Drugs in health and disease

Question 1

ANTIPSYCHOTICS

i) what is chlorpromazine used to treat? (2)
ii) name two APs that can be used for hiccups
iii) what may benperidol be used for?

Answer 1

i) chlorpromazine - psychosis and anti emetics
ii) chlorpromazine and haloperidol can be used for hiccups
iii) benperidol for deviant sexual behaviour

Question 2

DOSE RESPONSE CURVES

i) what can cause competitive inhibition of a drug?
ii) what happens to the dose response curve when competitive inhibition occurs?
iii) what is a non competitive inhibitor of a drug? give an eg

Answer 2

i) competitive inhib by an antagonist - competes for same binding sitee
ii) curve haas paralell shift but no change to max response (just need more to get to max)
iii) non competitive inhibitor - inhibitor binds an enzyme regardless of whether the agonist has already bound (naloxone)

Question 3

CHLORPROMAZINE HYDROCHLORIDE

i) why is it kept in a brown bottle?
ii) is it a stable drug? does it cross BBB?
iii) which brain area does it block NT in? (2) which NT is implicated?
iv) which brain area reduces halluc/delusions? why brain area relieves nausea and vomiting?

Answer 3

i) decomposes on exposure to air and light
ii) stable and crossess BBB
iii) blocks NT in cortical limbic area and CTZ - DA transmission is blocked
iv) limbic - delusions / CTZ - vomiting

Question 4

ADMIN OF ANTIPSYCHOTICS

i) if APs are given by IM injection in an emergency - is the dose lower or higher thaan oral? why?
ii) in what situation may rate of absorption be increased?
iii) how often should dose of APs given in emergency be reviewed?
iv) give two short term indications for APs

Answer 4

i) lower dose due to absence of first pass metab
ii) inc rate of abs due to increased muscle blood flow in active patients eg with tics
iii) review daily
iv) short term - calm patients and alleviate severe anx

Question 5

SCHIZOPHRENIA

i) how long may patients need APs for?
ii) what type of symptoms do APs relieve? what do they also prevent?
iii) which type of symptoms are they less effective against?
iv) do patients with acute or chronic symptoms respond better to treatment?

Answer 5

i) lifelong

ii) relieve positive symptoms eg hallucinations and delusions
- can also prevent relapse

iii) less effective against negative symptoms eg apathy/withdrawal
iv) patients with acute symptoms respond better

Question 6

FIRST GENERATION APS

i) what group are they derived from?
ii) which receptors are predominantly blocked?
iii) which group has the least EPS? give an eg
iv) which group has the most pronounced EPS? give an eg

Answer 6

i) phenothiazines
ii) block D2 Rs
iii) group 2 eg pericyazine
iv) group 3 - prochlorperazine / haloperidol

Question 7

SECOND GEN APS

i) give an example
ii) why do they have a wide range of side effects?

Answer 7

i) olanzapine - antipsych, antimanic, mood stabiliser
ii) lots of SEs as work on lots of receptors

Question 8

ADVERSE DRUG REACTIONS

i) name four extra pyramidal SEs
ii) name four other SEs of APs

Answer 8

i) EPS - parkinsonian syndrome, dystonia, akathisia, tardive dyskinesia
ii) hyperPRL, sexual dysfunc, CV side effecets, neuroleptic malignant syndrome

Question 9

CHLORPROMAZINE

i) name four indications
ii) name three receptors it blocks
iii) does it promote or inhibit release of prolactin?
iv) name three effects it has due to its action on the autonomic NS
v) how are salivary and gastric secreetions affected?
vi) how is it excreted? (2)

Answer 9

i) schz, mania, short term in severe anx, hiccup, acute psychoses
ii) blocks D2, cholinergic, alpha adrenergic, histamine, 5H
iii) promotes release of PRL by blocking PRL release inhibitory factor
iv) vasodilation, hypotension, tachycardia
v) reduced salivary and gastric secretions
vi) excreted via urine and faeces - GI abs

Question 10

EP SIDE EFFECTS

i) name two drugs that can supress parkinsonian SEs?
ii) what is dystonia? which group of people do these most commonly occur in?
iii) what is akathisia?
iv) what is tardive dyskinesia? what dose of drugs cause this? when may short tterm TD occur? is it reversible?

Answer 10

i) parkinsonian - supress by anticholinregics/antimuscarinics

ii) dystonia is abnornmal face and body movement
- common occurs in young people

iii) akathisia - restlessness
- occurs after large initial doses

iv) TD is rhythmic, involuntaary movementt that occurs with long term therapy or at high doses
- short term can occur on withdrawal of drug
- may not be reversible

Question 11

PROLACTIN

i) do most APs increase or decrease PRL? why?
ii) which type of APs cause this? name a drug
iii) name a drug that has the opposite effect
iv) name four clinical symptoms of the effect on PRL

Answer 11

i) most increase PRL as DA inhibits PRL release
ii) 1st gen APs / risperidone
iii) ariprazole reduces PRL
iv) hyperprolactin - sexual dysfunc, reduce BMD, mestrual disturb, breast enlarge, galactorrea