Antipsychotics

Question 1

definition: psychosis

Answer 1

denotes a variety of mental disorder with multiple causes and manifestations

systemic and psychiatric diseases
toxic manifestations of chemical agents

Question 2

what are the positive symptoms of schizophrenia?

Answer 2

delusions 
hallucinations (auditory) 
agitation 
paranoia 
aberrant thinking 
intrusion of thoughts

Question 3

what are the negative symptoms of schizophrenia?

Answer 3

emotional apathy (flat affect)
socially withdrawn
inattentiveness

Question 4

what is the dopamine hypothesis of schizophrenia pathophysiology?

Answer 4

hyperactivity of the mesolimbic / mesocortical system - excessive limbic DA activity leading to psychosis

cannot explain cognitive impairment

Question 5

what is the key MOA of the main class of atypical antipsychotic drugs?

Answer 5

blockage of 5HT2a receptor

Question 6

what is the glutamate hypothesis of schizophrenia pathophysiology?

Answer 6

hypofunction of NMDA receptors located on GABAergic interneurons

Question 7

many antipsychotic drugs block what receptors?

Answer 7

D2

Question 8

neuroleptic drugs have side effects on what brain system?

Answer 8

extrapyramidal

Question 9

what are the main therapeutic indications for antipsychotic drugs?

Answer 9

schizophrenia
psychotic behavior
severe mania
antiemetic

Question 10

what are the typical antipsychotic agents?

Answer 10

chlorpromazine
thioridazine
fluphenazine
haloperidol

Question 11

what are the atypical antipsychotic agents?

Answer 11

clozapine 
olanzapine 
risperidone 
aripiprazole 
quetiapine 
ziprasidone

Question 12

chlorpromazine is what class of antipsychotic?

Answer 12

typical

Question 13

olanzapine is what class of antipsychotic?

Answer 13

atypical

Question 14

thioridazine is what class of antipsychotic?

Answer 14

typical

Question 15

quetiapine is what class of antipsychotic?

Answer 15

atypical

Question 16

ziprasidone is what class of antipsychotic?

Answer 16

atypical

Question 17

risperidone is what class of antipsychotic?

Answer 17

atypical

Question 18

fluphenazine is what class of antipsychotic?

Answer 18

typical

Question 19

haloperidol is what class of antipsychotic?

Answer 19

typical

Question 20

clozapine is what class of antipsychotic?

Answer 20

atypical

Question 21

aripiprazole is what class of antipsychotic?

Answer 21

atypical

Question 22

what are the pharmacokinetics of antipsychotics?

Answer 22

low bioavailability

depot forms

Question 23

what is the distribution of antipsychotics?

Answer 23

large volume of distribution

Question 24

how are the antipsychotics metabolized? what are the products?

Answer 24

CYP450 - liver

clinically significant metabolites

Question 25

what is the MOA of the typical antipsychotic drugs?

Answer 25

dopamine receptor antagonist (post synaptic D2)

Question 26

what is the MOA of the atypical antipsychotic drugs?

Answer 26

antagonist at 5HT2a and D2 receptors

Question 27

clozapine has strong binding to what receptor?

Answer 27

serotonin

Question 28

D2 affinity is correlated to what side effects?

Answer 28

extrapyramidal

Question 29

antipsychotic drugs act mostly on what brain system?

Answer 29

mesolimbic-mesocortical VTA - limbic system and neocortex

Question 30

what are the anti-dopaminergic effects of antipsychotic drugs?

Answer 30

``` cognitive motor - EPS - parkinsonian, dystonia, TDK nausea and vomiting endocrine - hyperprolactinemia weight gain - mostly with atypicals ```

Question 31

what are the pharmacologic effects of antipsychotic drugs?

Answer 31

anticholinergic antihistaminic antiadrenergic (primarily a1)

Question 32

neuroleptic malignant syndrome is a side effect of antipsychotic drugs acting on what system?

Answer 32

DA

Question 33

the newer atypical antipsychotics are better at relieving which side effects?

Answer 33

less EPS less hypotensive less sedation

Question 34

which antipsychotics are LEAST strongly associated with EPS effects?

Answer 34

clozapine and quetiapine

Question 35

which antipsychotic drug is MOST strongly associated with EPS effect?

Answer 35

risperidone

Question 36

which age group is higher risk for developing TDK following antipsychotic therapy?

Answer 36

older

Question 37

which antipsychotic drugs are heavily associated with weight gain? are they typicals or atypicals?

Answer 37

clozapine and olanzapine atypicals