Antipsychotics Flashcards
What is psychosis?
A variety of mental disorders with multiple causes and manifestations
Severe psychiatric disorders are characterized by what?
Delusion and hallucinations
Positive or negative symptom of schizophrenia: delusions/hallucinations
Positive
Positive or negative symptom of schizophrenia: agitation
Positive
Positive or negative symptom of schizophrenia: emotional apathy
Negative
Positive or negative symptom of schizophrenia: paranoia
Positive
Positive or negative symptom of schizophrenia: socially withdrawn
Negative
Positive or negative symptom of schizophrenia: Intrusion of thoughts
Positive
Positive or negative symptom of schizophrenia: inattentiveness
Negative
Positive or negative symptom of schizophrenia: aberrant thinking
Positive
Schizophrenia is what type of disorder?
Neurodevelopmental
What is the difference between the positive and negative symptoms of schizophrenia?
Positive is a manifestation of abnormal behavior
Negative is absence of normal behavior
What is the dopamine hypothesis of schizophrenia?
Hyperactivity of the mesolimbic mesocortical DA system causes psychosis
What is the MOA of many of the antipsychotic drugs?
Block D2 receptors
What are the postmortem findings of a schizophrenia brain?
DA levels and D2 receptors density are increased
Why is the dopamine theory of schizophrenia no perfect?
Cannot explain the cognitive impairment
What is the route of innervation from the hippocampus to the cortical regions?
Hippo to VT to cortical regions
What is the serotonin hypothesis of schizophrenia? What leads credence to this theory?
Overactivation of 5HT2A receptors
Blocking these work
What is the glutamate hypothesis of schizophrenia? What leads credence to this theory?
Hypofunction of NMDA receptors can lead to hyperstimulation of cortical neurons
NMDA inhibitors can exacerbate symptoms
What are neuroleptics?
Subtype of antipsychotics that produce extrapyramidal side effects
What are the extra pyramidal symptoms?
Parkinsonian-like symptoms
What are the typical vs atypical antipsychotics?
Typical = older Atypical = newer
What is the major change with atypical antipsychotics compared to typical?
Less extrapyramidal effects
What are the four main therapeutic indications for antipsychotics?
Schizophrenia
Psychotic behaviors
Severe mania
Antiemetic
What are the four typical antipsychotics?
Chlorpromazine
Thioridazine
Fluphenazine
Haloperidol
What are the 6 atypical antipsychotics?
Clozapine Olanzapine Risperidone Aripiprazole Quetiapine Ziprasidone
What are the two aliphatic drugs?
Chlorpromazine
Promethazine
What are the two piperidine drugs?
Thioridazine
Mesoridazine
What are the two piperazine drugs?
Prochlorperazine
Fluphenazine
What are the two thioxanthenes?
thiothixene
What is the relative bioavailability of antipsychotics? Vd?
Low bioavailability
Large Vd
Atypical antipsychotics are metabolized how?
CYP450 system in the liver
What is the MOA of most typical antipsychotics?
Dopamine (D2) receptor antagonists
What are the MOAs of atypical agents?
5HT-2A receptor and D2 receptor antagonists
What is the relationship between D2 receptor affinity and potency of antipsychotics
Direct, and very strong fit
What are the common side effects of antipsychotics and BP? Why?
Cause orthostatic hypotension by blocking alpha2
Why is it important to block both dopamine and 5HT like the atypical antipsychotics do?
Stop the EPS
What is the role of the limbic and neocortex system in schizophrenia?
Behavior and psychosis
What is the role of the nigrostriatal system in schizophrenia?
Coordination of voluntary movement–blockage leads to EPS
What is the role of the tuberoinfundibular zone?
Inhibition of prolactin secretion from the anterior pituitary
What is the role of the medullary periventricular area in schizophrenia?
Chemoreceptor zone that is involved in eating behavior
What is tardive dyskinesia?
Involuntary movements of the tongue, mouth, face, and head
What is episthotinus?
Spasm of the back
What is akathisia?
Motor restlessness and anxiety
What are the endocrine side effects of antipsychotics?
Hyperprolactinemia
Gynecomastia
Why is weight gain associated with antipsychotics? What two antipsychotics are these symptoms associated with?
DA or H1 mechanism
Clozapine
Olanzapine
What are the antihistamine effects with antipsychotics?
Sedation
Weight gain
What are the anti-adrenergic effects with antipsychotics?
Postural hypotension
Reflex tachy
ED
What are the DA mediated adverse effects of antipsychotics?
EPS
Hyperprolactinemia
Neuroleptic malignant syndrome
What atypical agent is most strongly associated with EPS? least?
Risperidone = most
Clozapine and quetiapine
What are the EPS risk factors with antipsychotics?
Rapid dose escalation
Who usually gets that tardive dyskinesia with antipsychotics?
Older pts
What antipsychotic drugs are strongly associated with weight gain?
Clozapine Olanzapine Risperidone Quetiapine Aripiprazole Ziprasidone
What are the reasons for pts to stop taking antipsychotics? (besides obvious)
Lack of disease insight
EPS
Sexual side effects
Typical or atypical antipsychotic: chlorpormazine
typical
Typical or atypical antipsychotic: clozapine
Atypical
Typical or atypical antipsychotic: olanzapine
Atypical
Typical or atypical antipsychotic: thioridazine
Typical
Typical or atypical antipsychotic: fluphenazine
typical
Typical or atypical antipsychotic: haloperidol
Typical
Typical or atypical antipsychotic: risperidone
Atypical
Typical or atypical antipsychotic: aripiprazole?
Atypical
Typical or atypical antipsychotic: Quetiapine
Atypical
Typical or atypical antipsychotic: Ziprasidone
Atypical
What are the three high potency typical antipsychotics?
Trifluoperazine
Fluphenazine
Haloperidol
What are the two low potency typical antipsychotics?
Chlorpromazine
Thioridazine
What is the major side effect with clozapine?
Agranulocytosis