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Pharm3 > Antipsychotic Drugs > Flashcards

Antipsychotic Drugs Flashcards

1
Q

Psychosis

A

Inability to distinguish reality from delusion. Schizophrenia is the most common psychotic disorder and is the most hospitalized

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2
Q

Delusions

A

False beliefs not held by people of the same cultural background

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3
Q

Disordered Thinking

A

Confused thoughts that do not link up

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4
Q

Hallucinations

A

Sensing things to feel real but do not exist

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5
Q

Serotonin Hypothesis

A

LSD and other hallucinogens are agonists of 5-HT receptors. Serotonin is the endogenous agonist of these receptors. Modulate the release of dopamine, NE, glutamate, GABA and Ach in the cortex, limbic and striatum. Second gen antipsychotics are antagonists of this receptor keeping it in an inactivated state.

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6
Q

Dopamine Hypothesis

A

Old and incomplete hypothesis. D2 receptor is targeted by 1st gen antipsychotics. Can cause psychosis with exogenous dopamine.

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7
Q

Nigrastriatal pathway

A

Loss of these neurons contributes to Parkinson’s symptoms. 1st gen drugs block this pathway causing parkinsons symptoms.
Chlorpromazine / haloperidol

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8
Q

Mesocortical pathway

A

Prefrontal cortex suppression causing flat mood, poor cognition and motivation + emotion

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9
Q

Mesolimbic

A

When enhanced causes positive symptoms like hallucinations

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10
Q

Tuberohypophyseal

A

Suppresion of this pathway by 1st gen antipsychotics can cause abnormal breast development in males.

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11
Q

Extrapyramidal symptoms

A

Caused by blocking D2 receptors in the nigrostrital tract
-Parkinsonism (pill rolling tremor + rigidity) 5-30 days. Elderly
-Dystonia (grimacing and muscle spasms of the face and neck) 1-5 days. Generally in young individuals
- Akathisia (restlessness of the lower extremities) 5-60 days
-Tardive Dyskinesia (protrusion and rolling the tongue with a chewing motion) months to years. Elderly.

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12
Q

Emergency Drug for Parkinsonism

A

Diphenhydramine

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13
Q

Glutamate Hypothesis

A

PCP and MK-801 noncompetitive NMDA inhibitors causing cognitive impairment and psychosis

Serotonin antagonists better than D2 at blocking effects

Hypofuntion of NMDA receptors leads to decreased inhibition of neuronal function

Diminished GABAergic activity disinhibits leading to hyperstimulation

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14
Q

Positive Symptoms

A

Hallucinations
Delusions
Disorganized thoughts

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15
Q

Negative Symptoms

A

Alogia
Flattened Affect
Asocial

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16
Q

Cognitive Sympotms

A

Memory issues
Attention Deficits
Planning
Decision Making

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17
Q

Potency of First Gen

A

Low Potency
- Chlorpromazine
- Thioridazine
Most Potent
- Trifluoperazine
- Perphenzine
- Fluphenazine
Most Commonly Used
- Haloperidol

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18
Q

Chlorpromazine

A

Stronger blocking D2 than serotonin

a receptor blockade (Hypotension)
Muscarinic receptor blockade (Dry mouth, nausea, constipation)
H1 receptor blockade (Drowsiness)
CNS Depression
Decreased Seizure Threshold
QT Prolongation (SCD)

Used un Schizo and Bipolar

Long Half Life

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19
Q

Haloperidol (4)

A

Less sedation than the others and minimal muscarinic receptor effects

D2

Schizo, Bipolar, Huntington’s Chorea, Tourette’s

Toxicity = Extrapyramidal and hyperprolactinemia

20
Q

Second Gen Mechanism

A

Action is greater at the serotonin receptors than D2

21
Q

Second Gen Effects

A

a receptor blockade 5ht

Muscarinic receptor blockade

Variable H1 receptor blockade

22
Q

Second Gen Applications

A

Schizo, improves both positive and negative symptoms

Bipolar, adjuctive with valproate or lithium

Agitation in Alzheimers and Parkinson’s (Risperidone, Clozapine)

Major Depression, Tourette’s, ASD (Aripiprazole)

ASD(risperidone)

Parkinson’s dementia(Pimavanserin) - Also shortens lifespan for some reason

23
Q

Why does aripiprazole not cause more severe side effects

A

Dual agonist/antagonist effects preventing dopamine response from going too low

24
Q

Drugs with Strong Effects at Muscarinic (COC)

A

Clozapine, Olanzapine, Chlorpromazine

Constipation, bowel obstruction, urinary retention.

Monitor Bowel

25
Q

Drugs with strong adrenergic blocking (CCT)

A

Clozapine, Chlorpromazine, Thioridazine

Orthostatic Hypotension

Titrate slowly

26
Q

Drugs with strong histamine receptor blocking

A

Clozapine, Chlorpromazine, Olanzapine

Sedation and Weight gain

Cessation causes insomnia and sleep disturbances

27
Q

Adverse Cardiac Effects

A

QRS Widening
Ventricular Arrhythmia

QT prolongation - SCD

27
Q

Weight Gain from antipsychotics

A

Dyslipidemia and impairment in glycemic control

Hyperleptinemia

28
Q

Neuroleptic Malignant Syndrome

A

Decreased Activity at D2 from antipsychotics

Parkinson’s symptoms

Hypothalamus effects ie, hyperthermia and increased BP + HR leading to CV and Resp complications

Muscle Rigidity -> Rhabdo -> Renal failure

29
Q

Management of Neuroleptic Malignant Syndrome

A

Mild : Rigidity + Tremor
Benzos

Moderate: Catatonia, confusion, and elevated temo
Bromocriptine

Severe
Temp > 40
Dantrolene and cooling blankets

30
Q

Serotonin Syndrome vs. NMS

A

Serotonin Syndrome
Develops in 24 hours
Neuromuscular hyperactivity
Resolves Quickly
Treat with Benzos and Serotonin blockers

NMS
Days to weeks
Neuromuscular sluggishness
Resolves slower
Dantrolene and Bromocriptine

31
Q

Schizophrenia(A)

A

Hallucinations and/or delusions and/or disorganized speech for 6 months

Treat with second gen except clozapine b/c side effects

Aripiprazole**

Benzos for Catatonic schizo

32
Q

Schizoaffective

A

Schizophrenia with mania+depression

Treat with antipsychs and lithium/valproic

33
Q

Drugs of choice for Bipolar

A

mood stabilizers rather than antidepressants because cause enhanced cycling

Lithium/valproate + Aripiprazole/Olanzapine

33
Q

Classification of Depression

A

Bipolar 1: high highs and low lows

Bipolar 2: slight highs and still low lows

Unipolar is just depression

Cyclothymia: Moderate highs and lows

Dysthymia: Mild depression

34
Q

Unipolar Depression Drugs (AAL)

A

Antidepressants + Aripiprazole + Lithium

35
Q

Carbamazepine

A

Mech: Unclear for bipolar. Sodium channel blocker

Used in acute mania and for prophylaxis of depression

SJS**

36
Q

Lamotrigine

A

Not effective at treating acute mania

SJS**

37
Q

Valproic Acid

A

Increasingly used as first choice for acute maniaL

38
Q

Lithium

A

Mech Unclear

No significant antagonism on autonomic receptors or specific CNS

No sedation

Don’t give to pregnant patients**

39
Q

Lithium Toxicity

A

Intoxication, Ataxia, GI effects,
CV, Hyperpyrexia

Silent syndrome: Cerebellar and brainstem dysfunction, Extrapyramidal, Dementia

40
Q

Tourette’s

A

Looks like OCD early on

Aripiprazole only approved therapy

Haloperidol is used off label

41
Q

Autism

A

Risperidone and aripiprazole used to treat irritability in autism patients

42
Q

Psychosis in Parkinson’s (ROC)

A

Loss of serotonin neurons and up-regulation of serotonin 2A receptors

Risperidone, Olanzapine, Clozapine used

Pimavanzserin is most effective parkinsons dementia but increased mortality

43
Q

Huntington’s(THC)

A

Overactivity in dopaminergic nigrostriatal pathways

Tetrabenazine drug of choice

Halperidol for chorea or clozapine for rigid HD

44
Q

Alzheimer’s (HRC)

A

Avoid use of medications with anticholinergic properties

Tx Haloperidol, reperidone, or clozapine
Nuerochemical disturbance deficiency Ach

Pharm3 (7 decks)

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