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Block 3: Pathophysiology and pharmacology > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

What are the key characteristics of a psychotic episode?

A
  1. Delusion
  2. Hallucinations
  3. Lack of self awareness
  4. Disrupted thought patterns
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2
Q

What is schizophrenia?

A

Distortions of thinking and perception
Distortions of affect (inappropriate to situation)
Disturbance lasting 6+ months
At least one month of 2+ classical symptoms (delusions, hallucinations, disorganised behaviour, negative symptoms)

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3
Q

What are the 4 A’s (negative symptoms) of schizophrenia?

A

Anhedonia (lack of joy)
Affective blunting (reduction in mood)
Alogia (lack of speech)
Avolition (lack of motivation)

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4
Q

What characterises disorganisation syndromes?

A

Alterations in speech, thought patterning and behaviour (thought pattern changes commonly involve thought insertion or withdrawal, thought echo and thought broadcasting)

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5
Q

What are the classes of antipsychotic drugs?

A 
First generation (classical/ typical)
Second generation (atypical) 
Third generation (new)
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6
Q

What is the main target of first generation antipsychotics?

A

Dopamine (D2) receptors

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7
Q

What is the main target of second generation antipsychotics?

A

Serotonin (5HT) receptors

[and Dopamine receptors]

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8
Q

Which class of antipsychotics has a higher risk of neurological side effects?

A

First generation antipsychotics

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9
Q

Which class of antipsychotics has a higher risk of metabolic side effects?

A

Second generation antipsychotics

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10
Q

Which class of antipsychotics has a higher risk of extrapyramidal side effects?

A

First generation antipsychotics

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11
Q

What are the 4 main dopamine pathways within the CNS?

A

Mesocortical
Mesolimbic
Nigrostriatal
Tuberohypophyseal

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12
Q

What behaviours are associated with the prefrontal cortex?

A 
Judgement 
Personality
Reasoning 
Positive emotions 
Planning
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13
Q

What behaviours are associated with the limbic system?

A 
Negative emotions 
Sensory perception 
Spatial awareness
Memory 
Social recognition
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14
Q

Which antipsychotic drugs are first generation?

A

Haloperidol

Chlorpromazine

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15
Q

Which antipsychotic drugs are second generation?

A

Aripirazole
Clozapine
Amisulpride
Risperidone

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16
Q

What other receptors (aside from D2) can first generation antipsychotics act as antagonists on?

A

Histamine (H1)
Muscarinic (M1)
Alpha-1 Adrenergic

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17
Q

What side effects are associated with 5HT antagonists?

A

Constipation
Dizziness
Weight gain
Drowsiness

18
Q

What side effects are associated with D2 antagonists?

A

Rigidity
Tremor
Slow speech
Stiffness

19
Q

What is the ‘gold standard’ antipsychotic?

A

Clozapine

20
Q

What is the nigrostriatal pathway?

A

One of the major dopamine pathways in the brain

Efferent connection between the substantia nigra and corpus striatum

21
Q

What is the extrapyramidal system?

A

Part of the motor system causing involuntary movements.

Includes the rubrospinal, reticulospinal, tectospinal and vestibulospinal tracts as well as the basal ganglia.

22
Q

What symptoms characterise Tardive Dyskinesia?

A

Involuntary movement
Protruding tongue
Grimacing
Twisting of the face and limbs

23
Q

What symptoms characterise Neuroleptic Malignant Syndrome?

A

High fever
Autonomic dysfunction
Altered consciousness

24
Q

What are the 5 domains of symptoms exhibited by people with schizophrenia?

A
  1. Positive symptoms
  2. Negative symptoms
  3. Anxiety/ depression
  4. Cognition symptoms
  5. Aggressive symptoms
25
Q

What side effects can you get from 1st gen antipsychotics due to their antagonist effects on Muscarinic (M1) receptors?

A

Constipation
Blurred vision
Dry mouth

26
Q

What side effects can you get from 1st gen antipsychotics due to their antagonist effects on Histamine (H1) receptors?

A

Weight gain

Sedation

27
Q

What side effects can you get from 1st gen antipsychotics due to their antagonist effects on Dopaminergic (D2) receptors?

A

Prolactin elevation
Rigidity
Slow movements

28
Q

What side effects can you get from 1st gen antipsychotics due to their antagonist effects on alpha1 andrenergic receptors?

A

Hypotension

Drowsiness

29
Q

Changes in which dopamine pathway can result in elevation of prolactin levels?

A

Tuberohypophyseal

30
Q

How might an increase prolactin level present in patients?

A

Enlargement of breasts
Increased lactation
Irregular menstrual cycle (due to oestrogen deficiency)
Erectile dysfunction and infertility (due to testosterone deficiency)

31
Q

Which group of side effects are more apparent in 2nd gen antipsychotics?

A

Cholinergic effects

32
Q

Which symptoms are classed as extrapyramidal side effects?

A

Slowed movement
Tremor
Akathisia (restlessness/ inability to stay still)
Sedation

33
Q

Which hyperkinetic disorders can be treated with antipsychotics?

A 
Huntingdon's Disease
Dystonia 
Restless leg syndrome 
Choreoathetosis 
Sydenham Chorea
34
Q

Why do antipsychotics cause Tardive Dyskinesia?

A

Down-regulation of dopamine system and increased glutamatergic transmission resulting in oxidative neurodegeneration

35
Q

Which dopamine pathway is involved in controlling movement?

A

Nigrostriatal

36
Q

Which 2 basal ganglia nuclei form the striatum?

A

Putamen

Caudate nucleus

37
Q

What is the dopamine hypothesis of schizophrenia?

A

Caused by excessive DA release in the mesolimbic pathway (causes positive symptoms)
Hypoactivity of DA in mesocortical responsible for negative/ cognitive/ affective symptoms)

38
Q

What anatomical changes are seen in patients with schizophrenia?

A

Degeneration of grey matter (esp. medial temporal lobes)
Enlarged ventricles and sulci (esp. medial temporal lobes)
Reduced blood flow in basal ganglia and frontal lobes

39
Q

How can Tardive Dyskinesia be managed?

A

Decrease symptoms through supplement use (Vit E and Vit B6), Benzodiazepines and Beta-Blockers

[Nb. no definitive cure for TD, can spontaneously remit]

40
Q

What causes Neuroleptic Malignant Syndrome?

A

Genetic polymorphism of D2 receptor gene present in approx. 15% of schizophrenic patients
Onset of syndrome after starting antipsychotic treatment

Block 3: Pathophysiology and pharmacology (16 decks)

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