Antipsychotics: Lacher

Question 1

What do Schizophrenic brains produce more of than normal brains?

Answer 1

Dopamine

Question 2

How do first generation antipsychotics work?

Answer 2

Block D2 receptors in all 4 dopaminergic pathways

Question 3

Name some first generation antipsychotics.

Answer 3

Haloperidol, Chlorpromazine.

Question 4

Name the 4 dopaminergic pathways and where they come from and go to.

Answer 4

1. Mesolimbic: ventral tegmentum to the nucleus accumbens.
2. Mesocortical: ventral tegmentum to frontal and limbic cortex.
3. Nigrostriatal: Substantia nigra to stratum.
4. Tuberoinfundibular: Hypothalamus to anterior pituitary

Question 5

Which dopaminic pathway is responsible for mediating the positive symptoms of Schizophrenia?

Answer 5

Mesolimbic

Question 6

Which dopaminergic pathway mediates the negative symptoms of Schizophrenia?

Answer 6

Mesocortical

Question 7

Which dopaminergic pathway mediates posture and voluntary movement (blocking it may lead to the Parkinsonian symptoms of Schizophrenia)?

Answer 7

Nigrostriatal

Question 8

Which dopaminergic pathway inhibits prolactin release?(blocking it may result in Galactorrhea/Amenorrhea)

Answer 8

Tuberoinfundibular

Question 9

How do second generation antipsychotics work?

Answer 9

Block D2 an 5-HT2A receptors (blocking 5-HT2A receptors actually leads to an increase in dopamine release).

Question 10

If you use a second generation antipsychotic, what might it do to negative symptoms?

Answer 10

It may improve them!

Question 11

Describe Clozapine.

Answer 11

2nd generation antipsychotic. Reduction in suicide! No Parkinson-life side effects.

Life-threatening adverse effect: Agranulocytosis.

Question 12

Name the second generation antipsychotics that do not induce agranulocytosis (but the aren’t as good as Clozapine in terms of no Parkinsonian symptoms and reduction of suicide).

Answer 12

Risperidone (most potent), Olanzapine, Quetiapine, Ziprasidone, Aripiprazole

Question 13

What are the three classes of symptoms in Schizophrenia?

Answer 13

Positive symptoms (ex. hallucinations), negative symptoms (Ex. social isolation), and cognitive symptoms (poor concentration, slow thinking)

Question 14

What can cause tradeoff dyskinesia?

Answer 14

DA receptor disuse supersensitivity (take patient off of antipsychotic and the D2 receptors become really sensitive to dopamine!
More common in First Gen’s.

Question 15

What are adverse effects to SGA’s?

Answer 15

Weight gain, increase incidence of Type II Diabetes Mellitus, Increase in LDL—>associated with onset of myocarditis and cardiomyopathies.