Antipsychotics

Question 1

what are the actions of antipsychotics

Answer 1

• antagonising the actions of dopamine in the brain thus blocking their activity

Question 2

what other clinical conditions can antipsychotics treat

Answer 2

emesis
huntingtons disease
depression

Question 3

what are positive symptoms of schizophrenia

Answer 3

• delusions
• hallucinations
• thought disorders

Question 4

what are the negative symptoms of schizophrenia

Answer 4

• withdrawal from social contact and fattening of emotion responses

Question 5

increase in dopamine where causes psychotic effects

Answer 5

the restricted area of the temporal lobe (amygdala)

Question 6

where is there increased dopamine synthesis and release in schizophrenic patients

Answer 6

the striatum

Question 7

what are the three dopamine pathways in the brain

Answer 7

1. Tuberohypophyseal
2. Nigrostriatal
3. Mesocortical

Question 8

what are glutamates actions which suggest it plays a role in the psychotic episodes schizophrenics experience

Answer 8

this is the same method of actions that drugs like PSA and Ketamine take

if there is a decrease in glutamate and receptor density this results in schizophrenia

Question 9

What is the role of GABA

Answer 9

the primary inhibitory neurotransmitter for the central nervous system (CNS)

Question 10

Excess dopamine could contribute to what schizophrenia symptoms

Answer 10

positive

Question 11

reduced glutamate could contribute to what schizophrenia symptoms

Answer 11

negative

Question 12

important second generation antipsychotic

Answer 12

CLOZAPINE

these treat both positive and negative schizophrenia symptoms

Question 13

first generation antipsychotics

Answer 13

these only treat positive symptoms

Question 14

what other receptors do antipsychotics act on

Answer 14

muscarinic
alpha adrenergic

dopamine
serotonin
histamine H1

Question 15

Behavioural Effects of taking antipsychotic medication

Answer 15

– Apathy and reduced initiative
– Display few emotions, drowsy
• Can be easily stirred from this
– Aggressive tendencies inhibited
– Effects are distinct from those produced by hypnotics and anxiolytics

Question 16

common side effects of antipsychotic medication

Answer 16

• urinary retention
• weight gain
• seizure
• sedation
• extrapyramidal symptoms
• postural hypotension
• sexual dysfunction
• arrhythmias and sudden cardiac death
• dry mouth

Question 17

acute, reversible Parkinson-like symptoms that are a side effect of taking antipsychotic medication

Answer 17

due to block of nigro-striatal dopamine receptors

Question 18

slowly developing tardive dyskinesia

Answer 18

– Involuntary movements of face and limbs
– Appears after months/years of treatment
– Associated with proliferation of dopamine
receptors in the corpus striatum
– Treatment is generally unsuccessful
– Less common with newer antipsychotics

Question 19

Endocrine actions of antipsychotic medication

Answer 19

– ↑ prolactin secretion by blocking D2 receptors in the pituitary

Question 20

Anti-muscarinic actions of antipsychotic medication

Answer 20

– Blurring of vision, dry mouth & eyes, constipation – Can help attenuate extrapyramidal actions

Question 21

α-adrenoreceptor blocking actions of antipsychotic medication

Answer 21

– Orthostatic hypotension

Question 22

H1-receptor blocking actions of antipsychotic medication

Answer 22

– Sedative and anti-emetic actions

Question 23

Neuroleptic malignant syndrome

Answer 23

– Rare, but life threatening
– Fever, muscle rigidity, altered mental status,
autonomic dysfunction
– Often occurs upon initiation or change of dose

Question 24

when should you prescribe clozapine

Answer 24

• treatment refractory or resistant patients