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Psych Exam 1 > Antipsychotics - Linger > Flashcards

Antipsychotics - Linger Flashcards

1
Q

aripiprazole

A

atypical antipsychotic

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2
Q

lurasidone

A

atypical antipsychotic

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3
Q

olanzapine

A

atypical antipsychotic

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4
Q

quetiapine

A

atypical antipsychotic

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5
Q

risperidone

A

atypical antipsychotic

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6
Q

ziprasidone

A

atypical antipsychotic

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7
Q

clozapine

A

special use atypical antipsychotic

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8
Q

chlorpromazine

A

typical low potency antipsychotic

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9
Q

haloperidol

A

typical high potency antipsychotic

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10
Q

atypical

A

because dramatic reductionin extrapyramidal side effects

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11
Q

dopamine hypothesis

A

evidence for:

  • antipsychotics - some block D2 receptors postsynaptic
  • drugs increase DA - aggravate schizophrenia or trigger psychosis
  • DA receptors - more in brain of schizophrenic
  • post-mortem - more DA and D2 receptorrs in schizophrenic nucleus accumbens, caudate, putamen

evidence against:

  • decreased cortex/hippocampus DA activity - underlie cognitive impairment and negative sx of schizophrenia
  • many atypicals - lower affinity for D2 receptors - but effective for schizophrenia tx

dopamine hypothesis - oversimplification

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12
Q

serotonin hypothesis

A

hallucinogenics - LSD, mescalin

-serotonin receptor agonists

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13
Q

bio basis of schizophrenia

A

DA, serotonin, glutamate imbalance

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14
Q

glutamate hypothesis

A

low function NMDA receptors

  • on GABA internerous
  • induce disinhibition of glutamatergic activity - hyperstimulation
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15
Q

atypical antipsychotics

A

greater effect at 5-HT2a than D2 receptors

-dissociation of EPS and antipsychotic efficacy

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16
Q

phenothiazine derivative

A

chlorpromazine

aliphatic

more sedation and weight gain

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17
Q

butyrophenone derivative

A

haloperidol

high level of EPS

more potent, fewer autonomic effects

  • but more EPS
  • compared to phenothiazines
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18
Q

cholinergic rebound and withdrawal movement disorders

A

clozapine

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19
Q

cholinergic rebound

A

also with chlorpromazine and thioridazine

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20
Q

relapse to schizo after stop taking drug

A

most - 6 months

except - clozapine - rapid and severe relapse

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21
Q

efficacy of typical antipsychotics

A

D2 receptor affects

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22
Q

atypical antipsychotics

A

block 5-HT2A more potently than inhibit D2 receptors

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23
Q

mesolimbic mesocortical pathway

A

behavior and cognition

VTA - projection to limbic system and neocortex

inhibition of DA activity - antipsychotic effect

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24
Q

nigrostriatal pathway

A

coordination of movement

substantia nigra to dorsal striatum (caudate/putamen)

inhibit - EPS

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25
tuberoinfundibular system
PRL release DA inhibits arcuate nucleus and periventricular neurons -to hypothalamus and posterior pituitary pathway inhibited by antipsychotics - PRL release
26
D1-like
D1 and D5 increase cAMP - activate Gs and adenylyl cyclase
27
D2-like
D2, D3, and D4 decreased cAMP - Gi - inhibit Ca channels, open K channels
28
D2 receptors
role in action of antipsychotics
29
D2 binding affinity
strong correlation with antipsychotic potency and EPS
30
typical antipsychotics
need 60% occupancy of striatal D2 receptors for antipsychotic EPS at 80%
31
atypical antipsychotics
need 30-50% occupancy of striatal D2 receptors for antipsychotic bc concurrent high occupancy at 5-HT2A receptors
32
aripiprazole
high D2 occupancy - without EPS partial agonist at D2
33
catatonic schizo tx
benzos
34
reduce risk of suicide in schizoaffective pt
clpzapine
35
non-psych indications of antipsychotics
antiemetic | neuroleptanesthesia
36
first line tx of schizophrenia
atypical antipsychotics | -except clozapine and olanzapine
37
effective drug tx
both positive and negative sx improve
38
acute control uncoop patient
haloperidol
39
autonomic side effect
chlorpromazine
40
severe EPS
haloperidol
41
agranulocytosis
clozapine
42
lower seizure threshold
clozapine
43
QT prolongation
ziprasidone
44
dibenzothiazepine
quetiapine
45
dihydroindolone
ziprasidone
46
dihydrocarbostyril
aripiprazole
47
thienobenzodiazepine
olanzapine
48
benzisoxazole
risperidone
49
dibenzodiazepine
clozapine
50
butyrophenone
haloperidol
51
weight gain
olanzapine
52
atypicals
wide therapeutic index
53
adverse of clozapine
agranulocytosis and myocarditis only patients refractory high dose other agents -or suicidal
54
full effect of tx
16-20 weeks
55
electroconvulsive therapy
adjunct for tx of mood sx and positive sx augment - clozapine - max dose of clozapine ineffective
56
anhedonia
inablity to experience pleasure
57
akathisia
uncontrolled restlessness - can't sit still
58
tx of EPS
anticholinergic | antimuscarinic (antihistamine - diphenhydramine)
59
early motor effects antipsychotics
EPS - 1-3 days parkinsonism, increased activity akathisia - can't sit still acute dystonic rxns EPS and dystoni tx - anticholinergic or antihistamine never use levodopa in these patients
60
later motor effects of antipsychotics
tardive dyskinesia with chronic tx - months/years writhing movements of tongue, face body - choreoathetoid imbalance of cholinergic vs. dopaminergic activity in motor pathways
61
lower risk of tardive dyskinesia
clozapine or quetiapine
62
seizure threshold
lowered with most antipsychotics clozapine - seizures in 2-5% of patients
63
typical antipsychotics
affinity for muscarinic cholinergic and a1 adrenergic receptors anti-PS effect loss of accomodation, dry mouth, difficulty urinating, constipation orthostatis hypotension, dizzy, sedated, impotent, failure to ejaculate switch to newer typical agent
64
high risk of weight gain
clozapine | olanzapine
65
intermediate risk of weight gain
iloperidone paliperidone quetiapine risperidon
66
low risk weight gain
asenapine
67
lowest risk of weight gain
lurasidone aripiprazole ziprasidone
68
weight gain
follow food intake, BMI, blood sugars, and lipids hyperglycemia and hyperlipidemia common problems
69
hyperPRL
with antipsychotic use loss of DA inhibition of PRL secretion amenorrhea-galactorrhea, infertile, osteoporosis - women infertility, loss of libido, impotent, gynecomastia - men more with older typical antipsychotics -as well as risperidone and paliperidone
70
agranulocytosis
with clozapine need to monitor CBC - weekly first 6 months - every 3 weeks thereafter
71
QT prolongation
with several antipsychotics risk sudden death avoid antiarrhythmics and erythromycin (prolong QT)
72
antipsychotics in pregnancy
atypical preferred considered relatively safe - category C
73
neuroleptic malignant syndrome
life-threatening acute severe parkinsonism, muscle rigid, autonomic instability, HTN, hyperthermia, stress leukocytosis (infection misdiagnosis) side effect of antipsychotics tx - supportive - cool body, muscle relaxants
74
positive sx
excess DA - mesolimbic system
75
negative sx
loss of DA - mesolimbic system
76
dopamine receptors
GPCRs
77
typical vs atypical
typical - positive sx treatment | atypical - positive/negative sx treatment
78
loss of accomodation, dry mouth, difficulty urinating, constipation
muscarinic cholinoceptor blockade
79
orthostatic hypotension, dizzy, sedation, failure to ejaculate
a-adrenoreceptor blockade
80
parkinsons syndrome, akathisia, dystonia
dopamine receptor blockade
81
weight gain
combined H1 and 5-HT2 blockade
82
endocrine changes
dopamine receptor blockade
83
acute motor effects
D2 blockade basal ganglia - EPS treatable
84
late onset motor effects
tardive dyskinesia imbalance - cholinergic deficiency and dopaminergic supersensitivity may be irreversible
85
tx tardive dyskinesia
decrease dose - initially get worse - improve over weeks switch - quetiapine or clozapine
86
more severe with haloperidol
EPS
87
chlorpromazine
has activity at many receptors so get unwanted effects cholinergic, a-adrenergic, H1 low potent at D2
88
tx bipolar depression
aripiprazole less weight gain and hyperglycemia
89
olanzapine
bind 5-HT2a, Ma, and H1 high affinity severe weight gain
90
aripiprazole
partial D2 agonist
91
lurasidone
tx schizo and bipolar D2 and 5-HT2 - high affinity no QT prolongation
92
quetiapine
low affinity D2 and 5-HT2 higher affinity H1 and alpha1 - sedation and orthostatic off label use as sleep aid QT prolongation - poor choice for those with heart issue
93
risperidone
high affinity 5-HT2a, D2 and alpha1 highest EPS and hyperPRL floppy iris syndrome before cataract surgery
94
ziprasidone
high affinity 5-HT2a - lower affinity D2 CI - patient with recent MI - QT prolongation
95
antiemesis
DA blockade
96
neuroleptanesthesia
analgesia and amnesia droperidol fetanyil nitrous oxide

Psych Exam 1 (16 decks)

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