Antipsychotic Drugs- French

Question 1

Mesolimbic pathway

Answer 1

integration of sensory input and motor responses with affective data

hyperactivity- positive symptoms

Question 2

Mesocortical activity

Answer 2

communication and social abilities

hypoactivity- negative symptoms

Question 3

nigrostriatal pathway

Answer 3

planned, coordinated, movement

loss of dopamine in this region can lead to parkinson’s like movements

Question 4

tuberinfundibular pathway

Answer 4

hypothalamus release DA in pituitary to inhibit prolactin release

side effects of antipsychotics:
hyperprolactinemia
poikilothermia
weight gain

Question 5

glutamate hypothesis

Answer 5

hypofuntion of NMDA receptors in GABAergic interneurons in PFC changes mesolimbic and mesocortical pathways- positive and negative symptoms

• increased mesolimbic DA release- positive symptoms
• decreased mesocortical DA release- negative symptoms

Question 6

haloperidol

Answer 6

typical antipsychotic: high D2/5HT2a ratio

high clinical potency: greater D2 blocking activity
greater risk of extrapyramidal toxicity

Question 7

chlorpromazine

Answer 7

typical antipsychotic: high D2/5HT2a ratio

low clinical potency: less D2 blocking activity
less extrapyramidal toxicity

Higher doses cause other side effects:
antimuscarinic: dry mouth, sedation
alpha1 blockade: hypotension
antihistamine: sedation

Question 8

typical antipsychotics

Answer 8

high D2/5HT2a ratio
good D2 block
good efficacy agains positive symptoms of schizophrenia
high incidence of extrapyramidal toxicity

Question 9

atypical antipsychotics

Answer 9

low D2/5HT2a ratio
poor D2 block

good 5HT2a block associated with good efficacy against negative symptoms schizophrenia,and treatment resistant

Question 10

most potent to least potent

Answer 10

haloperidol: high
clozapine: medium
Chloropromazine= quetiapine: low

Question 11

most extrapyramidal toxicity to least

Answer 11

haloperidol: very high
chlorpromzine: medium
clozapine= quetiapine: very low

Question 12

most hypotensive actions to least

Answer 12

chlorpromazine: high
clozapine: medium
quetiapine: low to medium
haloperidol: low

Question 13

most sedative to least sedative

Answer 13

chlorpromazine: high
quetiapine: medium
haliperidol= clozapine: low

Question 14

chlorpromazine SE

Answer 14

Autonomic:
muscarinic blockade: dry mouth, tachycardia, loss of accommodation, difficulty urinating, constipation
alpha 1 adernergic blockade: orthostatic hypotension, impotence

Sedation: high, antimuscarinic and antihistaminic

Question 15

Phases of Extrapyramidal Symptoms

Answer 15

Acute Dystonia: 1-5 days
ttx: antimuscarinic agents: diphenhydramine, benzotropine

akathisia: 6-60 days
ttx: reduce dose or change drug, adde anticholinergic beta blocker, benzodiazepines

pseudoparkinsonism: 5-90 days
ttx: anticholinergic or amantadine (DA agonist)

Tardive dyskinesia: 3-6 months
worsens upon withdrawl of antipsychotic drug
usually irreversible
20-40% incidence with chronic treatment
ttx: prevention

Question 16

clozapine SE

Answer 16

agranulocytosis 2% patients
hypersalivation
weight gain
lipids
dose related lowering seizure threshold

Question 17

neuroleptic malignant syndrome

Answer 17

catatonia, stupor, fever, unstable blood pressure

treat with sodium dantrolene

Question 18

babies

Answer 18

will cross placenta

will be excreted in breastmilk

Question 19

quetiapine

Answer 19

effective against positive and negative symptoms
little to no extrapyramidal dysfunction
weight gain

may require high doses if associated hypotension
short half life requires twice daily dosing