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PCOL 1 > Drugs for Mania and Schizophrenia > Flashcards

Drugs for Mania and Schizophrenia Flashcards

1
Q

Alternating between periods of EXTREMELY low mood and euphoric/irritable mood

Strong familial component, genetically determined

A

Manic-Depressive Disease

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2
Q

Elevated, expansive or irritable mood accompanied by
hyperactivity, pressure of speech, flight of ideas,
grandiosity, hyposomnia, and distractibility.

A

Mania

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3
Q

MOA of Lithium Carbonate

A

Inhibits recycling of phosphoinositide leading to decreased levels of IP3 and DAG

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4
Q

Pharmacokinetics of Lithium Carbonate

A

Not metabolized in the liver

Sodium competes with Lithium for renal tubular
reabsorption and thereby can increase the
excretion of Lithium

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5
Q

Adverse effects of Lithium Carbonate

A

Fine tremors at therapeutic doses (one of the most
common adverse effect

Polyuria (interferes with the action of ADH)

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6
Q

Limitation of Lithium Carbonate

A

Not effective in the management of RAPID CYCLING
→is a term used when a person with bipolar disorder experiences four or
more mood swings (episodes) within a 12-month period.

An episode may consist of depression, mania, or a condition known as mixed-state
in which depression and mania are co-occurring

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7
Q

Drug better than lithium in the management of rapid cycling

A

Valproic Acid

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8
Q

Drug used in the management and prophylaxis of mania

Alternative for patients who did not respond to lithium therapy

A

Carbamazepine

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9
Q

Examples of Antipsychotics

A

Aripiprazole

Risperidone

Ziprasidone

Olanzapine

Quetiapine

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10
Q

Causes of Schizophrenia

A

Genetic & Ecological

Dopamine & Serotonin Hypothesis

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11
Q

Evidences of Dopamine Hypothesis

A

Abnormalities in DA neurotransmission.

Most antipsychotic drugs block D2 receptors.

Drugs that act by increasing neuronal release of DA or by
blocking the neuronal reuptake of DA can induce psychotic
behavior that resembles the behavior of schizophrenic
patients.

Post-mortem studies have reported increase in dopamine
receptor density in brain of schizophrenics who were not
treated with antipsychotic drugs.

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12
Q

Description of Serotonin Hypothesis

A

5HT2A and 5HT2C stimulation leads to inhibition of cortical
and limbic DA release.

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13
Q

Positive Psychotic Symptoms (D,H,C,A)

A

Delusions

Hallucinations

Catatonia

Agitation

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14
Q

Disorganized Psychotic Symptoms (CT, DS, DB,DP)

A

Confused thinking

Disorganized speech

Disorganized behavior

Disorganized perceptions

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15
Q

NEGATIVE-deficit Symptoms (EF, Al, Av, An)

A

Emotional flattening

Alogia – limited speech

Avolition – lack of motivation

Anhedonia – lack of interest and pleasure

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16
Q

Cognitive Symptoms (DA, IM, DAF)

A

Decreased attention

Impaired memory

Decreased abstractive functions

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17
Q

Mood Symptoms (D,S,H)

A

Dysphoria

Suicidality

Hopelessness

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18
Q

Three Schizophrenia Phases

A

Prodromal

Psychotic (acute)

Residual (chronic)

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19
Q

Prodromal Phase (D,S,H,I,PC)

A

Dysphoria

Suicidality

Hopelessness

Decline in functioning
that precedes 1st
psychotic episode

Socially withdrawn

Irritable

Physical complaints

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20
Q

Psychotic (acute) Phase (DHCA,PD,D,DT)

A

Positive symptoms

Perceptual disturbance

Delusions

Disorganized thought

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21
Q

Residual (chronic) Phase

A

Occurs between episodes of psychosis
Marked by negative symptoms

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22
Q

Increased activity in this pathway may
cause delusions, hallucinations, and
other positive symptoms.

A

Mesolimbic Pathway

23
Q

Decreased activity in this pathway can
cause apathy, withdrawal, lack of
motivation and pleasure, and other
negative symptoms.

A

Mesocortical Pathway

24
Q

Inhibition of this pathway causes
extrapyramidal side effects of
antipsychotic drugs.

A

Nigrostriatal Pathway

25
Q

Inhibition of this pathway leads to
elevated serum prolactin levels.

A

Tuberofundibular Pathway

26
Q

MOA of Typical/1st Generation Antipsychotics

Antipsychotics AKA “Neuroleptics/ Major tranquilizers” usually take several weeks for their effects to fully develop

A

Blockade of Dopamine

Target: Mesolimbic neurons, Nigrostriatal neurons, Tuberofundibular neurons

Effect: Alleviate Positive symptoms, Extrapyramidal side effects, Hyperprolactinemia

27
Q

MOA of Typical/2nd Generation Antipsychotics

A

Blockade of Serotonin

Target: Mesocortical neurons

Effect : Alleviate Negative symptoms

28
Q

Examples of First generation Phenothiazines (“ZINE”)

A

CHLORPROMAZINE
PROMAZINE
TRIFLUPROMAZINE
FLUPHENAZINE
PERPHENAZINE
ACETOPHENAZINE
TRIFLUOPERAZINE
PROCHLORPERAZINE
THIORIDAZINE
MESORIDAZINE
*PIMOZIDE
PIPERACETAZINE

29
Q

Examples of First generation Butyrophenone (“PERIDOL”)

A
  • HALOPERIDOL
    DROPERIDOL
30
Q

Examples of First generation Thioxanthines (“XENE” | “XOL”)

A

THIOTHIXENE
CHLORPROTHIXENE
FLUPENTIXOL

31
Q

Nervous system disorder that involves
repetitive movement or unwanted sounds (tics)
that can’t be controlled, caprolalia, and
echolalia.

A

Tourette Syndrome

32
Q

Examples of Second Generation (“PINE” | “ONE” | “OLE” | “PRIDE”)

A

OLANZAPINE - As effective as Haloperidol in alleviating positive symptoms

CLOZAPINE
- First atypical neuroleptic; lowers the risk of suicide and tardive dyskinesia
- Use us limited because of adverse effects

QUETIAPINE - Indicated for mania and adjunctive therapy for MDD

ARIPRIPRAZOLE - Indicated for Tourette Syndrome

LOXAPINE
RISPERIDONE
PRALIPERIDONE
ZIPRASIDONE
SERTINDOLE
AMILSUPRIDE

33
Q

Adverse effects of clozapine

A

Seizures

Agranulocytosis - requires
monitoring of leukocyte during the
first 6 months of therapy.

34
Q

Adverse effects of risperidone

A

QT prolongation

35
Q

Adverse effects of Thioridazine

A

Pigmentary retinopathy

Cardiac toxicity

36
Q

Adverse effects of Chlorpromazine

A

Corneal Deposits

37
Q

General adverse effects of Antipsychotics

A

Alpha-1 adrenoceptor blockade

Muscarinic receptor blockade

Histamine receptor blockade (CNS)

Neuroleptic Malignant Syndrome

38
Q

A severe form of drug toxicity that occurs in 0.5% to 1% of patients treated with antipsychotics

A life-threatening condition characterized by
muscle rigidity, hyperthermia, and autonomic dysfunction (tachycardia, diaphoresis, tachypnea, and urinary and
fecal incontinence)

A

Neuroleptic Malignant Syndrome

39
Q

Management of Neuroleptic Malignant Syndrome

A

Discontinue antipsychotic drug

Administer DANTROLENE

Provide supportive care

40
Q

Adverse effects of dopamine blockade: inhibition of the dopamine receptors in the striatal pathway

A

Extrapyramidal Syndrome

Tardive Dyskinesia

41
Q

Adverse effects of dopamine blockade: inhibition of the dopamine receptors in the tuberofundibular pathway

A

Hyperprolactinemia

42
Q

General management of Extrapyramidal Syndrome

A

Decrease the dose of the antipsychotic drug

Change into atypical antipsychotic

Administration of drug that can counteract it

43
Q

Extrapyramidal Syndrome Manifestations

A

Akathisia

Pseudo parkinsonism

Dystonia

44
Q

motor restlessness; most difficult to treat

compelled to pace, shuffle their feet, shift positions, unable to sit quietly

A

Akathisia

45
Q

Management of Akathisia

A

Administration of BZD (Benzodiazepines)

46
Q

tremors, rigidity, and bradykinesia

A

Pseudo parkinsonism

47
Q

Management of Pseudo Parkinsonism

A

Administration of anticholinergic agents

48
Q

abnormal muscle tension of the neck and face (oculogyric crisis, gloss spasm, tongue protrusion, torticollis)

difficulty to move

A

Dystonia

49
Q

Management of Dystonia

A

Diphenhydramine, anticholinergic agents

50
Q

Abnormal involuntary movements occurring with CHRONIC antipsychotic therapy (months to years).

Abnormal movements of the face and tongue with widespread choreoathetosis.

“superdensity phenomenon”

A

Tardive Dyskinesia

51
Q

Management of Tardive Dyskinesia

A

Lower the dose or discontinue and give atypical agents

52
Q

Prevention of Tardive Dyskinesia

A

Lowest dose for the shortest period of time required to control symptoms of schizophrenia. The drug should be discontinued periodically to assess the need for continued treatment and possibly to reduce dopamine super sensitivity.

53
Q

Manifestations of Hyperprolactinemia

A

Galactorrhea - milk production from the breast unrelated to pregnancy or lactation

Amenorrhea - the absence of menstruation

Gynecomastia in men

PCOL 1 (10 decks)

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