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Neurology > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

What is psychosis

A

Variety of mental disorders with delusions , auditory or visual hallucinations and disorganized thinking

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2
Q

What is schizophrenia

A

Particular kind of psychosis with clear sensorium and marked thinking disturbance

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3
Q

What are the positive symptoms of schizophrenia

A 
Delusions 
hallucinations 
thoughts disorder 
abnormal disorganized behavior 
catatonia
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4
Q

Negative symptoms of psychosis

A 
Social withdrawal 
flattening of emotional responses 
 anhedonia 
reluctance to perform every day tasks 
chronic and persistent and less responsive to some antipsychotic agent
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5
Q

Do we know the cause of psychosis

A

Still unclear but might be linked to genetics and environment

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6
Q

What is the serotonin hypothesis

A

Hallucination are produced by LSD and mescaline which are serotonin agonist

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7
Q

What is a key factor in mechanism of action of antipsychotic

A

Blockades of serotonin receptor 5-HT2a

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8
Q

What drugs are 5-HT2c inverse agonist

A

Clozapine
asenapine
Olanzapine

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9
Q

What happens wonder stimulation of 5HT2c

A

Inhibition of cortico and Limbic dopamin release

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10
Q

What is the dopamine hypothesis

A

Psychosis might be due to excessive Limbic dopaminergic activity

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11
Q

What happens if the drug increases dopaminergic activity

A

Aggravate schizophrenia psychosis or psychosis de novo produced

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12
Q

What type of reçeptors density is increaesed in the brain of post mortem schizophrenic

A

Dopamine receptor

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13
Q

What is the glutamate hypothesis

A

NMDA receptor do not function well so there’s reduced inhibitory influence on the neuronal function which contributes to schizophrenia

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14
Q

What are the classes of drugs part of the first generation antipsychotics

A

Phenothiazines
Thioxanthenes
Butyrophenone

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15
Q

example of phenothiazines

A 
Chlorpromazine
Thioridazine 
Trifluoperazine 
Perphenazine
Fluphenazine
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16
Q

Example of thioxanthenes

A

Thiothixene

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17
Q

Examples of butyrophenone

A

Haloperidol

droperidol

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18
Q

Class of drugs in second-generation antipsychotics

A

Atypical

miscellaneous

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19
Q

Examples of atypical antipsychotics

A 
Clozapine 
Asenapine
Olanzapine
Quetiapine
Sulpiride
Amisupride
Paliperidone
Risperidone
Sertindole
Ziprasidone
Zotepine
Aripiprazole
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20
Q

Example of miscellaneous antipsychotics

A

Pimozide

Molindone

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21
Q

Types of phenothiazines with sedation& weight gain effects

A

Aliphatic derivatives and piperidine derivatives

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22
Q

Most potent phenothiazines types

A

Piperazine derivatives

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23
Q

Most widely used butyrophenone

A

Haloperidol

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24
Q

ExAmple of diphenylbutylpiperidines

A

Pimozide
Clopimozide
Fluspirilene
Penfluridol

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25
Q

The more potent with less autonomic effect l , phenothiazines or butyrophenone

A

butyrophenone

26
Q

Prototype of atypical antipsychotic

A

Clozapine

27
Q

Active metabolite of risperidone

A

Paliperidone9 hydroxyrisperidone

28
Q

Main moa of atypical antipsychotic drugs

A

Alter 5HT2a receptor activity With synergy at Partial agonist of 5-HT1a

29
Q

Name of of atypical antipsychotic that are potent for D2 and D3 receptors and antogonize 5HT7

A

Amisulpride

Sulpiride

30
Q

Systemic availability of haloperidol

A

65%

31
Q

Systemic availability of chlorpromazine and thioridazine

A

25-35%

32
Q

Are antipsychotic drugs highly lipid soluble and protein bound

A

Yes

33
Q

Dube antipsychotic drugs have large volumes of distribution

A

Yes

34
Q

What is the average time for a relapse of stable patient with schizophrenia who discontinue the medication

A

Six months

35
Q

How is relapse after discontinuation of clozapine

A

It’s very rapid and severe so should never be discontinued abruptly unless needed

36
Q

 Metabolism of antipsychotic drugs

A

Oxidation or the methylation by liver cytochrome P450- cyp2d6, CYP1A2, cyp3a4

37
Q

Would you expect antipsychotic drugs to interfere with metabolism of other drugs at typical clinical dose

A

No

38
Q

What mechanism is that the basis of efficacy of phenothiazine antipsychotic drugs

A

D2 receptor blockade

39
Q

Why are they adverse effects with phenothiazines antipsychotics

A

Block Alfa Adrenergic receptors, muscarinic receptors , h1 receptors , serotonin receptors

40
Q

Most closely related pathway to behavior and psychosis

A

Mesolimbic Mesocortical pathway

41
Q

Pathway involved in coordination of voluntary movement

A

Nigrostriatal pathway

42
Q

This system neurons release dopamine which inhibits prolactin secretion from anterior pituitary

A

Tuberoinfundibular system

43
Q

System involved in eating behavior

A

Medullary periventricular pathway

44
Q

Pathway that regulates anticipatory motivational phase of copulatory behavior in rats

A

Incertohypothermic pathway

45
Q

What are the function D1 and D5receptors

A

Increases cyclic AMP by G protein stimulatory activation of adenylyl cyclase

46
Q

Action of D2, D3, D4 receptors

A

Decreases cyclic AMP and inhibits calcium channels

47
Q

Effect f antipsychotics on non psychotic individuals

A 
Severe EPS
aka this in
Sleepiness
Restlessness
Autonomic effects
48
Q

antipsychotics that raise prolactin level

A

Old typiciL antipsychotics
Risperidone
Paliperidone

49
Q

Cardiovascular effect of chlorpromazine and thioridazine

A 
Orthostatic hypotension
Tachycardia
Abnormal ECG (thioridazine)
50
Q

Antipsychotics with risk of arrhythmias

A

Sertindole
Ziprasidone
Quetiapine

51
Q

Antipsychotics psychiatric indications

A 
Schizophrenia
Psychotic bipolar disorder
Psychotic depression
Treatment resistant depression
Manic phase of bipolar disorder
52
Q

Best treatment for catatonic schizophrenia

A

Benzodiazepines

53
Q

Non psychiatric indications of antipsychotics

A

Antiemetics ( prochlorpromazine , benzquinamide because of dopamin receptor blockade )

Pruritus for h1 receptor blockade
Preoperative sedatives ( promethazine )

Neuroleptanesthesia (butyrophenone

54
Q

Atypical Antipsychotics with less weight gain

A

Ziprasidone

55
Q

Only atypical antipsychotics indicated to reduce risk of suicide

A

Clozapine

56
Q

When should you take clozapine

A

If failed to respond to substantial doses of conventional antipsychotic drugs

57
Q

Behavioral effects of antipsychotics

A

Pseudodepression

Toxic confusional States

58
Q

Neurological effect of antipsychotic

A

Extrapyramidal reactions
Tardive dyskinesia
Seizure

59
Q

Agent with the least likelihood of causing tardive dyskinesia

A

Clozapine

quetiapine

60
Q

Drugs with less potential for seizure

A 
Risperidone 
Molindone
 Thioridazine 
Haloperidol
Pimozide
Trifluoperazine 
Fluphenazine
61
Q

Metabolic effect of antipsychotics

A 
Weight gain 
hyperglycemia 
hyperlipidemia diabetic ketoacidosis 
triglycerides HDL ratio
Hyperprolactinemia

62
Q

Read the rest

A

Neurology (31 decks)

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