Antipsychotics and Antipileptics

Question 1

What is the most common type of Psychosis?

Answer 1

Schizophrenia

Question 2

What are Neuroleptics?

Answer 2

Antipsychotic drugs that were designed to treat the patient rather than just sedating them. They allow for normal behavior and thinking during acute psychotic episodes and prevent recurrence of psychosis

Question 3

Which dopamine receptor is most important for antipsychotic effects?

Answer 3

D2

Question 4

How do Antipsychotics work?

Answer 4

Overall they work by blocking the D2 (dopamine) receptors to some extent

Question 5

What are the 2 categories of Antipsychotics?

Answer 5

Traditional and Atypical

Question 6

Why are Atypical antipsychotics considered better than the Traditional antipsychotics?

Answer 6

While they may be less effective than traditional drugs, they have a decreased risk of movement disorders since they dont affect dopamine receptors as strongly. They also have a lower incidence of relapse.

Question 7

What is the most feared side effect of antipsychotics?

Answer 7

Tardive Dyskinesia
-may be irreversible!!!
-involuntary fragmented movements
-rhythmic movements of mouth, tongue, and jaw
-involuntary sucking and smacking noises
-serious swallowing disorders
-choraoathetoid movements of extremities
-dystonias of neck and trunk

Question 8

What are the different types of extrapyramidal symptoms that could occur due to taking antipsychotics?

Answer 8

-Tardive Dyskinesia
-Pseudoparkinsonism
-Akathisia
-Dyskinesia
-Dystonia
-Neuroleptic malignant syndrome

Question 9

Why do Atypical antipsychotics have a lower risk of extrapyramidal symptoms?

Answer 9

They block serotonin receptors more than dopamine receptors

Question 10

Pseudoparkinsonism

Answer 10

Due to antipsychotics blocking dopamine receptors some patients may develop symptoms similar to that of parkinsons: resting tremor, bradykinesia, rigidity
-symptoms will typically disappear when dose is adjusted

Question 11

Akathisia

Answer 11

A side effect of antipsychotics where patients feel motor restlessness (cant lie still or sit still), also agitation, pacing the floor or insomnia
-can be managed by altering dose

Question 12

Dyskinesia and Dystonia

Answer 12

Involuntary and uncoordinated movements in arms, legs, neck and face
-side effect of antipsychotics

Question 13

Neuroleptic Malignant Syndrome

Answer 13

Very serious side effect of taking high doses of traditional antipsychotic meds. Symptoms include catatonia, stupor, rigidity, tremors, fever, and can lead to death
**medical emergency- stop taking meds!

Question 14

What are the non-motor side effects associated with antipsychotics?

Answer 14

-weight gain
-diabetes
-increased plasma lipids
-anticholinergic effects (cant see, cant pee, cant poo)
-sedation
-orthostatic hypotension
-cardiovascular or endocrine problems

**These are produced by atypical antipsychotics

Question 15

What is Epilepsy?

Answer 15

A chronic neurological disorder characterized by recurrent seizures due to cerebral neurons firing rapidly

Question 16

What causes cerebral neurons to fire rapidly in those with Epilepsy?

Answer 16

-specific incidences: stroke, tumor, encephalopathy, head trauma
-birth trauma or genetic abnormality
-unknown cause

Question 17

Effectiveness of Antipileptic medications

Answer 17

They are effective 50% of the time eliminating seizures, effective 25% of the time reducing seizures and ineffective 25% of the time

Question 18

What are the two categories of seizures?

Answer 18

1. Generalized: whole brain is involved
   -grand mal seizures
   -petit mal seizures
2. Focal: only part of brain is involved
   -simple: remains conscious
   -complex: loses consciousness

Question 19

What is the goal of Anti-seizure drugs?

Answer 19

To suppress the excitability of neurons that initiate seizures by:
1. increase the activity of CNS inhibitory neurons
2. decrease the activity of CNS excitatory neurons
3. stabilize the opening and closing of neuronal sodium or calcium channels

Question 20

What are the two categories of seizure meds?

Answer 20

1. First generation- original drugs
2. Second generation

Question 21

What are the 3 different ways first generation antiseizure drugs work?

Answer 21

1. Increasing GABA to inhibit the firing of certain neurons
2. Decrease the effects of excitatory amino acids (glutamate)
3. Alter the movement of sodium and calcium across neuronal membrane

Question 22

What are the 6 classes of First Generation Antiseizure meds?

Answer 22

1. Barbiturates
2. Benzos
3. Hydantoins
4. Iminostilbenes
5. Succinimides
6. Valproates

Question 23

Barbiturates mechanism of action

Answer 23

Increases the inhibitory effects of GABA

Question 24

Benzo mechanism of action

Answer 24

Increases the inhibitory effects of GABA

Question 25

Which class is the primary for treating partial seizures and grand mal seizures?

Answer 25

Iminostilbenes: Tegretol

Question 26

Why take second generation drugs over first generation?

Answer 26

They are no more effective than 1st generation drugs, but they have very mild side effects

Question 27

Which second generation drugs are most commonly used?

Answer 27

1. Gabapentin: reduces neuronal activity in seizure disorders
2. Pregabalin

Question 28

General side effects of second generation drugs

Answer 28

-dizziness
-sedation
-HA
-ataxia
-fatigue
-skin and vision problems

Question 29

Why do women with Epilepsy have an increased risk of birth defects?

Answer 29

Utero exposure to the anti-seizure meds

Question 30

How should someone discontinue seizures meds once they are under control?

Answer 30

meds should be tapered off over a 3-6 month period

Question 31

Why are barbiturates not commonly used?

Answer 31

They have such a small TI which results in high overdose ability