Antipsychotic Drugs

Question 1

A debilitating disease affecting up to 1% of population

Answer 1

Schizophrenia

Question 2

Who is at the highest risk for Schizophrenia?

Answer 2

late adolescence or early adulthood

Question 3

What is considered positive symptoms in schizophrenia?

Answer 3

those that appear to reflect an ADDITION to or an EXCESS of normal functions

Question 4

What are three positive symptoms associated with schizophrenia?

Answer 4

• Hallucinations
• Delusions
• Disorganized thinking

Question 5

What is considered negative symptoms in schizophrenia?

Answer 5

those symptoms that are absent from normal behavior (loss of function)

Question 6

What are three negative symptoms associated with schizophrenia?

Answer 6

• Flat affect
• Anhedonia
• Social withdrawal

Question 7

What is the etiology for SZ?

Answer 7

there is no consensus on a single etiology

Question 8

What is a possible etiology for SZ?

Answer 8

due to a abnormal development of a gene in utero

Question 9

What is the oldest hypothesis for dopamine?

Answer 9

a increased dopamine transmission

Question 10

Prior to the 20th century what did people with mental illness receive for SCZ?

Answer 10

locked in mental asylums receiving only limited custodial care

Question 11

What did Ugo Cerletti develop?

Answer 11

Electroconvulsive therapy (ECT)

Question 12

How did the ideal of ECT develop?

Answer 12

from watching pigs being anesthetized with electroshock before being butchered.

Question 13

What is trans-orbital lobotomy?

Answer 13

using a ice pick through the upper eyelid and swing it back and forward to destroy connectivity of frontal lobe

Question 14

What year was antipsychotic drugs created

Answer 14

1950s

Question 15

What was the 1940s-50s considered a dark time?

Answer 15

40,000-50,000 Lobotomies performed

Question 16

What was the first antipsychotic discovered?

Answer 16

Chlorpromazine

Question 17

Chlorpromazine was discovered from what?

Answer 17

Promethazine (H1 antagonist)

Question 18

What is the underlying problem of SCZ?

Answer 18

a increase in dopamine

Question 19

What is used to treat POSITIVE symptoms of SCZ?

Answer 19

1st gen drugs

Question 20

What is the class of first generation drugs to txt SCZ?

Answer 20

Phenothiazines

Question 21

What are the 3 types of 1st gen drugs?

Answer 21

Haloperidol, Chlorpromazine, Perphenazine

Question 22

What is the MOA for 1st gen drugs?

Answer 22

blocks dopamine D2R

Question 23

T/F ALL classical antipsychotics are dopamine D2 receptor antagonists?

Answer 23

True

Question 24

What is Mesolimbic Pathway?

Answer 24

hyperactivity thought to underlie positive symptoms

Question 25

What does blocking the Mesolimbic pathway do?

Answer 25

reduce positive symptoms

Question 26

What is Mesocortical Pathway?

Answer 26

cortical dopamine regulates cognitive function (extapyramidal side effects)

Question 27

What does blocking the Mesocortical Pathway do?

Answer 27

ineffective at treating negative and cognitive sympotms

Question 28

What is the Nigrostriatal Pathway?

Answer 28

controls movements

Question 29

What disease is associated with the nigrostriatal pathway?

Answer 29

Parkinson disease

Question 30

What are symptoms of Parkinson?

Answer 30

tremor, rigidity, and bradykinesia

Question 31

What symptoms does antipsychotics produce?

Answer 31

"Parkinson like phenotype" and Tardive Dyskinesias

Question 32

What is the Tuberoinfundibular pathway?

Answer 32

inhibits prolactin release

Question 33

What does blocking the Tuberoinfundibular pathway do?

Answer 33

lead to hyperprolactinemia (galactorrhea, amenorrhea, sexual dysfunction)

Question 34

What is neuroleptic malignant syndrome?

Answer 34

Very severe form of parkinsonism

Question 35

What is the treatment for Neuroleptic Malignant Syndrome?

Answer 35

discontinue APD | Primarily supportive care

Question 36

What is the problem with administering dopamine agonist?

Answer 36

because your giving them more dopamine, which they already have excess

Question 37

T/F anti-psychotics are rarely abused?

Answer 37

TRUE

Question 38

Why is anti-psychotics not abused?

Answer 38

because your blocking dopamine

Question 39

What is a atypical neuroleptics drug?

Answer 39

Clozapine

Question 40

What are 3 unique things about atypical neuroleptics?

Answer 40

- Low propensity to cause Parkinsonian symptoms - No reported cases of Dystomia - No reported cases of Tardive Dyskinesia

Question 41

What distinguishes between typical and atypical antipsychotics better than any known pharmacologic feature?

Answer 41

Ratio 5-HT2a/ D2

Question 42

What does 5HT2- inhibit?

Answer 42

dopamine function in nigrostriatal

Question 43

What does 5HT2- not inhibit?

Answer 43

mesolimbic pathway

Question 44

5-HT2 antagonist promotes ______ release in nigrostriatal pathway therefore decreasing Parkinsonian sde effects

Answer 44

dopamine

Question 45

What are the four problems with anti-psych drugs?

Answer 45

- weight gain - QT prolongation - Side effects - Sedation

Question 46

What are the 2 Biggest side effects of anti-psych?

Answer 46

Weight gain and QT prolongation

Question 47

What causes patient compliance to decrease in anti-psych drugs?

Answer 47

weight gain

Question 48

Which drug had good effectiveness and is well tolerated as a 2nd gen drug?

Answer 48

Perphenazine

Question 49

What drug was slightly better than other drugs, but was slightly associated with significant weight gain?

Answer 49

Olanzapine

Question 50

Why did 74% of patients discontinue study medications?

Answer 50

inefficacy (35%) or intolerable side effects (20%)

Question 51

Where does the pathology likely lie in the APD treatment of dopamine?

Answer 51

upstream of the dopamine system

Question 52

How was antipsychotics drug found?

Answer 52

serendipitously

Question 53

What are 3 novel approaches to SCZ txt?

Answer 53

- Hippocampal DBS - Hippocampal selective benzodiazepine - Cell transplants

Question 54

What does antipsychotics block?

Answer 54

D2 receptors

Question 55

What does atypical antipsychotics block?

Answer 55

D2 and 5HT2A receptors

Question 56

What improves cognition and negative symptoms with atypical antipsychotics?

Answer 56

Less EPS

Question 57

T/F NO agent has been shown to be superior to another?

Answer 57

True

Question 58

T/F Current drugs are adequate?

Answer 58

FALSE, far far from adequate

Question 59

What were the results of performing a lobotomy on a patient?

Answer 59

unresponsive, lethargic, vegetative state