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Psychopharmacology > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

What are the 3 symptom dimensions of schizophrenia?

A

positive, negative, and cognitive

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2
Q

What are the positive symptoms of schizophrenia?

A

Delusions
Hallucinations
Distortions in language
Abnormal behavioral monitoring

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3
Q

What are the types of abnormal behavioral monitoring?

A

disorganized
catatonic
agitated

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4
Q

What are two other things that can induce psychosis?

A

Medical disorders (eg. Huntingtons, DLB, etc.) Drugs

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5
Q

What types of drugs can induce psychosis?

A

stimulants
anti-inflammatories
anticholinergics(e.g. L-DOPA, Benadryl)
hallucinogens

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6
Q

What are the negative symptoms of schizophrenia?

A 
Affect flattening
Alogia
Avolition
Anhedonia
Asociality
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7
Q

What are the cognitive symptoms of schizophrenia?

A

Thought disorder including incoherence, loose associations, neologisms
Impaired attention/information processing
Impaired verbal fluency
Impaired memory/learning
Impaired executive functioning
Aggressive and hostile symptoms
Depressive and anxious symptoms

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8
Q

What is the most studied DA receptor?

A

D2

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9
Q

What terminates DA action?

A 
Reuptake pumps (transporters)
MAO inside presynaptic neuron and synapse
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10
Q

DA hypothesis of schizophrenia

A

DA overactivity in mesolimbic pathway (VTA to nucleus accumbens) leads to positive symptoms of schizophrenia

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11
Q

Mesolimbic DA pathway

A

from bentral tegmental ares (VTA)

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12
Q

What is the difference in mechanism of action between cocaine and amphetamines?

A

Both block reuptake of DA, but only amphetamines increase the release of DA into the synaptic cleft, and in fact reverse the action of reuptake receptors.

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13
Q

How do all antipsychotic drugs act to decrease positive symptoms of schizophrenia?

A

They antagonize/block D2 receptors

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14
Q

Nigrostriatal dopamine pathway

A

From substantia nigra to basal ganglia/striatum (part of the extrapyramidal system); releases DA, which binds to D2 receptors

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15
Q

EPS

A

dystonia
akathisia
psuedoparkinsonism

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16
Q

Acute dystonia

A

Painful spasms involving tongue, face, jaw, (facial grimacing); neck (spasmodic torticollis), back, eyes (oculogyric crisis), larynx (laryngospasms), hand (writer’s cramp), or foot

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17
Q

Akathesia

A

Severe restlessness, pacing, anxiety, agitation; patients often don’t tell doctors about this and just D/C on their own.

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18
Q

What system is the nigrostriatal pathway a part of?

A

Extrapyramidal System (EPS)

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19
Q

What does decreased activation of D2 receptors result in?

A 
Parkinson's disease
Extrapyramidal symptoms (ESP's)
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20
Q

Tuberoinfundibular DA pathway

A

From hypothalamus to anterior pituitary gland

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21
Q

Disinhibition of DA in the tuberoinfundibular pathway can cause what condition?

A

Hyperprolactinemia

22
Q

What does hyperprolactinemia lead to?

A

gynecomastia, galactorrhea
anovulation, amenorrhea
Decrease in testosterone & estrogen

23
Q

What does DA normally block in the tuberoinfundibular pathway?

A

Prolactin

24
Q

What does DA normally block in the nigrastriatal pathway?

A

ACh

25
Q

Why is the 5HT2A receptor so important?

A

It inhibits DA release in all 4 pathways.

26
Q

How is 5HT action terminated?

A 
reuptake
enzymatic degradation (MAO)
27
Q

How do atypical AP’s work?

A

Antagonize 5HT2A receptors…

28
Q

What are atypical AP’s also known as?

A

mood stabilizers

29
Q

What type of drug is sometimes given in conjunction with atypical AP’s to treat affective symptoms of psychosis?

A

Anticonvulsants

30
Q

Anticonvulsants + atypicals are often used to treat what?

A

Behavioral dysfunction in children (e.g. children with ASD who have severe head banging)

31
Q

What does the antagonism of H1 (histamine 1) receptor lead to?

A

Sedation (due to inhibition of histamine in the CNS)

Weight gain, especially if the 5HT2C receptor is also blocked

32
Q

Antagonism of ACh-Mi (cholinergic, muscarinic) receptor leads to:

A 
Memory problems
Delirium
Blurred vision
Dry mouth
Constipation 
Urinary hesitation/retention
Reflex tachychardia
33
Q

What’s the saying that is used to describe SE of AP’s?

A

Mad as a hatter, blind as a bat, dry as a bone, red as a beet.

34
Q

Antagonism of a1 (alpha adrenergic) receptor leads to:

A 
low blood pressure 
postural hypotension (orthostasis)
dizziness
increased heart rate (compensatory)
Ejaculatory dysfunction, priapism (prolonged erection)
Constricted pupils
35
Q

What population are AP’s not FDA-approved for?

A

Elderly/geriatric due to increased risk of death

36
Q

Prolongation of QTc can lead to what?

A

heart arrhythmia

37
Q

What is an important affect of AP’s on the cardiovascular system?

A

Some AP’s (thioridazine, Geodon) can prolong QTc, which leads to slower electrical activity in heart, which can lead to hearth arrhythmia.

38
Q

What are some side effects associated with atypicals?

A 
Cardiometabolic effects
Sedation
Anticholinergic (includes sexual dysfunction)
Orthostasis & dizziness
Sexual dysfunction
Rashes
Photosensitivity & temperature deregulation
Liver effects
Seizures
39
Q

What is the most serious SE of atypicals?

A

Cardiometabolic effects

40
Q

What are cariometabolic effects also known as?

A

Metabolic syndrome

41
Q

What are the symptoms of cardiometabolic effects/metabolic syndrome?

A

Weigh gain
Dyslipidemia
Hyperglycemia (risk of Type 2 diabetes)
QTc prolongation

42
Q

Which atypicals have the worst cardiometabolic effects?

A

Clozaril & Zyprexa

43
Q

Which atypicals have the least cardiometabolic effects?

A

Geodon & Abilify (although some of the newer atypicals are touting less cardiometabolic effects)

44
Q

What is the main reason for partial/non-responses and relapses in schizophrenia?

A

Poor adherence

45
Q

What is poor adherence usually due to?

A

Side effects

46
Q

What are some of the main consideration regarding adherence that should be addressed?

A

Pts must not skip doses.
Pts should tell doctors about any SE’s
Involve significant others when possible (helpful in maintaining adherence)

47
Q

Options for Inadequate responses

A

Optimization
Augmenting
Switching drug classes (i.e. atypical vs typical)
Polypharmacy

48
Q

Optimization

A

Check adherence
Check DDI’s, including drug abuse
Increase dose (perhaps beyond those used in studies)
Increase for therapeutic effects

49
Q

What is the most common type of optimization?

A

Increasing dosage (perhaps beyond those used in studies)

50
Q

Augmenting

A

Adding a non-psychotic (e.g. antidepressants, anxiolytics, mood stabilizers)

51
Q

Switching

A

Switching to another AP, hopefully rationally based on symptoms & SEs of specific patient

52
Q

Polypharmacy

A

Adding another AP (usually adding an FGA to an atypical, since atypicals are usually prescribed first); Not as common (or as justified) as for bipolar

Psychopharmacology (7 decks)

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