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Antipsychotics Flashcards

1
Q

The hyperactive, positive symptoms of psychosis are due to what?

A

Increased Dopamine in the Mesolimbic Region

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2
Q

The hypoactive, negative symptoms of psychosis are due to what?

A

Decreased Dopamine in the Mesocortical Region

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3
Q

Negative and Cognitive Symptoms are due to which brain area?

A

DFPFC

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4
Q

Negative and Affective Symptoms are due to which brain area?

A

VMPFC

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5
Q

Which area of the brain is responsible for the prolactin related side effect of antipsychotics?

A

Tuberoinfundibular Region

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6
Q

What are the drug abuse/withdrawal causes of Psychosis?

A
  1. Hallucinogens
  2. Amphetamines
  3. Cocaine
  4. Alcohol Withdrawal
  5. Sedative Withdrawal
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7
Q

What are the toxic causes of Psychosis?

A
  1. Heavy Metals
  2. Digitalis
  3. L-Dopa
  4. Pollutants
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8
Q

What are the metabolic causes of Psychosis?

A
  1. Hypoglycemia
  2. Porphyria
  3. Cushing’s syndrome
  4. Abnormal Calcium or Thyroid Levels
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9
Q

What are the nutritional causes of Psychosis?

A
  1. Thiamine Deficiency
  2. Niacin Deficiency
  3. Vitamin B12 Deficiency
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10
Q

What are some neurological causes of Psychosis?

A
  1. Stroke
  2. Tumor
  3. Alzheimer’s
  4. Pick’s Disease
  5. Hypoxic Encephalopathy
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11
Q

What are the two Types of Psychosis?

A
  1. Affective Disorders or Manic Depressive Disorders

2. Schizophrenia

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12
Q

How are Affective Disorders or Manic/Depressive Disorders treated?

A

With antidepressants or mood stabilizers

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13
Q

Which drug class is better to treat Positive Symptoms of Schizophrenia?

A

Typical Antipsychotics (Neuroleptics)

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14
Q

Which drug class is better to treat Negative Symptoms of Schizophrenia?

A

Atypical Antipsychotics (Second Generation)

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15
Q

List 6 common Positive Symptoms

A
  1. Agitation
  2. Delusions
  3. Disorganized Speech
  4. Disorganized Thinking
  5. Hallucinations
  6. Insomnia
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16
Q

List 6 common Negative Symptoms

A
  1. Apathy
  2. Flat affect
  3. Lack of motivation
  4. Lack of pleasure
  5. Poverty of Speech
  6. Social Isolation
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17
Q

What are the three classes of Atypical Antipsychotics?

A
  1. Azepines
  2. Benzisoxazole
  3. Benzisothiazolylpiperzine
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18
Q

Name the 6 Atypical Antipsychotic Drugs

A
  1. Clozapine
  2. Olanzapine
  3. Quetiapine
  4. Risperidone
  5. Arpiprazole
  6. Ziprasidone
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19
Q

What are the 5 classes of Typical Antipsychotics

A
  1. Phenothiazines
  2. Thioxanthenes
  3. Butyrophenones
  4. Azepines
  5. Dihydroindolone
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20
Q

What are the 12 Typical Antipsychotic Drugs?

A
  1. ChlorpromaZINE
  2. FluphenaZINE
  3. ThioridaZINE
  4. TrifluoperaZINE
  5. MesoridaZINE
  6. PerphenaZINE
  7. ThioTHIXENE
  8. ChlorproTHIXENE
  9. HALOPERIDOL
  10. SPIPERONE
  11. LOXAPINE
  12. MOLINDONE
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21
Q

What is the MOA of Atypical Antipsychotics?

A

Competitive Blockade of Serotonin Receptors (and less so Dopamine)

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22
Q

What is the MOA of Typical Antipsychotics?

A

Competitive blockade of Dopamine Receptors (and less so Serotonin)

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23
Q

Which two features result in Atypicals having fewer Parkinson like side effects?

A
  1. Higher affinity for Serotonin Receptors

2. Specific to Mesolimbic over Nigro-Striatal

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24
Q

Adverse Effects of Antipsychotics are due to blockade of which receptors?

A
  1. Alpha 1 Adrenergic
  2. Histamine
  3. Muscarinic
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25
Q

Which diseases may be treated by Antipsychotic drugs?

A
  1. Psychosis
  2. Tourette’s
  3. Huntington’s
  4. Hiccough
  5. Nausea
  6. Motion Sickness
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26
Q

What is excreted from the kidneys after use of antipsychotics?

A

Glucuronide Conjugates

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27
Q

How long before positive symptoms go away?

A

1-3 weeks

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28
Q

Which symptoms go away within days of antipsychotic treatment?

A
  1. Agitation/Hostility
  2. Aggression
  3. Anxiety
  4. Abnormal Sleep/Eat patterns
29
Q

Within 1-2 weeks which symptoms should improve with antipsychotic treatment?

A
  1. Improved Socialization
  2. Improved Self Care habits
  3. Improved Mood
  4. Decrease abnormal movements
30
Q

Which symptoms take 3-6 weeks to improve after treatment with antipsychotics?

A
  1. Thought Disorder
  2. Delusions/Hallucinations
  3. Conversation
31
Q

In Dopaminergic neurons, what is the presynaptic change with antipsychotics?

A

initial- Activates Neurons (increased DA, cAMP and decreased K currents)
long term- inactivated

32
Q

In Dopaminergic Neurons, what is the postsynaptic change with antipsychotics?

A

Initial- receptor blockade

Long Term- Receptor Supersensitivty

33
Q

Which diseases are treated by Haloperidol?

A
  1. Tourette’s

2. Huntington’s Disease

34
Q

Which drug decreases the threshold for seizures and is therefore contraindicated?

A

Chlorpromazine

35
Q

Which drug is used for intractable hiccough?

A

Chlorpromazine

36
Q

Which drug causes deposits around the lens and cornea?

A

Chlorpromazine

37
Q

Which drug causes deposits around the Retina?

A

Thioridazine

38
Q

Which antipsychotics cannot be used as anti-emetics?

A

Aripiprazole and thioridazine

39
Q

How do antipsychotics cause anti-emetic effect?

A

Blocking D2 receptors in the Chemical Trigger Zone

40
Q

A low dose of antipsychotics may be used for what purpose?

A

Anti-emetic

41
Q

Which drug can be used to treat drug-induced nausea (like chemo)?

A

Prochlorperazine

42
Q

What is Droperidol used for?

A

Neuroleptanesthesia

43
Q

What are the main side effects due to blockage of D2 Receptors

A
  1. Extrapyramidal Effects
  2. Tardive Dyskinesia
  3. Neuroleptic Malignant Syndrome
  4. Prolactin Effects
44
Q

What are extrapyramidal side effects caused by D2 blockage?

A
  1. Akathisia (restlessness)
  2. Pseudoparkinsonism
  3. Dystonias, grimacing and torticollis
45
Q

Which drugs cause worse extrapyramidal side effects?

A
  1. Haloperidol
  2. Fluphenazine
  3. Thiothizene
46
Q

Which drugs cause fewer extrapyramidal side effects?

A
  1. Ones with strong Anticholinergic Effects (Thioridazine and Chlorpromazine)
  2. Atypicals
47
Q

What is the treatment for extrapyramidal effects?

A
  1. Stop Drug

2. Anticholinergic (Trihexyphemidyl, Benztropine, Procyclidine and Biperidin)

48
Q

What is Tardive Dyskinesia?

A

Abnormal facial/oral muscles that occur years after treatment (due to super sensitivity to DA caused by long term receptor blockade)

49
Q

Which drugs are more/less likely to cause Tardive Dyskinesia?

A
  1. All (especially Typicals)

2. Lower in Clozapine

50
Q

Can Tardive Dyskinesia be treated?

A

Not in the advanced state. May become worse upon withdrawal because D2 receptors have been up-regulated

51
Q

What is Neuroleptic Malignant Syndrome?

A

Potentially fatal condition of muscle rigidity, fever, altered consciousness, autonomic dysfunction (tachy, diaphoresis, tachpnea, incontinence)

52
Q

Which drugs are more likely to cause Neuroleptic Malignant Syndrome?

53
Q

What is the treatment for Neuroleptic Malignant Syndrome?

A
  1. STOP Antipsychotic Immediately
  2. Give Bromocriptine (D2 Agonist) and Dantrolene
  3. Cool patient
54
Q

Which drugs are more likely to cause prolactin side effects?

A

The Phenothiazines (Chlorpromazine, Fluphenazine, Thioridazine, Trifluoperazine, Mesoridazine, and Perphenazine)

55
Q

What are the side effects due to blockage of Cholinergic (M) receptors?

A
  1. Dry Mouth
  2. Blurred Vision
  3. Urinary Retention
  4. Constipation
  5. Confusion
56
Q

Which drugs cause worse Antimuscarinic effects?

A
  1. Thioridazine
  2. Chlorpromazine
  3. Olanzapine
    * 4. Clozapine (but it increases salivation)
57
Q

What are the side effects due to blockage of A1 and A2 Adrenergic Receptors?

A
  1. Orthostatic Hypotension –> Syncope

2. inhibition of ejaculation

58
Q

Which drugs result in more severe anti-adrenergic side effects?

A
  1. Chlorpromazine

2. Mesoridazine

59
Q

Sedation is due to blockage of which receptors?

60
Q

Which drugs result in worse sedation (due to Histamine blockade)?

A
  1. Chlorpromazine
  2. Olanzapine
  3. Quetiapine
  4. Clozapine
61
Q

What is a contraindication for anti-psychotics?

62
Q

Which drug –> leukopenia and agranulocytosis?

63
Q

Long term antipsychotics –> Perioral Tremor (Rabbit Syndrome); which is the treatment?

A
  1. Antiparkinson’s drugs

2. Anticholinergics

64
Q

Which drug –> Abnormal T Waves and possible Ventricular Arrhythmias?

A

Thioridazine

65
Q

Which drug –> QT Prolongation?

A

Ziprasidone

66
Q

Atypical Antipsychotics (and to a lesser extent Typicals) may result in what after long term use?

A

Metabolic Syndrome (Type II DM, HTN, Hyperlipidemia)

67
Q

Which drugs result in drastic increases in weight, lipids and glucose?

A
  1. Clozapine
  2. Olanzapine
  3. Chlorpromazine
68
Q

Which drug decreases weight, lipids and glucose?

Neuro/Psych Exam (12 decks)

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