Antipsychotics Flashcards

1
Q

Another name for antipsychotic drugs

A

Neuroleptics

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2
Q

Another name for typical antipsychotics

A

Conventional antipsychotics

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3
Q

What receptors do typical antipsychotics block?

A

Dopamine type 2 (D2) receptors

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4
Q

Blocking the D2 receptor decreases neurotransmission in what pathway? What is the result?

A

Mesolimbic pathway - reduces positive symptoms like hallucinations

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5
Q

Are antipsychotic meds specific in terms of receptors blocked?

A

No - all receptors are blocked in multiple pathways, so lots of side FX

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6
Q

What pathway is the therapeutic target of D2?

A

Mesolimbic

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7
Q

Blocking the mesolimbic pathway additionally blocks what functions of the pathway? What side FX does this result in?

A

Reward and pleasure - leads to apathy, anhedonia, amotivation, social withdrawal, known as secondary negativism b/c it’s in addition to negative symptoms

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8
Q

Dopamine blockade can worsen the deficit in what pathway, leading to worsening of cognitive and emotional symptoms? It may already be deficient in what disease?

A

Mesocortical pathway

Schizophrenia

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9
Q

Potent D2 blockade in the nigrostriatal tract results in what short-term extrapyramidal side effects (EPS):

A
  • Parkinsonian symptoms
  • Dystonic symptoms
  • Akathesia
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10
Q

Dopamine normally suppresses what neurotransmitter activity in nigrostriatal pathway

A

Acetylcholine

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11
Q

What medications are used to treat extrapyramidal side effects (EPS)

A

Anticholinergics - diphenhydramine or benztropine

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12
Q

Long-term D2 blockade in nigrostriatal pathway results in what movement disorder

A

Tardive dyskinesia (TD) - involuntary tongue and facial movements

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13
Q

Dopamine blockade in tuberoinfundibular tract leads to what side effects as a result of increased plasma prolactin

A

Galactorrhea, amenorrhea, infertility, bone loss

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14
Q

Name the blockade that causes the following side FX:

Dry mouth, blurred vision, constipation, cognitive blunting

A

Muscarinic anticholinergic blockade

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15
Q

Name the blockade that causes the following side FX:

Weight gain and drowsiness

A

Histamine blockade

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16
Q

Name the blockade that causes the following side FX:

Orthostatic hypotension

A

a-1 adrenergic blockade

17
Q

What syndrome is a rxn to antipsychotics and involves:

High fever, muscle rigidity, confusion, autonomic instability, high serum creatinine phosphokinase, high liver enzymes

A

Neuroleptic Malignant Syndrome (NMS)

18
Q

Haloperidol (Haldol)

Side FX?

A

High potency typical anti-psychotic, potent D2 antagonism

-EPS, TD, NMS

19
Q

Chlorpromazine (Thorazine)

Side FX?

A

Low potency typical anti-psychotic, less potent D2 antagonism

  • Anticholinergic side FX
20
Q

Mechanism differences that make an antipsychotic atypical

What side FX do these drugs decrease?

A

1) Shorter binding time at D2 receptors
2) 5HT2A antagonism

EPS and hyperprolactinemia, as well as tardive dyskinesia (b/c shorter D2 binding periods mean less striatum sensitization), decreases negative symptoms

21
Q

What receptor does serotonin bind on dopamine neurons? What action does this have?

A

5HT2A - inhibits dopamine release

22
Q

Clozapine (Clozaril)

A

Atypical antipsychotic

Reduces risk of suicide, decreases violence and aggression

Side FX: AGRANULOCYTOSIS (test question), sedation, seizures
causes few EPS, no TD, no prolactin elevation

23
Q

Olanzapine (Zyprexa)

A

Atypical antipsychotic

No EPS symptoms, very sedating,

24
Q

Risperidone (Risperdal)

A

Atypical antipsychotic at lower doses

At high doses, acts more like a typical antipsychotic, which leads to EPS and increases prolactin

Approved for pediatric use

25
Paliperidone (Invega)
Atypical antipsychotic Next generation of Risperidone, sustained release, more easily dosed, less EPS FX Increases QTc interval
26
Qeutiapine (Seroquel)
Atypical anti-psychotic Used preferentially in Parkinson's patients virtually NO EPS, no prolactin elev, may have enhanced NE activity
27
Ziprasidone (Geodon)
Atypical antipsychotic that SIGNIFICANTLY prolongs QTc interval Low symptoms of EPS, low prolactin elev, less propensity for weight gain
28
Aripiprazole (Abilify)
Atypical antipsychotic Role for augmentation in depression, not as sedating, can cause agitation or akathesia, lower CM risk
29
Drawbacks of atypical anti-psychotics?
- Increase risk factors for cardiac/metabolic disease - Weight gain, obesity - Diabetes - Premature death
30
Successful treatment of though disorders involves optimizing ______ function (what neurotransmitter?)
Dopamine
31
Weight gain as a result of atypical anti-psychotics is mediated through what mechanisms
Histamine blockade and through actions of serotonin systems (5HT2C)
32
Most risk to least risk for weight gain and CM risk amongst atypical anti-psychotics?
``` COQR/PZA Clozaril Olanzapine Quetiapine Risperidone/Paliperidone Zipasidone Aripiprazole ```