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Pharmacology 2 > Antipsychotic Drugs > Flashcards

Antipsychotic Drugs Flashcards

-Understand the three symptom clusters associated with schizophrenia -Compare and contrast the mechanisms of action of typical and atypical antipsychotics -understand the differences in efficacy and side effect profile classes of antipsy

1
Q

A debilitating disease affecting up to 1% of population

A

Schizophrenia

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2
Q

Who is at the highest risk for Schizophrenia?

A

late adolescence or early adulthood

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3
Q

What is considered positive symptoms in schizophrenia?

A

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

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4
Q

What are three positive symptoms associated with schizophrenia?

A
  • Hallucinations
  • Delusions
  • Disorganized thinking
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5
Q

What is considered negative symptoms in schizophrenia?

A

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

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6
Q

What are three negative symptoms associated with schizophrenia?

A
  • Flat affect
  • Anhedonia
  • Social withdrawal
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7
Q

What is the etiology for SZ?

A

there is no consensus on a single etiology

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8
Q

What is a possible etiology for SZ?

A

due to a abnormal development of a gene in utero

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9
Q

What is the oldest hypothesis for dopamine?

A

a increased dopamine transmission

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10
Q

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

A

locked in mental asylums receiving only limited custodial care

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11
Q

What did Ugo Cerletti develop?

A

Electroconvulsive therapy (ECT)

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12
Q

How did the ideal of ECT develop?

A

from watching pigs being anesthetized with electroshock before being butchered.

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13
Q

What is trans-orbital lobotomy?

A

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

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14
Q

What year was antipsychotic drugs created

A

1950s

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15
Q

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

A

40,000-50,000 Lobotomies performed

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16
Q

What was the first antipsychotic discovered?

A

Chlorpromazine

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17
Q

Chlorpromazine was discovered from what?

A

Promethazine (H1 antagonist)

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18
Q

What is the underlying problem of SCZ?

A

a increase in dopamine

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19
Q

What is used to treat POSITIVE symptoms of SCZ?

A

1st gen drugs

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20
Q

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

A

Phenothiazines

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21
Q

What are the 3 types of 1st gen drugs?

A

Haloperidol, Chlorpromazine, Perphenazine

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22
Q

What is the MOA for 1st gen drugs?

A

blocks dopamine D2R

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23
Q

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

A

True

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24
Q

What is Mesolimbic Pathway?

A

hyperactivity thought to underlie positive symptoms

25
Q

What does blocking the Mesolimbic pathway do?

A

reduce positive symptoms

26
Q

What is Mesocortical Pathway?

A

cortical dopamine regulates cognitive function (extapyramidal side effects)

27
Q

What does blocking the Mesocortical Pathway do?

A

ineffective at treating negative and cognitive sympotms

28
Q

What is the Nigrostriatal Pathway?

A

controls movements

29
Q

What disease is associated with the nigrostriatal pathway?

A

Parkinson disease

30
Q

What are symptoms of Parkinson?

A

tremor, rigidity, and bradykinesia

31
Q

What symptoms does antipsychotics produce?

A

“Parkinson like phenotype” and Tardive Dyskinesias

32
Q

What is the Tuberoinfundibular pathway?

A

inhibits prolactin release

33
Q

What does blocking the Tuberoinfundibular pathway do?

A

lead to hyperprolactinemia (galactorrhea, amenorrhea, sexual dysfunction)

34
Q

What is neuroleptic malignant syndrome?

A

Very severe form of parkinsonism

35
Q

What is the treatment for Neuroleptic Malignant Syndrome?

A

discontinue APD

Primarily supportive care

36
Q

What is the problem with administering dopamine agonist?

A

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

37
Q

T/F anti-psychotics are rarely abused?

A

TRUE

38
Q

Why is anti-psychotics not abused?

A

because your blocking dopamine

39
Q

What is a atypical neuroleptics drug?

A

Clozapine

40
Q

What are 3 unique things about atypical neuroleptics?

A
  • Low propensity to cause Parkinsonian symptoms
  • No reported cases of Dystomia
  • No reported cases of Tardive Dyskinesia
41
Q

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

A

Ratio 5-HT2a/ D2

42
Q

What does 5HT2- inhibit?

A

dopamine function in nigrostriatal

43
Q

What does 5HT2- not inhibit?

A

mesolimbic pathway

44
Q

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

A

dopamine

45
Q

What are the four problems with anti-psych drugs?

A
  • weight gain
  • QT prolongation
  • Side effects
  • Sedation
46
Q

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

A

Weight gain and QT prolongation

47
Q

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

A

weight gain

48
Q

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

A

Perphenazine

49
Q

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

A

Olanzapine

50
Q

Why did 74% of patients discontinue study medications?

A

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

51
Q

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

A

upstream of the dopamine system

52
Q

How was antipsychotics drug found?

A

serendipitously

53
Q

What are 3 novel approaches to SCZ txt?

A
  • Hippocampal DBS
  • Hippocampal selective benzodiazepine
  • Cell transplants
54
Q

What does antipsychotics block?

A

D2 receptors

55
Q

What does atypical antipsychotics block?

A

D2 and 5HT2A receptors

56
Q

What improves cognition and negative symptoms with atypical antipsychotics?

A

Less EPS

57
Q

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

A

True

58
Q

T/F Current drugs are adequate?

A

FALSE, far far from adequate

59
Q

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

A

unresponsive, lethargic, vegetative state

Pharmacology 2 (9 decks)

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