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Psych > Antipsychotic Drugs > Flashcards

Antipsychotic Drugs Flashcards

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1
Q

Dopamine hypothesis of schizophrenia

A
  • Blocking D2 receptors in CNS (mesolimbic frontal system) alleviates psychotic symptoms
  • Drugs that increase dopaminergic activity aggravate schizophrenia
  • Schizophrenic patients have increased dopamine receptor density
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2
Q

Relationship between clinical efficacy of antipsychotics and affinity for D2 receptors

A

Higher affinity for D2 receptors = lower dose needed to achieve efficacy

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3
Q

EPS

A

Extrapyramidal symptoms- reversible neurologic effects

  • Movement disorders:
  • Parkinson-like syndrome
  • Akathisia
  • Dystonia
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4
Q

Akathisia

A

Motor restlessness- part of EPS

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5
Q

Dystonia

A

Muscle spasms- part of EPS

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6
Q

What do you treat acute dystonia with?

A

Diphenhydramine (antihistamine + anticholinergic) OR muscarinic blocking agents

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7
Q

Tardive dyskinesia

A

Choreoathetoid movements of lips/buccal cavity

-effect of chronic use of antipsychotics

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8
Q

Treat tardive dyskinesia

A
  • Discontinue drug
  • Eliminate drugs with anticholinergic action
  • Add diazepam
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9
Q

Neuroleptic malignant syndrome

A

Most severe adverse effects of antipsychotics

  • muscle rigidity, excessive sweating, autonomic instability, lead pipe rigidity, altered mental status, fever, rhabdomyelisis
  • can persist for days even after neuroleptic is stopped
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10
Q

Treat neuroleptic malignant syndrome

A

Dantrolene (muscle relaxant at ryanodine receptor) + bromocriptine (dopamine agonist)

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11
Q

Are antipsychotics lipophilic or lipophobic?

A

Lipophilic- readily enter CNS

High Vd- long duration

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12
Q

Chlorpromazine

A

Typical antipsychotic- low potency

-corneal deposits

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13
Q

Thioridazine

A

Typical antipsychotic- low potency

  • retinal deposits
  • strongest autonomic and anti-muscarinic effects
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14
Q

Haloperidol

A

Typical antipsychotic- high potency

  • blocks D2 the most –> high EPS
  • weakest autonomic and muscarinic effects
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15
Q

Fluphenazine

A

High potency typical antipsychotic

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16
Q

Trifluoperazine

A

High potency typical antipsychotic

17
Q

Phenothiazine

A

Typical antipsychotic

-sedation

18
Q

What do typical antipsychotics treat?

A
  • Positive symptoms of schizophrenia
  • Motor tics
  • Acute agitation/aggression
  • Acute psychosis
19
Q

Side effects of blocking D2 receptor in pituitary

A
  • hyperprolactinemia
  • gynecomastia
  • amenorrhea
  • galactorrhea
  • infertility
  • decreased libido
20
Q

Low potency typical antipsychotics side effects

A
    • | H1
    • | a1
    • | muscarinics
21
Q

Mechanism of typical antipsychotics

A

–| D2

Can have some –| of H1, a1, muscarinics

22
Q

Mechanism of atypical antipsychotics

A

–| 5-HT2 and a little –| D2

23
Q

What do atypical antipsychotics treat?

A
  • positive (D2) AND negative (5-HT2) symptoms of schizophrenia
  • resistant MDD
24
Q

Clozapine

A

Atypical antipsychotic (–| 5-HT2A)

  • higher affinity for D4 (vs D2)
  • toxicity: agranulocytosis, myocarditis/cardiomyopathy, lowered seizure threshold
  • highest risk of antimuscarinic effects among atypicals
25
Q

Olanzapine

A

Atypical antipsychotic

-metabolic toxicity

26
Q

Quetiapine

A

Atypical antipsychotic

-QT interval prolongation

27
Q

Risperidone

A

Atypical antipsychotic

  • highest risk of causing EPS among atypicals (most D2 inhibition)
  • can help manage Tourette’s
  • adjunct therapy (with SSRIs) for OCD
28
Q

Ziprasidone

A

Atypical antipsychotic

  • QT interval prolongation
  • lowest risk of metabolic side effect
29
Q

Aripiprazole

A

Atypical antipsychotic
-partial agonist at D2- works by diminishing subcortical DA hyperfunction (reduces Emax) but increases DA transmission in PFC by acting as agonist

30
Q

Side effects of atypical antipsychotics

A
  • metabolic effects: weight gain, hyperlipidemia, hyperglycemia (black box warning for hyperglycemia)
  • sedation (H1)
  • orthostatic hypotension (a1)
  • antimuscarinics (mostly just clozapine)
  • prolactinemia (D2 blockade)- less so than typicals
  • NMS (less so than typicals)

Psych (4 decks)

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