Anti-Psychotics-Pechnick

Question 1

What are some of the positive symptoms of Schizophrenia?

Answer 1

Hallucinations, delusions, thought and movement disorders

Question 2

What does the revised dopamine theory of Schizophrenia say?

Answer 2

• Positive symptoms are due to hyperactivity in the mesolimbic dopamine system
• Negative symptoms & cognitive deficits are due to hypoactivity in the mesocortical dopamine system

Question 3

Which drugs are First-Generation Antipsychotics?

Answer 3

Phenothiazine-type drugs:
1. Chlorpromazine
2. Perphenazine
3. Trifluoperazine
4. Thioridazine
5. Fluphenazine
Non-phenothiazine-type drugs:
1. Thiothixene
2. Haloperidol

Question 4

Which pharmacologic activity produces the therapeutic effects of antipsychotics?

Answer 4

Block dopamine receptors

Question 5

What are some pharmacologic effects of antipsychotics?

Answer 5

CNS: affect hypothalamus, seizures
Autonomics: cause symp effects
CV: block a1 receptors (can cause orthostatic hypotension)

Question 6

Do antipsychotics cure Schizophrenia?

Answer 6

No, just reduce some symptoms

Question 7

What is the black box warning of first gen antipsychotics?

Answer 7

Elderly pts w/dementia-related psychosis using these drugs are at an increased risk of death

Question 8

What are some non-psychiatric uses of antipsychotics?

Answer 8

• Neuroleptic anesthesia
• Intractable hiccup
• Nausea and vomiting

Question 9

How do antipsychotics inhibit nausea and vomiting?

Answer 9

B/c visceral stimuli and the chemoreceptor trigger zone cause dopamine and serotonin to be released and antipsychotics block their uptake!

Question 10

What is the early onset neurological SE of antipsychotics?

Answer 10

• Extrapyramidal syndrome (EPS) - Too much ACh, not enough DA
• Sx: Parkinsonian syndrome, akathisia, acute dystonic reactions
• Tx: stop or reduce antipsychotics, antimuscarinic drugs

-CONTRAINDICATED: L-DOPA and directly-acting DA agonists because they can cause psychosis

Question 11

Acute EPS is a result of blocking of which pathway?

Answer 11

Nigrostriatal (extrapyramidal) pathway

Question 12

Which anti-psychotics are more likely to produce EPS?

Answer 12

Haloperidol very likely, chlorpromazine & thioridazine are much less likely

Question 13

What is the late onset neurological SE of antipsychotics?

Answer 13

• Tardive Dyskinesia
• Too much DA, not enough ACh
• Tx: Muscarinic agonists, slowly decrease the dose of the drug and change them to an atypical antipsychotic

Question 14

What is the endocrine SE of antipsychotics?

Answer 14

Hyperprolactinemia:

• Gynecomastia in men, galactorrhea in women
• Amenorrhea
• A tuberoinfundubular problem

Question 15

What is Neuroleptic Malignant Syndrome (NMS)?

Answer 15

• Rare idiosyncratic response mostly seen in males and can be fatal
• Presentation similar to malignant hyperthermia
• Tx: dopamine agonists (bromocriptine or amantadine) and dantrolene

Question 16

Which SE of first gen antipsychotics is disabling and frequently permanent?

Answer 16

Tardive dyskinesia

Question 17

Which drugs are 2nd gen or atypical antipsychotics? (6)

Answer 17

(ZOO CAR)

1. Ziprasidone
2. Olanzapine
3. Ouetiapine
4. Clozapine
5. Aripiprazole
6. Risperidone

Question 18

What is the pharmacologic activity of the 2nd gen antipsychotics?

Answer 18

• Dopamine receptor antagonist as well as serotonin receptor antagonist
• Extremely nonselective

Question 19

What are some SE of 2nd gen antipsychotics?

Answer 19

• Less likely to produce EPS and tardive dyskinesia
• Type II diabetes and dyslipidemia
• Weight gain

Question 20

Why was the widespread use of Clozapine limited?

Answer 20

Causes agranulocytosis in 1% of pts

Question 21

What is the MOA of atypical antipsychotics?

Answer 21

Non-selective direct inhibitory action on dopamine and serotonin pathways