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Emma H&N > Antipsychotic Drugs > Flashcards

Antipsychotic Drugs Flashcards

1
Q

positive symptoms

A

delusions
hallucinations
disorganized speech/thought

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2
Q

negative symptoms

A

anhedonia
flattened affect
apathy

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3
Q

primary mechanisms of antipsychotics

A

Blockade of dopamine (D2) receptors

  • -typical agents
  • -help with positive symptoms

Blockade of serotonin (5HT2) receptors

  • -atypical/2nd generation
  • -help with negative symptoms
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4
Q

how are negative symptoms relieved?

A

blockade of serotonin (5HT2) receptors

–atypical, 2nd gen

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5
Q

how are positive symptoms relieved?

A

blockade of dopamine (D2) receptors

–typical, 1st gen

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6
Q

negative symptoms due to

A

insufficient DA activity in mesocortical tract

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7
Q

positive symptoms due to

A

overactivity of DA activity in mesolimbic system

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8
Q

dopamine hypothesis

A

Assumes over activity of DA in mesolimbic pathway correlates with positive symptoms
-block dopamine type 2 receptors, then alleviate positive symptoms

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9
Q

serotonin hypothesis

A

Insufficient DA release at ends of neurons in mesocortical pathways correlates with negative symptoms
-less DA to interact with prefrontal cortex

  • serotonin suppresses release of DA from mesocortical pathway
  • block serotonin (5HT2) receptor, then take away inhibition and allow DA to be released
  • alleviates negative symptoms
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10
Q

chlorpromazine

A

low potency older/typical agent

name recognition

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11
Q

haloperidol

A

high potency older/typical agent

name recognition

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12
Q

clozapine

A

most common newer/atypical agent

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13
Q

newer/atypical agents have a _______ potency, so they have a ________ dose

A

newer/atypical agents have a HIGHER potency, so they have a LOWER dose

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14
Q

consequences of blockage of dopamine in mesolimbic pathway

A

antipsychotic

-decreases positive symptoms

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15
Q

consequences of blockage of dopamine in mesocortical pathway

A

antipsychotic

-decreases negative symptoms

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16
Q

consequences of blockage of dopamine in nigrostriatal pathway

A

causes extrapyramidal movements

-Parkinson’s like symptoms

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17
Q

consequences of blockage of dopamine in tuberoinfundiblar pathway

A

causes prolactin release

  • amenorrhea, galactorrhea (women)
  • gynecomastia, reduced libido (men)
  • fertility problems
18
Q

common adverse reactions to antipsychotics

A

Hyperprolactinemia
-galactorrhea, amenorrhea, gynecomastia, reduced libido

Postural hypertension
-due to NE stimulating alpha-1 receptors, increasing BP

QT prolongation
-cardiotoxicity

Extrapyramidal Syndromes (EPS)
-dystonias, parkinsonism
19
Q

why do psychostimulants cause cardiotoxicity?

A
  • block K+ channels
  • longer ventricular repolarization
  • ventricular dysrhythmia
  • prolonged QT interval
20
Q

how to treat extrapyramidal side effects

A

Lower dose of antipsychotics.
Change drug.

Drug therapy:

  • benzotropine (cogentin)
  • trihexyphenidyl
  • ANTIMUSCARINICS
21
Q

why do extrapyramidal sx occur with antipsychotics?

A

DA and ACh are in balance.

  • if DA is blocked, then balance is tipped to favor ACh
  • increased ACh = increased output to basal ganglia = EPS
22
Q

Acute dystonic reaction

what is it?
Tx?

A

EPS related adverse effect

  • oculogyric crisis
  • torticollis

Tx: antimuscarinics (antihistamines) (benztropine)

23
Q

tardive dyskinesia (TD)

what is it?
Tx?

A
  • persistent EPS
  • could persist rest of life
  • elderly at greater risk
  • use minimal doses for minimal duration
  • change to atypical agent

Tx: valbenzazine (Ingrezza)

24
Q

neuroleptic malignant syndrome

what is it?
Tx?

A
  • hyperpyrexia (fever)
  • rigidity
  • autonomic instability
  • delerium
  • more likely with high doses
  • rare

Tx:

  • stop drug
  • dantrolene, bromocriptine
25
Q

what should you consider if the patient is pregnant (with antipsychotic use)?

A
  • infant may have abnormal motor movements

- withdrawal effects

26
Q

poikilothermia

A
  • inability to control body temp
  • common in low potency, older agents
  • due to changes in hypothalamus
27
Q

most common atypical antipsychotics

A 
Clozapine
Risperidone
Olanzapine
Quetiapine
Aripiprazole
  • newer
  • more expensive (even the generic)
28
Q

adverse effects of atypical antipsychotics

A
  • increases in weight, blood glucose, and lipids
  • orthostasis (alpha-receptor blockade)
  • others: somnolence, dizziness, inc LFTs, CYP450 interactions)
  • EPS is LESS likely to occur
  • –decreased prolactin disturbances
29
Q

clozapine

role?
adverse effects?

A
  • atypical, newer
  • most effective antipsychotic
  • seldom used
  • least likely to develop EPS

Adverse Effects

  • sedation
  • weight gain
  • sialorrhea (xs saliva)
  • seizures (rare)
  • agranulocytosis (v rare, but super serious)
30
Q

time to effect for antipsychotics

A
  • most sx improve slowly

- higher potency = higher response

31
Q

duration of treatment for antipsychotics

A
  • most require prolonged maintenance
  • rebound effect if abruptly stopped

maintenance is the best efficacy, but due to illness are likely not to be continued

32
Q

receptor blockade of typical vs atypical antipsychotics

A

TYPICAL: D2 > 5HT2A

ATYPICAL: 5HT2A > D2

33
Q

effectiveness of typical vs atypical antipsychotics

A

TYPICAL: mainly for positive symptoms

ATYPICAL: both positive and negative symptoms

34
Q

movement disorders of typical vs atypical antipsychotics

A

TYPICAL: more

ATYPICAL: less

35
Q

metabolic effects of typical vs atypical antipsychotics

A

TYPICAL: less

ATYPICAL: more

36
Q

consequences of blocking alpha-1 receptor

A

orthostasis

37
Q

consequences of blocking dopamine-2 receptor

A

extrapyramidal movements

38
Q

consequences of blocking histamine-1 receptor

A

sedation

weight gain

39
Q

consequences of blocking muscarinic receptor

A

dry mouth, blurred vision, urinary retention, constipation

40
Q

class wide safety concern for antipsychotics

A

eldery patients with dementia-related psychosis is treated with antipsychotic drugs are at an increased risk of death compared to a placebo

  • more pleasant with antipsychotic, easier to treat
  • may shorten life
41
Q

drug-induced psychoses can be commonly caused by which drugs?

A 
anticholinergic drugs
benzodiazepines
antipsychotic agents
dopaminergic agents
corticosteroids
withdrawal from sedatives/alcohol

Emma H&N (49 decks)

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