Antipsychotics and Antimanic Flashcards
how does the mesolimbic differ from the mesocortical pathway in terms of positive and negative symptoms
mesolimbic- positive symptoms
mesocortical- negative symptoms
how does the nigrostriatal differ from the tuberoinfundibular pathway in terms of schizophrenic symptoms
nigrostratal- extrapyramidal symptoms
tuberoinfundibular- hyperprolactinemia
what is the effect of atypical antipsychotics for schizophrenia
increase dopamine in mesocortical tract (control negative symptoms)
inhibit activity of mesolimbic path (control positive symptoms)
*controls + and - symptoms
what is the effect of typical antipsychotics for schizophrenia
inhibit mesolimbic path activity (controls positive symptoms)
less increase in mesocortical pathway (controls negative symptoms)
do typical or atypical antipsychotics for schizophrenia have more of an impact on the mesocortical tract? Mesolimbic tract
atypical= more mesocortical
both inhibit mesolimbic
how do D1 receptors differ from D2 receptors
D1 increase cAMP
D2 decreased cAMP
D1 receptors are __ coupled
D2 receptors are __ coupled
D1= Gs
D2= Gi or Go
what is the difference between the receptors primarily blocked by typical vs atypical antipsychotics
typical antipsychotics block dopamine D2 receptors
atypical antipsychotics block serotonin (5-HT2) receptors
what is an example of a high potency antipsychotic drug
haloperidol
atypical antipsychotic drugs control more __ symptoms
typical antipsychotics control more __ symptoms
atypical control negative
typical control positive
do atypical or typical antipsychotics produce more extrapyramidal symptoms
typical
although one may block a certain predominantly, all antipsychotics block what 2 receptors
D2 dopamine
serotonin (5-HT2)
do typical or atypical antipsychotics block muscarinic, alpha1, and histaminergic receptors
typical
what body temperature effect is seen with antipsychotic drug use
poikilothermic effect- loss of body regulation= body temperature varies with the environment
what are 3 cardiovascular system effects seen with antipsychotic drugs
orthostatic hypotension
QT prolongation
ventricular arrhythmia
what is an example of a typical (first generation) antipsychotic drug
chlorpromazine
what are 2 adverse effects of antipsychotic use
cholestatic jaundice (hypersensitivity reaction)
bone marrow suppression
how does thioridazine differ from chlorpromazine as an antipsychotic
more antimuscarinic effects
less extrapyramidal side effect
what are 2 adverse effects of the typical antipsychotic thioridazine
pigmentary retinopathy
cardiac arrhythmia
haloperidol is effective in acute schizophrenia to treat __ symptoms
positive or negative
positive
is Haloperidol short or long term acting
long acting injection
haloperidol has less antimuscarinic effects but its use is limited due to __
extrapyramidal symptoms and anticholinergic effects
what are 2 antipsychotics that can be used for Tourette’s syndrome
Pimozide
Haloperidol
what effects of typical antipsychotic drugs can tolerance be developed for
sedative and hypotensive
not antipsychotic and extrapyramidal
what are 3 adverse effects of antipsychotic use
extrapyramidal symptoms such as:
acute muscular dystonia
akinesia
drug induced pseudo-parkinsonism symptoms
how are extrapyramidal symptoms of antipsychotics treated
anticholinergic drugs benztropine, benzhexol
chronic toxicity of antipsychotics causes what symptom
tardive dyskinesia
what antipsychotic is the only drug to not induce tardive dyskinesia
clozapine
does chronic toxicity leading to tadive dyskinesia occur more with typical or atypical antipsychotic use
typical
what is the treatment for tardive dyskinesia caused by chronic antipsychotic toxicity
Valbenazine or Deutetrabenazine
what is the mechanism of action of Valbenazine or Deutetrabenazine used for management of chronic antipsychotics toxicity
inhibit monoamine transporter 2 and decreases amines
what are 5 adverse effects of antipsychotic drugs
hyperprolactinemia
weight gain
hyperglycemia, insulin resistance, and dyslipidemia–>diabetes
retinopathy
cardiotoxicity
antipsychotic drugs can cause neuroleptic malignant syndrome, especially with what drug
haloperidol
what causes neuroleptic malignant syndrome
rapid and excess dopamine receptor blockade
what are 3 effects of neuroleptic malignant syndrome caused by antipsychotic drugs
elevation of creatine kinase and liver transaminase
autonomic dysfunction
altered mental state
what drugs can be used for treatment for neuroleptic malignant syndrome
Bromocriptine
Amantadine
what atypical antipsychotic drug has the greatest risk for developing cardiotoxicity
Ziprasidone
antipsychotic drugs causing Parkinson-like symptoms is due to __ while tardive dyskinesia symptoms is due to __
Parkinson- dopamine receptor blockade
tardive dyskinesia- supersensitivity of dopamine receptors
do typical or atypical antipsychotics have a greater risk for metabolic effects and QT prolongation
atypical
is Clozapine an atypical or typical antipsychotic
atypical
what is the mechanism of action of Clozapine
blocks 5-HT2 and D4 with higher affinity than D2
what is the most effective antipsychotic drug
Clozapine
what are 4 adverse effect of Clozapine
agranulocytosis
sialorrhea
constipation
hyperglycemia (diabetes)
in what cases is Clozapine used for
drug resistant schizophrenia
(due to its adverse effects)
what drug is used for the prevention of the manic phase of bipolar disorder
Olanzapine with lithium
what drug similar to Clozapine doesn’t induce agranulocytosis
Olanzapine
what is the mechanism of action of the atypical antipsychotic Risperidone
blocks 5-HT2 receptors
what is the preferred antipsychotic drug
Risperidone
what are 3 adverse effects of the atypical antipsychotic Risperidone
hyperprolactinemia
prolonged QT interval
more extrapyramidal symptoms
what atypical antipsychotic has the greatest risk for QT prolongation
Ziprasidone
what atypical antipsychotic is preferred for schizophrenia with depression
Quetiapine
what is the mechanism of action of the atypical antipsychotics Aripiprazole
partial agonist of D2 and 5-HT2 receptors
what atypical antipsychotic can be used for maintenance rather than severe psychosis
Aripiprazole
what atypical antipsychotic drug increases prolactin
Risperidone
what atypical antipsychotic is used for Huntington’s chorea
Haloperidol
what antipsychotic can be used for intractable hiccups
Clorpromazine
what antipsychotic can be used for neuroleptanalgesia (semiconscious and nonreactive state)
Droperidol with fetanyl
are typical or atypical drugs more effective in schizophrenia
atypical
when giving antipsychotics, there is a potential for more anticholinergic effects if given with __ or __
TCA
antiparkinsonian drugs
antipsychotic drugs are contradicted in what 3 patients
chronic alcoholics (lowers seizure threshold)
mood disorders
nursing mothers
typical antipsychotics have a higher risk for __ side effects while atypical have a higher risk for __ side effects
neurological
metabolic
what drug is used in acute mania and bipolar maintenance
lithium
what is the mechanism of action of lithium
inhibits inositol monophosphate (decreases inositol concentration)
increased BDNF
what are 3 adverse effects of lithium
nephrogenic diabetes insipidus
hypothyroidism
increased leukocytes
lithium is contradicted in what patients
pregnant/breastfeeding
lithium has high drug interaction with what 3 classes of drugs
diuretics
NSAIDS
neuroleptics
effect of diuretic use with lithium
increased plasma lithium
effect of NSAID use with lithium
enhances lithium toxicity by decreasing its clearance
lithium is the preferred drug for what 3 conditions
bipolar affective disorder
prevention of acute manic episodes
depression in bipolar
what 2 drugs are alternatives for lithium in acute mania
Carbamazepine
Valproate
how does Valproate stabilize mood
inhibits histone deacetylase which increases BDNF
