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PSYCHIATRY > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

What is the dopamine hypothesis?

A

-blocking of dopamine activity in the CNS can improve psychosis

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2
Q

Name 3 Typical Anti-psychotics.

A

(1st Generation)

  1. Haloperidol
  2. Chlorpromazine
  3. Trifluoperazine
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3
Q

What does activation of D2 receptors result in?

A
  • inhibition of adenylyl cyclase

>reduce cAMP

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4
Q

Where are the D2 receptors found ?

A
  • Limbic system
  • Prefrontal cortex
  • Basal ganglia
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5
Q

What is the MAIN MOA of Typical Anti-psychotics?

A
  • blockade of D2 receptors
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6
Q

What conditions can be treated with Typical Anti-psychotics? (7)

A
  1. Schizophrenia (+)ve symptoms
  2. Psychosis
  3. Mania
  4. OCD
  5. Delirium (Haloperidol)
  6. Tourette’s Syndrome
  7. Huntington’s disease
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7
Q

Which pathway do the typical anti-psychotics act on for it to cause motor dysfxn?

A
  • Nigrostriatal Pathway
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8
Q

What other NTs are affected by the intake of Typical Anti-psychotics?

A
  1. Serotonin
  2. Histamine
  3. Epinephrine
  4. Ach
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9
Q

Which typical anti-psychotic is known to block histamine and alpha-1 receptors MORE than D2 r.?

A

Chlorpromazine

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10
Q

Which typical anti-psychotic blocks the D2 receptors the most?

A

Haloperidol

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11
Q

What are S.Es Typical Antipsychotics when blocking dopamine?

A 
Parkinsonism (rigidity/bradykinesia/resting tremor) 
Hyperprolactinemia
>Amenorrhea 
>Galactorea
>Gynecomastia

Anti-Emetic (esp. Chlorpromezine)

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12
Q

What occurs as a result of other receptors being blocked?

A
  1. Ach Blockade> DRY MOUTH and CONSTIPATION
  2. A-1 receptors> Hypotension
  3. Histamine receptor > sedation and CONSTIPATION
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13
Q

What is the pyramidal system?

What occurs if this system is damaged?

A
  • corticospinal system —because it runs through the PYRAMIDS of the medulla
  • WEAKNESS when damaged
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14
Q

What is the extrapyramidal system responsible for?

A

-modulation of the movements
- and it involves the Basal Ganglia Nuclei and the associated tracts
> MOVEMENT DISORDERS occur with damage to the extrapyramidal system

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15
Q

What are EPS?

A

-Movement S.Es: Akathisia, Bradykinesia, Tardive dyskinesia, dystonia

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16
Q

What is dystonia?

A
  • spasms or stiffness
  • occurs within HOURS/days of administering the drug
  • jaw is locked/ can’t move arm
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17
Q

How to treat dystonia?

A

Benztropine

-anticholinergic drug; blocks M1 receptors

18
Q

What is the most COMMON EPS with Anti-psychotic drugs?

A

Akathisia- restlessness, URGE to move

- mistaken for worsening of psychotic condition

19
Q

When does Akathisia usually set in?

A
  • within DAYS
20
Q

How to treat Akathisia?

A
  • lower the dose
  • benzodiazepines
  • propanolol
21
Q

Which EPS kicks in within WEEKS of drug administration?

A
  • Bradykinesia

drug-induced Parkinsonism

22
Q

How to treat Bradykinesia?

A

Benztropine

like dystonia- frozen muscles; slow movement

23
Q

What occurs with Tardive Dyskinesia?

A

Choreoathetosis

  • twisting and writhing, irregular MOTIONs
  • mouth, tongue, face limbs
  • —sets in months/ years after use of drugs
  • permanent!
24
Q

Name 3 High potent Typical Antipsychotics.

And why are they of high potency?

A
  • haloperidol
  • fluphenazine
  • trifluoperazine
  • the main s.e: EPS with just 1mg dosage
25
Q

List 2 low potency Typ.Antipsychotics.

A
  1. Chlorpromazine
  2. Thioridazine

—-need 50-100mg for therapeutic effect

26
Q

What form of S.Es are seen with the low potency drugs?

A

More NEUROLOGICAL s.es

  • sedation
  • dry mouth
27
Q

What is a RARE, dangerous S.E to Typical Antipsychotics?

A

NMS—Neuroleptic Malignant Syndrome (onset= 7-10 days after administr.)
—-watch out for RIGID MUSCLES (EPS) & FEVER

28
Q

What 3 other conditions are seen with NMS?

A
  1. Mental Status Changes (encephalopathy)
  2. elevated Creatine Kinase (Muscle Damage)
  3. Myoglobinuria> acute renal failure (rhabdomyolysis)
29
Q

How to treat NMS?

A
  • Dantrolene (muscle relaxant)

- bromocriptine (Dopamine Agonist)

30
Q

Which Anti-psychotic is known to PROLONG the QT interval on the ECG? Dangers of prolonged QT?

A
  • IV Haloperidol

- —Torsades de pointes may turn up

31
Q

Which Typical antipsychotic results in corneal deposits?

A
  • Chlorpromazine

> will ACCELERATE the ageing of the lens

32
Q

Which typical anti-psychotic results in RETINAL deposits? How does it present as?

A
  • Thioridazine

- browning of their vision

33
Q

Main diff. between TYPICAL and ATYPICAL anti-psychotics?

A
  • atypical: LESS EPS s.es
34
Q

Why are second gen. antipsychotics known to reduce psychotic symptoms more efficiently than typical antispsychotics?

A
  • —d/t its greater Serotonin blocking receptor effect

- increased 5-HT2A receptors activity is said to cause hallucinations

35
Q

WHat are the 2 main s.e of CLOZAPINE?

A

-bone marrow toxicity
>AGRANULOCYTOSIS ….therefore should monitor weekly (then monthly later)
-SEIZURES (2-5%)

36
Q

What to do if pt presents with: Amenorrhea, Galactorhea and Gynaecomastia in men?

A
  1. measure prolactin level
  2. scan head
  3. check med list
37
Q

High rates of Hyperprolactinemia is seen in what drugs?

A
  • Haloperidol
  • Fluphenazine
  • RISPERIDONE
  • PALIPERIDONE
38
Q

What is ARIPIPRAZOLE?

A
  • its a D2 partial AGONIST

- —less dopamine blockade s.e

39
Q

What is the S.E of ARIPIPRAZOLE?

A

-akathisia

40
Q

Risks of use of anti-psychotics on elderly?

A
  • STROKE

- THROMBOEMBOLISM

PSYCHIATRY (32 decks)

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