Antipsychotics

Question 1

• Brain dopamine pathways? (4)
• 2 sites of psychosis?
• 6 effects of D2 block? which are beneficial?
• 4 EPSE’s? Treat how?

Answer 1

• Mesolimbic (VTA –> NA); mesocotrical ( VTA –> PFC); NS (SN –> Striatum); Tub. Infund/ hypothal.
• D2 block of mesolimbic; 5HT2 block of mesocotrical
  1. ) ML = + symptoms 2.) MC = incr. - symp. 3.) NS = EPSE’s 4.) TI = Hyperprolactinemia 5.) Hypothal = wt. gain, poikilothermia 6.) chemo trigger zone = anti emetic
• 1 and 6
  1. ) Acute Dystonia = Treat with anti ach (dephenhydramine/ benztropien)
  2. ) Akathisia = Lower dose, anti-ach, BB
  3. ) Pseudoparkinsons = anti ach
  4. ) TD = Prevent

Question 2

• 4 effects of 5HT2A block?
• Adverse rxns: Clozapine? (2) Atypicals weight gain why? Poikilothermia why? Galactorrhea why? Photosensitivity? Neuroleptic malignant syndrome? Treat with?

Answer 2

• MC = less - symp; M block = Can’t, see…; a1 block = orthohypo; H1 block = sedation
• Agranulo/ lower seizure threshold; hypothal DA block; hypothal DA block; TI DA block; yes –> dantrolene

Question 3

• Delusion?
• Role of mesolimbic? Steps? (4)
• Mesocortical pathway? Negative symptoms due to?
• 5HT2A in striatum/ PFC? On pyramidal cells?
• Schizo prevalence? Age of onset?
• Psychosis due to?
• 2 Typicals? 4 Atypicals?

Answer 3

• Founded in some reality
• Integrate sensory input; VTA –> SA –> Decreased GABA on Thal –> Increase GLU on Cortex
• VTA –> DLPFC/VMPFC; Cell loss in PFC
• Lowers/ Raises = block helps with both
• 1%; 15-35
• Stimuli processed by Glutaminergic pyramidal cells that is acted on GABAneric interneurons; GABA dysfx
• Chlopromazine; Haloperidol (Many EPSE’s)
• Clozapine, respiridone, olanzipine, aripirazole