Drug Therapy Flashcards

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1
Q

Define “typical antipsychotics”

A

Are dopamine antagonists in that they bind to but do not stimulate dopamine receptors and so reduce the symptoms of schizophrenia.

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2
Q

Define the term “atypical antipsychotics”

A

Carry a low risk of extrapyramidal side effects, have a beneficial effect on negative symptoms and cognitive impairment, and are suitable for treatment-resistant patients.

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3
Q

What are the use of antipsychotics?

A
  • To reduce dopamine in areas of the brain associated with symptoms of schizophrenia.
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4
Q

Give an example of a typical antipsychotic

A

Chlorpromazine

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5
Q

Give an example of an atypical antipsychotic

A

Clozapine

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6
Q

Outline the benefits of typical antipsychotics

A
  • Reduce dopamine by binding to but not stimulating dopamine receptors in the mesolithic pathway.
  • Eliminate hallucinations and delusions
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7
Q

Outline the costs of typical antipsychotics

A
  • Kapur et al (2000) - between 60% and 75% of d2 receptors in the mesolimbic pathway must be blocked for these drugs to be effective = in order to do this must block other areas of the brain = undesirable side effects
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8
Q

Outline the benefits of atypical antipsychotics

A
  • Carry a lower risk of extrapyramidal side effects
  • Have a beneficial effect on negative symptoms
  • Suitable for treatment-resistant patients.
  • Have a stronger affinity for serotonin receptors and a lower affinity for dopamine receptors.
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9
Q

What is also a difference between typical and atypical antipsychotics?

A
  • Atypical = act on dopamine system by blocking d2 receptors but only temporarily then rapidly dissociate to allow normal dopamine transmission
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10
Q

Why is rapid dissociation a benefit of atypical antipsychotics?

A
  • Leads to lower extrapyramidal side effects - have little effect on the dopamine system that control movement.
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11
Q

AO3

Is there a difference between antipsychotics and placebos?

A

P: Research support = antipsychotics > placebos.
E: Leucht et al (2012) - meta-analysis of 65 studies, involving nearly 6,000 patients.
Some given placebo, while others remained on medication.
Within 12 months = 64% of placebo patients relapsed compared to 27% of antipsychotics
E: Clearly shows superiority of antipsychotic drugs compared to placebo in preventing relapse

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12
Q

A03

What are the side effects that typical antipsychotics can produce?

A

P: Can produce movement problems = extrapyramidal side effects - as drugs impact extrapyramidal area of brain, which helps control motor activity.
E: More than half of patients = symptoms of Parkinson’s Disease.
When taken for a long time = tar dive dyskinesia, i.e involuntary movements of the tongue, face and jaw.
E: Side effects = distressing to patient leading to other drugs to control them or they may stop medication completely

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13
Q

AO3

Are typical antipsychotics subject to ethical problems?

A

P: Problems with typical drugs raise ethical concerns
E: Recently in the US, a large out of court settlement was awarded to a tardive dyskinesia sufferer on the basis of Article 3 of the Human Rights Act, which states that ‘ no one shall be subjected to inhuman or degrading treatment or punishment’
E: Suggests that is side effects, deaths and psychosocial consequences were taken into account, a cost-benefit analysis of typical antipsychotics would most likely be negative.

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14
Q

AO3

What are the advantages of atypical over typical antipsychotics?

A

P: Atypical = more advantages. Key advantage = fewer side effects
E: Atypical - newly developed drugs like olanzapine and quetiapine, are less likely to produce extrapyramidal side effects commonly found in typical drugs.
E: Patients more likely to continue with medication = reduction in symptoms.

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15
Q

AO3

Is there a difference between atypical and typical drugs in terms of reduction of symptoms or side effects?

A

P: The info of atypical drugs = more superior than typical. may not be the case.
E: Crosley et al (2010) - meta-analysis of 15 studies to examine efficacy (reduction of symptoms) and side effects.
Found = no difference in terms of effect on symptoms
Found = difference in side effects. Typical = more extrapyramidal side effects. Atypical = gained more weight.
E: Concluded no differences in efficacy between the two, but clear difference in side-effect profile.

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16
Q

AO3

Can the use of antipsychotic medication lead motivational problems for patients?

A

P: Ross and Read (2004) - medication reinforces view that there is ‘something wrong’ with patient.
E: Leads them to think about possible stressors (such as life history or current problems) that might contribute to their condition = reduces motivation to look for solutions that might alleviate these stressors and reduce their suffering.
E: Read (2005) concludes that as human misery is largely inflicted by other people then the best solution are usually human - rather than chemical or electrical - interventions.