Antipsychotics Flashcards

1
Q

structural abnormalities associated with schizophrenia

A
enlarged cerebral ventricles
atrophy of cortical layers
reduced volume of basal ganglia
-reduced CBF
reduced glucose utilization in prefrontal cortex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

positive schizophrenia symptom

A

presence of inappropriate behaviors:

  • hallucinations
  • delusion
  • paranoid delusions
  • mood disturbances
  • confusion & suicidal thoughts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

negative schizophrenia symptoms

A
absence of appropriate behaviors:
-loss of normal function
-social w/d
reduced speech and thought
loss of energy
inability to experience pleasure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

dopamine hypothesis of schizophrenia

A
  • symptoms are in part due to increase in the activity of dopaminergic neurons
    evidence: typical antipyschotics block d2 receptors (mesolimbic and striatal-frontal)
  • drugs that increase dopa activity aggrevate schizo
  • dopa receptor density is increased in schizo brains
  • dopa levels and d2 receptor density increased in nucleus accumbens, caudate, putamen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

mesolimbic p’way

A

role: motivation, reward, emo behaviors
- auditory hallucinations, delusions, thought d/o with hyperactivity (schizo)
- INCREASED d2 receptor interaction shuts off downstream cascade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

mesocortical p’way

A

cognition, executive fxn, emo

-hypoactivity in this pway causes negative symptoms of schizophrenia (less D2 receptor interaction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

nigrostriatal p’way

A

motor planning, purposeful movement
-normal during schizophrenia
but hyperactivity from rx can lead to hyperkinetic movement d/o (dyskinesias, chorea) - often irreversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

tuberoinfundibular pathway

A

inhib prolactin release normally

-normal in schizophrenia, but hypoactivity from meds can cause galactorrhea, amenorrhea, sexual dysfxn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Typical antipsychotics (chlorpromazine, fluphenazine, haloperidol, thiothixene)

A
  • inhibit D2 receptors, regardless of p’way

- return mesolimbic p’way to normal, but exacerbate the mesocortical p’way

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

neuroleptic malignant syndrome

A
  • rare but lifethreatening, idiosyncratic reaction to neuroleptic meds
  • often begins 4-14 d after start of drug or dose increase
    sym: hyperthermia, rigidity, mental status changes, autonomic instability
  • 0.2-3.2% of patients
  • manifests in parkinson’s patients
    rx: supportive: -d/c use, circ/vent support, bromocriptine (DA agonist), dantrolene (muscle rigidity)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

serotonin hypothesis of schizophrenia

A

-either increased release of serotonin or serotonin receptors are more sensitive; either way, more signals than normal
serotonin regulates dopamine release via GABA interneuron
-shuts of dopaminergic neuron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

atypical antipsychotics (risperidone, quetiapine, olanzapine, paliperidone, ariprazole, clozapine)

A

block 5HT 2A (some 2C), inhibits serotonin receptors, only sends small amt GABA to dopa neuron (targeting mesocortical p’way -decreased)
-also antagonize D2 receptors, but with much less affinity than typical meds
5HT 2A receptors also regulate glutamate release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

glutamate p’way to schizophrenia

A

5HT 2A receptors also regulate glutamate release, dampen it, stabilizes cognitive p’ways
-non-NMDA receptor interaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

atypical antipsychotics SE (risperidone, quetiapine, olanzapine, paliperidone, ariprazole, clozapine)

A

lower likelihood (compared to typical) of: extrapyramidal symptoms (debatable), neuroleptic malignant syndome
increased risk of: metabolic syndrome (esp clozapine and olanzapine), obesity, DM II, granulocytosis and leukopenia (clozapine – delayed)
sedation
sexual dysfunction
postural hypertension
CV arrhythmia/SCD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Typical antipsychotics (chlorpromazine, fluphenazine, haloperidol, thiothixene) SE

A

sedation
sexual dysfunction
postural hypertension
CV arrhythmia/SCD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

chlorpromazine SE

A

muscarinic block (tachycardia, urinary retention, memory impairment, constipation, blurry vision, confusion); alpha block: (vasodilation, ortho hypotension, lightheaded, reflex tachy, sexual dysfunction), H2 block (sedation, weight gain, antiemetic)

17
Q

clozapine SE

A

muscarinic block (tachycardia, urinary retention, memory impairment, constipation, blurry vision, confusion); alpha block: (vasodilation, ortho hypotension, lightheaded, reflex tachy, sexual dysfunction),

18
Q

olanzapine SE

A

muscarinic block (tachycardia, urinary retention, memory impairment, constipation, blurry vision, confusion); alpha block: (vasodilation, ortho hypotension, lightheaded, reflex tachy, sexual dysfunction),

19
Q

quetiapine SE

A

muscarinic block (tachycardia, urinary retention, memory impairment, constipation, blurry vision, confusion); alpha block: (vasodilation, ortho hypotension, lightheaded, reflex tachy, sexual dysfunction),

20
Q

ariprazole SE

A

alpha block: (vasodilation, ortho hypotension, lightheaded, reflex tachy, sexual dysfunction)

21
Q

dopamine receptor SE

A

typical: all, mostly haloperidol
atypical: all

typical: increased prolactin
atypical: minimal increase in prolactin, mainly overdose

22
Q

serotonin receptor SE

A

all atypical APs

-sedation and weightgain

23
Q

H2 receptor SE

A

all atypicals

-sedation, weight gain, antiemetic

24
Q

typical antipsychotic interactions/adverse effects

A

inhibit drug elim (inhib CYPs- SSRI, macrolide antibiotics, antifungals), induction of CYP3a4 (barbs/anti-convuls), potentiate: analgesics, general anesth, CNS depressants
NEG IMPACT ON PARKiNSONS RX, blocks effect of L DOPA

adverse: hypotension, hypo/hyperthermia, seizures, coma, VTach

25
Q

Atypical antipsychotic interactions/adverse effects

A

-inhibits CYPs, decreases elim of SSRI, macrolides, antifungals
-induces CYP1A2/Cyp3A4 (except paliperidone)
CYP1A2 clozapine, olanzapine, smoking
+ barbs and anticonvulsants from CYP3A4
-potentiates analgesics, GA, CNS depressants
-less effect on Parkinson’s RX

effects at high doses: hypotension/hypo/hypertehermia, seizures, coma, VTach

26
Q

Symptomatic relief A vs T

A

typ: positive :yes; neg: little
Atyp: post: yes neg: YES

27
Q

Clinical potency T vs A

A

Typ: all high to medium
atyp: all very low to medium

28
Q

slow release formulas

A

fluphenazine deconate and haloperidol decanoate (noncompliance)
risperidone microspheres IM (noncompliance)

29
Q

metabolism A vs T

A

both metabolized to inactive by P450 liver enzympes: CYP2D6, CYP3A4; atyp: CYP1A2

30
Q

Tolerance: A vs T

A

both: some, but little physical dependence