Antipsychotics

Question 1

5 domains of schizophrenia

Answer 1

Positive symptoms (abnormal behaviours added)
Negative symptoms (normal behaviour missing)
Anx/dep
Aggressive symptoms
Cognitive symptoms

As disease progresses, negative > positive more (seems less crazy, but they are feeling worse)

Question 2

What is Dopamine Theory?

Answer 2

Amphetamine produces symptoms similar to acute schizophrenia.
● Most important as basis for pharmacotherapy:
- All antipsychotic drugs are D2 antagonists

Question 3

Dopamine pathways of brain

Answer 3

a. Nigrostriatal (part of EPS)
b. Mesolimbic (reward & emotion)
c. Mesocortical (cognition & attention
d. Tuberoinfundibular (regulates prolactin secretion)

Want to suppress b & c

Question 4

Serotonin theory

Answer 4

Serotonin theory applied in newer atypical antipsychotics

Question 5

Typical Antipsychotics MOA

Answer 5

• Chlorpromazine
  Anticholinergic (M1)
  Antihistamine (H1)
  Alpha-1 adrenoceptor inhibitor
  D2 inhibitor
• Haloperidol
  Alpha-1 adrenoceptor inhibitor
  D2 inhibitor

Question 6

What are EPS?

Answer 6

EP pathway includes basal ganglia (stratum, substantia nigra)
Acute dystonia (TRAP)
Tardive dyskinesia, Akathisia

Occurs bc D2 antagonist

Question 7

Name typical antipsychotics

Answer 7

Haloperidol
Chlorpromazine
Fluphenazine
Trifluoperazine

Question 8

What makes an antipsychotic atypical?

Answer 8

Less EPS

(often have greater affinity at 5-HT2, D4 receptors, mixed antagonism at mant receptors)

Question 9

Name atypical antipsychotics

Answer 9

Amisulpride
Aripiprazole
Clozapine / Olanzapine
Risperidone

Question 10

Side effects of atypical antipsychotics

Answer 10

Agranulocytosis
- only clozapine

Anticholinergic
Antihistamine
Alpha-1 adrenoceptor antagonism
New onset / exacerbation of diabetes (for risperidone it does not reverse when stopped)
Weight gain

Amisulpride is D2/3 selective antagonist
- None of above side effects
- Increased prolactin secretion
- Lactation, breast swelling, pain, gyno