Antipsychotics

Question 1

Schizophrenia

Answer 1

thought disorder characterized by divorcement from reality

Question 2

Positive symptoms of Schizophrenia

Answer 2

Psychotic detentions- hallucination, delusion, paranoid, grandeur
Disorganized dimension- speech and behavior

Question 3

Negative Sx of schizophrenia

Answer 3

5 A's
Avolition
Ahendonia
Asocial
Alogia
Affect blunted

Question 4

Progression of Schizophrenia

Answer 4

fluctuates between acute episodes and remission.

After initial episode pts will never regain their baseline function

Question 5

Goal of treating schizophrenia

Answer 5

Prevent exacerbations

Pts will be on meds for life- this and the side effects make compliance very difficult

Question 6

What pathways are involved in Schizophrenia

Answer 6

Da pathways
Nigrostriatal
Mesocorticol
Mesolimbic
Tuberoinfundibular

Question 7

Nigrostriatal effects of shizophrenia

Answer 7

Da blockade

movement disorders- this is where extrapyramidal effects occur

Question 8

Mesolimbic effects of schizophrenia

Answer 8

Da hyperactivity results in the positive symptoms

Question 9

Mesocortical effects of shizophrenia

Answer 9

Da hypoactivity

causes negative symptoms

Question 10

Tuberoinfundibular effects of schizophrenia

Answer 10

Da blockage decreases blockage of prolactin so more prolactin is released resutling in
ammenorhea and galactorrhea

Question 11

What pathway is targeted by typical antipsychotics

Answer 11

D2 receptors, antagonists

Work on positive symptoms

Question 12

How are typical antipscychotics broken down

Answer 12

High potency vs low potency based on affinity for D2 receptors

Question 13

What is the effect of this difference in affinity for D2 receptors

Answer 13

Extrapyramidal systems or not
high affinity= more EPS
low affinity= less EPS, but more AE at other receptor types

Question 14

what are the other receptor types targeted by typical antipsychotics

Answer 14

M, H1, alpha adrenergic

Question 15

High potency APs

Answer 15

potent at D2 receptors but less potent at other receptors, thus inc risk of EPS
ex: Haloperidol

Question 16

Low potency APs

Answer 16

higher potency at other receptors- antimuscarinic activity, anti histamine activity, anti alpha adrenergic activity.
Dec incidence of EPS
ex: Chlorpromazine

Question 17

What are the 5 main Da related AE of typical APs

Answer 17

Dystonia
Pseudoparkinsonism
Akathesia
Tardive dyskinesia
Neuroleptic Malignant syndrome

Question 18

Describe D2 blockage and Dystonia

Answer 18

protlonged painful muscle spasm- torticolus, Oculogyric Crisis
Tx with IV anticholinergics to restore Da/ Ach balance (Ach is anti kinetic, Da is prokinetic)

Question 19

Describe D2 blockage and pseudoparkinsonism

Answer 19

Resembles idiopathic PD, but has bilateral and faster onset

no real tx, but may develop tolerance to this

Question 20

Akasthesia

Answer 20

restless and inability to sit still or stay calm

tx betablockers or benzos

Question 21

Tardive dyskinesia

Answer 21

involuntary muscle movements normally oral or with the jaw
this is caused by an up-regulation of D2 receptors in the nigrostriatal pathway
this may be untreatable and irreversible
tx: lowe dosage switch to an atypical

Question 22

Neuroleptic malignant syndrom

Answer 22

muscle tension causes excess heat and disruption of the normal thermoregulatory proceses
Signs: lead pipe rigidity, fever over 38 C, myoglobinuria, altered consciousness
potentially fatal
tx: discontinue current meds, supportive, antiparkinsonian meds (Da agonist Bromocriptime)
only atypical antipsychotics should be used after this (not even risperidone)

Question 23

Antimuscarinic AE of Aps

Answer 23

constipation
dry mouth
urinary retention
but also reduces EPC by acting on the Ach/Da imbalance by reducing Ach so there is more Da

Question 24

Anti alpha 1 AE of AP

Answer 24

orthostatic Hypotension

Question 25

Anti Histaminic AE of AP

Answer 25

weight gain

drowsiness

Question 26

endocrine AE of APs

Answer 26

Hyperprolactinemia- by blocking Da- inc Prolactin
Women: galactorrhea and amehorhrea
Men: Gynecomastia and galactorrhea
both have sexual dysfunction
tx by switching to atypicap APs

Question 27

Atypical APs

Answer 27

work on positive Sx by blocking Da
improves negative Sx by blocking 5HT2A in the mesocortical pathway which inc dopamine release.
Move Da blockage to between 60 and 80% rather than 100% with the typicals (causes EPS, TD, and endrocine AE)

Question 28

What do atypical APs do in the mesocortical pathway

Answer 28

inc DA in frontal areas thus reversing hyporontality, alleviating negative Sx

Question 29

What do atypical APs due for endocrine AEs

Answer 29

decrease prolactin release thus block the prolactin related AE

Question 30

Atypical APs- names

Answer 30

Clozapine
Risperidone
Olanzapine
Quetiapine
Ziprasidone
Apriprazole

Question 31

Risperidone

Answer 31

only atypical that causes EPS Sx b/c has most DA blockage (exceeds the 80%)

Question 32

Clozapine

Answer 32

prototype- most effective for pos Sx, neg Sx, and suicide prevention
causes fatal AE: agranulocytosis, seizure, and weight gain
measure WBC and do not use if WBC <3000

Question 33

when is clozapine used

Answer 33

Clozapine is only used if pts have failed 2 atypical APs

Question 34

Atypical AEs

Answer 34

weight gain
hyperglycemia
lipid abnormalities

Question 35

Order of metabolic AE

Answer 35

Clozapine= olanzapine>risperidone> quetiapine>Ziprasidone and aripiprazole
mirrors efficacy

Question 36

What should be monitored at baseline and as pts take atypical APs

Answer 36

obesity and CV risks

Question 37

quetiapine

Answer 37

lowest D2 binding

DOC for psychosis with PD