Antipsychotics Flashcards
Define schizophrenia.
A mental disorder caused by an inherent dysfunction of the brain that manifests in:
- Delusions.
- Hallucinations (mostly auditory).
- Disturbed thinking and speech patterns.
What percentage of the population has schizophrenia?
1%
Which age group is most likely to develop schizophrenia?
Schizophrenia usually affects people during late adolesence or early adulthood.
What is the prevalence of schizophrenia by gender?
Equal prevalence in men and women.
Do genetics play a part in developing schizophrenia?
Yes.
Which area of the brain is associated with schizophrenia?
Schizophrenia is thought to occur as a result of a dysfunction of the mesolimbic and mesocortical dopaminergic neuronal pathways.
What are the positive symptoms of schizophrenia?
- Hallucinations.
- Bizarre delusions.
- Disorganized thought.
- Perception disturbances.
- Inappropriate emotions.
What are the negative symptoms of schizophrenia?
- Blunted emotions.
- Anhedonia.
- Lack of feeling.
- Social withdrawal.
- Lacking insight.
- Suicidal ideations.
- Social withdrawal.
- Paucity of speech.
- Diminished affect.
- Loss of drive.
- Impaired personal hygiene.
What are the cognitive manifestations of schizophrenia?
Disturbance in forming new memories and learning.
Which aspect of schizophrenia does the dopamine hypothesis cover?
The positive symptoms of schizophrenia.
What is the dopamine hypothesis?
Hyperactivity of dopamine D2 receptor neurotransmission in the mesocortical neuronal pathway contributes to the positive symptoms of schizophrenia, whereas negative and cognitive symptoms of the disorder can be attributed to the hypofunctionality of dopamine D1 receptor neurotransmission in the prefrontal cortex.
How was the dopamine hypothesis created?
Repeated administration of stimulants like amphetamines and cocaine (which enhance central dopaminergic neurotransmission) can cause a psychosis that resembles the positive symptoms of schizophrenia.
Low doses of amphetamine can induce a psychotic reaction in schizophrenics in remission.
Stress, a major predisposing factor in schizophrenia, can produce a psychotic state in recovered amphetamine addicts.
Is stress a major predisposing factor in schizophrenia?
Yes.
Which neurotransmitter is thought to cause the negative symptoms of schizophrenia?
Serotonin hyperactivity.
What other names are given to antipsychotics?
Neuroleptics.
Major tranquilizers.
Do antipsychotics cure?
They do not cure the disease and don’t eliminate the chronic thinking patterns, they just eliminate the schizophrenic symptoms by decreasing dopaminergic and/or serotonergic neurotransmission, thereby decreasing the intensity of hallucinations and delusions.
What is the general structure of antipsychotics?
Antipsychotics are present as several diverse heterocyclic structures with marked different potencies.
How are antipsychotic drugs divided?
- First-generation agents.
- Second generation agents.
How are first-generation antipsychotics further divided?
- Low potency first-generation antipsychotics.
- High potency first-generation antipsychotics.
Does the classification of antipsychotics relate to their clinical efficacy?
No! Rather, it specifies the affinity for the dopamine D2 receptor, which in turn, may influence the adverse effect profile of antipsychotics.
List first-generation antipsychotics (low potency).
- Chlorpromazine.
- Prochlorperazine.
- Thioridazine.
List first-generation antipsychotics (high potency).
- Fluphenazine.
- Haloperidol.
- Pimozide.
- Thiothixene.
List second-generation antipsychotics.
- Aripiprazole.
- Clozapine.
- Olanzapine.
- Quetiapine.
- Risperidone.
What is the mechanism of action of first-generation antipsychotics?
Blocking D2 dopamine receptors competitively.
What side effect/disorder is most associated with first-generation antipsychotics?
Movement disorders.
Which drug is more likely to cause movement disorders, haloperidol or chlorpromazine?
Haloperidol, as it binds tightly to dopaminergic receptors.
Are any first-generation antipsychotics clinically more effective than others?
No.
What is another term for second-generation antipsychotics?
Atypical antipsychotics.
Second-generation antipsychotics have fewer of what kind of symptoms?
Extrapyramidal symptoms (EPS).
What type of side effects are higher with second-generation antipsychotics?
Metabolic side effects.
Name three metabolic side effects associated with second-generation antipsychotics.
- Diabetes.
- Hypocholesteremia.
- Weight gain.
Why are second-generation agents commonly selected over first-generation antipsychotics?
To minimize movement disorders associated with first-generation antipsychotics.
What guides drug selection for antipsychotic patients besides minimizing side effects?
- Patient response.
- Comorbid conditions.
Should second-generation drugs be considered interchangeable?
No.
Why should second-generation drugs not be considered interchangeable?
Different patient responses.
How many types of dopamine receptors are there?
Five.
Which dopamine receptors excite neurons?
D1, D5.
Which dopamine receptors inhibit neurons?
D2, D3, D4.
Which type of receptor do neuroleptic drugs bind to in the brain?
Dopamine receptors.
What do all 1st generation and most 2nd generation antipsychotics block?
Dopamine receptors.
Blocking which dopamine receptors in the mesolimbic system leads to clinical efficacy with antipsychotic drugs usage?
D2 receptors.
Which drug is 100 times more potent towards the D2 receptor than chlorpromazine?
Haloperidol.
Which atypical antipsychotic has a higher affinity for D4 and lower for D2?
Clozapine.
What drugs antagonize the actions of antipsychotic drugs?
- Levodopa.
- Bromocriptine.
- Amphetamines.
What type of receptor-blocking activity other than dopamine receptors is involved in the mechanism of action for most 2nd generation antipsychotics?
Serotonin receptors.
Which specific serotonin receptors are particularly inhibited by most 2nd generation antipsychotics?
5-HT2A receptors.
Which receptors does Clozapine have a high affinity for?
D1, D4, 5-HT2, muscarinic, α-adrenergic.
Is Clozapine a strong or weak dopamine D2-receptor antagonist?
Weak.
Which receptors does Risperidone primarily block?
5-HT2A > D2.
Aripiprazole is a partial agonist at which receptors?
D2, 5-HT1A.
Aripiprazole is a blocker of which receptor?
5-HT2A.
Which receptors does Quetiapine block?
D2, 5-HT2A.
What is the mechanism of action for antipsychotic drugs?
Blockade at dopamine and/or serotonin receptors.
What symptoms do antipsychotic drugs reduce?
Hallucinations, delusions.
To a lesser extent, what negative symptoms do antipsychotic drugs reduce?
Blunted affect, anhedonia, apathy, impaired attention, cognitive impairment.
How long do antipsychotic effects usually take to occur?
Several days to weeks.
What are the therapeutic effects of antipsychotic drugs related to?
Secondary changes in the corticostriatal pathway.
Which second-generation agent ameliorates negative symptoms of schizophrenia to some extent?
Clozapine.
What effect do all antipsychotic drugs have on physical movement and anxiety?
- Calming effect.
- Reduce spontaneous movement.
How do antipsychotics compare to CNS depressants like barbiturates in terms of intellectual functioning?
Do not depress as much.
What is minimal with antipsychotic use compared to CNS depressants?
Motor coordination difficulties.
What are extrapyramidal effects caused by antipsychotics?
Dystonias, Parkinson-like symptoms, akathisia, tardive dyskinesia.
What is tardive dyskinesia?
Involuntary movements of the tongue, lips, neck, trunk, and limbs.
What probably causes unwanted movement symptoms in antipsychotic use?
Blocking dopamine receptors in the nigrostriatal pathway.
Which generation of antipsychotics exhibits a lower incidence of these symptoms?
Second-generation.
Which antipsychotic drugs do NOT have antiemetic effects?
Aripiprazole, thioridazine.
How do antipsychotics exert antiemetic effects?
Blocking D2 receptors in the chemoreceptor trigger zone.
What are common anticholinergic effects of antipsychotics?
Blurred vision, dry mouth, confusion.