Antipsychotics Masserano

Question 1

Neurodevelopmental Hypothesis of Schizophrenia

Answer 1

Fetal disturbance leads to abnormal neuron migration in developing brain
Excessive pruning or excessive loss of neurons from the start

Question 2

Neurodegenerative hypothesis of schizophrenia

Answer 2

Cause is not static and previously completed pathological process.
Overstimulation of the brain?

Question 3

First generation antipsychotics

Answer 3

Chlorpromazine

Haloperidol

Question 4

Potential side effects of 1st generation antipsychotics

Answer 4

1. EPS symptoms
   - dystonia
   - pseudoparkinson
   - akathisia
   - tardive dyskinesia
2. Hyperprolactinemia
3. Neuroleptic Malignant Syndrome
4. Anticholinergic
5. Antihistamine
6. Adrenergic antagonist

Question 5

Chlorpromazine side effects

Answer 5

1. Decrease the seizure threshold
2. Alpha-adrenergic antagonisty = hypotension
3. Anticholinergic effects
4. Potentiate CNS depressant effects of other drugs
5. Hyperprolactinemia
6. Neuroleptic malignant syndrome

Question 6

Torsades List Drugs

Answer 6

Some 1st generation antipsychotics come with a risk of Torsades de Pointe and can extend the QT interval

Question 7

Acute dystonias (EPS)

Answer 7

involuntary movements and spasms of the face, neck, and tongue which make swallowing difficult

Question 8

Akathasia (EPS)

Answer 8

Subjective feeling of wanting to be constantly in motion. Treat w/ anticholinergics or antianxiety drugs

Question 9

Pseudoparkonism (EPS)

Answer 9

tremor, muscle twitch, and rigidity. Treat w/ anticholinergics

Question 10

Tardive dyskinesia

Answer 10

Occurs after > 1 year of treatment

Involuntary movements of the facial muscles

Question 11

5-HT1a location and MOA

Answer 11

Postsynaptic neurons in which agonists enhance dopamine in cortex

Question 12

5-HT2a location and MOA

Answer 12

Presynaptic neurons and antagonists enhance dopamine in cortex

Question 13

Major side effects of 2nd generation antipsychotics

Answer 13

1. Weight gain
2. Diabetes mellitus
3. Cholesterol levels

Question 14

Clozapine adverse effect

Answer 14

Increased incidence of agranulocytosis.

Monitor of leukocyte count

Question 15

Clozapine BBW

Answer 15

AGRANULOCYTOSIS
Seizures
Myocarditis
INCREASED MORTALITY IN ELDERLY PTS WITH DEMENTIA

Question 16

Brexpipraole (Rexulti) MOA

Answer 16

Partial agonist of 5-HT1a and D2 receptors and antagonist activity at 5-HT2a/2b (negative symptoms)

Question 17

Cariprazine (Vraylar) MOA

Answer 17

Partial agonist at D2 and 5-HT1a and antagonist at 5-HT2a