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DEN 2026 - Pharmacology > Antipsychotics and Mood Stabilizers > Flashcards

Antipsychotics and Mood Stabilizers Flashcards

1
Q

What causes positive symptoms of schizophrenia?

A

Over-reatcivity of mesolimbic pathway

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2
Q

What causes negative and cognitive symptoms of schizophrenia?

A

Mesocortical pathway dysfunction

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3
Q

Describe how dopamine may lead to delusions

A
  • Dopamine mediates attention and reward
  • Excess dopamine causes inability to jettison irrelevant information
  • Brain connects dots of non salient information
  • Delusions occur
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4
Q

Describe schizophrenia

A
  • Chronic
  • Onset typically early 20s
  • Prevalence in 1% of population
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5
Q

Describe 2 cognitive impairments of schizophrenia

A
  1. Pattern of impairments

2. Drop in IQ

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6
Q

Describe a negative symptom of schizophrenia

A

Emotional blunting (social withdrawal, apathy)

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7
Q

Describe a positive symptom of schizophrenia

A

Psychosis (delusions, hallucinations, impaired insight)

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8
Q

Name 5 typical antipsychotic drugs

A
  1. Chlorpromazine
  2. Fluphenazine
  3. Flupentixol
  4. Haloperidol
  5. Sulpiride
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9
Q

Name 6 atypical antipsychotic drugs

A
  1. Olanzapine
  2. Quetiapine
  3. Risperidone
  4. Aripiprazole
  5. Amisulpride
  6. Clozapine
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10
Q

Describe the different in side effects between 1st and 2nd generation antipsychotic drugs

A
  • Typical more likely to produce EPSE (extra pyramidal side effects)
  • Atypical more likely to produce metabolic side effects
  • 2nd generation have broader receptor profile
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11
Q

What mediates antipsychotic drugs clinical effects?

A

Antagonism at dopamine D2 receptors

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12
Q

What type of symptoms do antipsychotic drugs improve?

A

Positive symptoms

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13
Q

Name 2 types of adverse effects mediated by dopamine antagonist for antipsychotic drugs

A
  1. EPSE (Nigrostriatal Tract)

2. Prolactin Elevation (Tuberoinfundibular System)

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14
Q

Name 4 types of receptors other than dopamine receptors which mediate adverse effects of antipsychotics

A
  1. Serotonin
  2. Histamine
  3. Muscarinic
  4. Alpha adrenergic
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15
Q

Name 4 side effects associated with EPSE

A
  1. Acute dystonia
  2. Parkinsonism
  3. Akathisia
  4. Tardive Dyskinesia
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16
Q

What is acute dystonia?

A

Sudden contraction of a muscle grow

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17
Q

How can acute dystonia be resolved?

A

Use of an anti-cholinergic agent e.g. procyclidine

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18
Q

Name 3 ways parkinsonism as an EPSE side effect could be resolved

A
  1. Reducing dose
  2. Changing antipsychotic
  3. Use of anticholinergic agent
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19
Q

What is tardive dyskinesia?

A

Writhing movements in face, tongue, trunk, arms or leg

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20
Q

What is the best treatment for tardive dyskinesia?

A

Switch treatment to 2nd generation antipsychotic

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21
Q

Name 3 types of second generation antipsychotics which are particularly susceptible for causing metabolic side effects

A
  1. Quetiapine
  2. Olanzapine
  3. Clozapine
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22
Q

Name 3 metabolic side effects of antipsychotics

A
  1. Weight gain
  2. Dry mouth / constipation
  3. Postural hypotension
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23
Q

What 3 receptors mediate weight gain as a metabolic side effect of antipsychotics?

A
  1. Antagonism of 5HT2C
  2. Antagonism of 5HT1A
  3. Antagonism of H1
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24
Q

What is clozapine used for?

A

Reserved for use in treatment resistant schizophrenia

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25
Q

What is resistant schizophrenia?

A

Schizophrenia which has not been resolved with 2 trials of antipsychotic for a minimum of 6 weeks each

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26
Q

Name 3 common side effects of clozapine

A
  1. Sedation
  2. Weight gain
  3. Hypersalivation
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27
Q

What is a side effect of clozapine which can be fatal?

A

Neutropenia leading to agranulocytosis

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28
Q

Describe the monitoring of patients on clozapine

A
  • Due to potential for agranulocytosis
  • Monitored weekly for 18 weeks
  • Biweekly for next 18 weeks
  • 4 weekly following first stable 36 weeks
29
Q

Describe the mechanism of action of aripiprazole

A

A partial agonist at dopamine D2 receptor

30
Q

Describe how aripiprazole functionally acts

A
  • Acts as antagonist in presence of increased dopamine transmission in mesolimbic area
  • Acts as an agonist in mesocortical area
31
Q

Name 2 side effects of aripirazole

A
  1. Akathisia

2. Agitation

32
Q

Name 3 psychotic disorders other than schizophrenia which would indicate the use of an antipsychotic

A
  1. Delusional disorder
  2. Severe depression with psychotic symptoms
  3. Mania with psychotic symptoms
33
Q

Name 2 non-psychotic disorders which would indicate the use of an antipsychotic

A
  1. Maintenance in bipolar affective disorder

2. Adjunctive treatment in depression

34
Q

Name 3 non-psychotic disorders which have evidence for the use of an antipsychotic

A
  1. OCD
  2. PTSD
  3. ASD
35
Q

What 3 types of mood may occur in a person suffering from bipolar disorder?

A
  1. Mania
  2. Depression
  3. Euthymic (normal)
36
Q

Name 3 core symptoms of a person suffering from depression

A
  1. Persistent sadness
  2. Tiredness
  3. Loss of interest
37
Q

Name 3 possible symptoms of a person suffering from depression outside of the 3 core symptoms

A
  1. Disturbed sleep
  2. Low self confidence
  3. Suicidal thoughts or acts
38
Q

What is may mania associated with?

A

Grandiose delusions

39
Q

What is mania / hypomania?

A

A pathological mood state lasting 4 or more days

40
Q

Name 4 characterizations of mania

A
  1. Elated mood
  2. Overactivity
  3. Increase energy
  4. Disinhibition
41
Q

Describe 3 components of neurobiology of bipolar disorder

A
  1. Increased dopamine neurotransmission
  2. Increase glutamate transmission
  3. Reduced GABA neurotransmission
42
Q

Name 3 types of treatment in bipolar disorder

A
  1. Treatment of bipolar depression
  2. Treatment of manic episodes
  3. Prevention of relapse
43
Q

What drug must be stopped during a manic episode?

A

Antidepressants

44
Q

Name 3 types of drugs which can be used to treat a manic episode during bipolar

A
  1. Antipsychotic
  2. Lithium
  3. Valproate
45
Q

Name 3 pharmacological treatments for bipolar depression

A
  1. Quetiapine / Olanzapine (+/- fluoxetine)
  2. Lamotrigine
  3. Lithium (less effective)
46
Q

What is a non-pharmacological treatments for bipolar depression?

A

Psychological treatments e.g. CBT

47
Q

What is a mood stabilizer?

A

Effective in preventing recurrence of manic and depressive relapses

48
Q

Name 4 types of mood stabilizers

A
  1. Antipsychotics
  2. Lithium
  3. Sodium valproate (depakote)
  4. Lamotrigine
49
Q

Name 3 modes of action of lithium

A
  1. Inhibits dopamine transmission pre synaptically and post synaptically
  2. Inhibits glutamate transmission post synaptically
  3. Increase GABA transmission pre synaptically and post synaptically
50
Q

Describe the pharmacokinetics of lithium

A
  • Absorption complete 6-8 hours
  • No protein binding / not metabolized
  • Excreted entirely in urine
  • Half life is 20 hours
51
Q

Describe 3 lithium side effects related to the kidneys and thyroid

A
  1. Polyuria / Polydipsia
  2. Nephrotoxicity
  3. Hypothyroidism
52
Q

Name 4 side effects not related to the kidneys and thyroid of lithium

A
  1. Leukocytosis
  2. Minor cognitive effects
  3. Muscle weakness
  4. Nausea / diarrhoea
  5. Weight gain
53
Q

What can occur during severe lithium toxicity?

A

Seizures leading to coma and death

54
Q

Name 4 possible causes of lithium toxicity

A
  1. Overdose
  2. Older patients more vulnerable to toxicity
  3. Factors affecting salt / water balance
  4. Medications
55
Q

Name 4 types of medication which may influence lithium levels

A
  1. Thiazide diuretics
  2. ACE inhibitors
  3. NSAIDs
  4. COX-2 inhibitors
56
Q

What is the predicted mechanism of action of sodium valproate?

A

Enhances GABA transmission

57
Q

How is sodium valproate metabolized?

A

Liver by CYP enzymes

58
Q

What is the main clinical indication of sodium valproate?

59
Q

What are 2 uses of sodium valproate when used as a mood stabilizer?

A
  1. Maintenance treatment

2. Treat acute mania

60
Q

What is a major contraindication of sodium valproate?

A

Women of childbaring age

61
Q

Name 3 common side effects of sodium valproate

A
  1. Nausea / vomiting
  2. Drowsiness
  3. Dizziness
62
Q

Name 3 uncommon side effects of sodium valproate

A
  1. Encephalopathy
  2. Liver failure
  3. Pancreatitis
63
Q

What is the mode of action of lamotrigine?

A

Acts of presynaptic voltage gated sodium channels to reduce glutamate neurotransmission

64
Q

How is lamotrigine metabolised?

A

Glucuronic acid conjugation

65
Q

What drug may reduce levels of lamotrigine?

A

Oral contraceptive pill

66
Q

What is the use of lamotrigine in bipolar disorder?

A

Second line treatment to prevent bipolar depression

67
Q

Name 2 severe side effects associated with lamotrigine

A
  1. Stevens Johnson Syndrome

2. Toxic Epidermal Necrolysis

68
Q

Name 4 common side effects of lamotrigine

A
  1. Loss of balance
  2. Nausea
  3. Drowsiness
  4. Insomnia

DEN 2026 - Pharmacology (22 decks)

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