

48
Q

Agranulocytosis is seen in use of

A

clozapine

  • *pts receiving this drug should have weekly blood counts for the 1st 6 mos and every 3 weeks thereafter
  • *Potentially fatal effects develop between 6th and 18th weeks of therapy
49
Q

Corneal and lens deposits are seen in use of

A

chlorpromazine

50
Q

Retinal deposits are seen in use of

A

thioridazine

51
Q

Can cause abnormal T waves

A

thioridazine

52
Q

Myocarditis is associated with

A

clozapine

53
Q

SE of thioridazine

A

QT prolongation
abnormal T wave
Retinal deposits

54
Q

Life-threatening disorder that Occur in pts who are extremely sensitive to pyramidal effects of antipsychotic agents

A

Neuroleptic Malignant Syndrome

55
Q

Two phases of bipolar affective disorder

A

Manic phase

Depression

56
Q

DOC for bipolar disorder

A

Lithium

57
Q

Lithium is excreted via

A

kidneys

58
Q

Effect of lithium on thyroid

A

decreased thyroid function (hypothyroidism)

59
Q

SE of lithium in kidneys

A

Nephrogenic DI

60
Q

Treatment of lithium-induced nephrogenic DI =

A

amiloride

vasopressin does not respond

61
Q

Effect of lithium on heart ECG

A

Bradycardia-tachycardia “sick sinus” syndrome

T-wave flattening

62
Q

Risk in pregnancy in taking lithium

A

Ebstein anomaly

Ebstein anomaly is a rare heart defect in which parts of the tricuspid valve are abnormal. The tricuspid valve separates the right lower heart chamber (right ventricle) from the right upper heart chamber (right atrium). In Ebstein anomaly, the positioning of the tricuspid valve and how it functions to separate the 2 chambers is abnormal.

63
Q

How to treat overdosage of lithium?

A

dialysis (peritoneal and hemodialysis)

64
Q

Effective in some patients who have failed to respond to lithium

A

Valproic Acid

65
Q

Used to treat acute mania and for prophylactic therapy

Used as mood stabilizer is similar to its use as anticonvulsant

A

Carbamazepine

66
Q

used in preventing depression that follows the manic phase

A

lamotrigine

67
Q 
An adolescent male is newly diagnosed with schizophrenia.Which of the following neuroleptic agents may improve his apathy and blunted affect?
A. Chlorpromazine.
B. Fluphenazine.
C. Haloperidol.
D. Risperidone.
E. Thioridazine
A

D. Risperidone is the only neuroleptic on the list that has some benefit in improving the negative symptoms of schizophrenia.

68
Q 
Which one of the following neuroleptics has been shown to be a partial agonist at the D2 receptor?
A. Aripiprazole.
B. Clozapine.
C. Haloperidol.
D. Risperidone.
E. Thioridazine.
A

A. Aripiprazole is the agent that acts as a partial agonist at D2 receptors.

69
Q

A 28-year-old woman with schizoid affective disorder and difficulty sleeping would be most benefited by which of the following drugs?

A. Aripiprazole.
B. Chlorpromazine.
C. Haloperidol.
D. Risperidone.
E. Ziprasidone.
A

B. Chlorpromazine has significant sedative activity as well as antipsychotic properties. Of the choices, it is the drug most likely to alleviate this patient’s major complaints, including her insomnia.

Pharmacology: CNS Drugs (3 decks)

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