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Pharmacology 3 > E1- Antipsychotics and Mood Stabilizers > Flashcards

E1- Antipsychotics and Mood Stabilizers Flashcards

1
Q

What causes “positive” symptoms like hallucinations, delusions, catatonic behavior, disorganized speech and thinking?

A

Over-active dopamine pathways in limbic system

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2
Q

What causes “negative” symptoms like apathetic behavior, withdrawn, anti-social, lack of motivation, and depressed?

A

Under-active dopamine pathways in in frontal cortex

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3
Q

What is the mesolimbic pathway? What is it associated with?

A

Ventral Tegmental Area (VTA) to limbic system (emotion)

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4
Q

What is the mesocortical pathway? What is it associated with?

A

Ventral Tegmental Area (VTA) to frontal cortex (cognition, emotion)

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5
Q

What is the nigrostriatal pathway? What is it associated with?

A

Substantia Nigra (SN) to striatum (motor control)

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6
Q

What is the tuberoinfundibular pathway? What is it associated with?

A

Hypothalamus to pituitary (prolactin)

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7
Q

What are general effects of antipsychotics?

A

Decrease aggression, restlessness, and anxiety
Slow psychomotor function
Sedation
Block muscarinic, alpha, and histamine receptors

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8
Q

Which antipsychotic has antiemetic effects?

A

Prochlorperazine

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9
Q

What are general SE of antipsychotics?

A 
“BAE WAX PANTS”
B- bruxism
A- anticholinergic effects
E- Extrapyramidal symptoms
W- weight gain
A- alpha blocker effects
X- xerostomia
P- prolactin secretion
A- antihistamine effects
N- neuroleptic malignant syndrome
T- tardive dyskinesia
S- seizure threshold
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10
Q

How is Parkinson’s like tremor (extrapyramidal symptom) treated?

A

Benztropine (anticholinergic)

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11
Q

What are choreiform, uncontrollable, jerky movements of face and limbs? Which drugs are least likely to cause this?

A

Tardive dyskinesia

Clozapine and Olanzapine

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12
Q

What is a life threatening SE of antipsychotics that causes muscle rigidity and hyperpyrexia?
How is it treated?

A

Neuroleptic Malignant Syndrome

Dantrolene and Bromocriptine

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13
Q

What are possible drug interactions with antipsychotics?

A 
Anticholinergics
Sedative-hypnotics
TCAs
Inducers of CYP450s (Carbamazepine, smoking)
Antihypertensives
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14
Q

What are the drugs classified as classical antipsychotics? (3)

A

Chlorpromazine
Fluphenazine
Haloperidol

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15
Q

What is the MOA of classical antipsychotics?

A

Block DA D2 receptors; target the mesolimbic system (alleviate “positive” sx)

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16
Q

What are the uses of Chlorpromazine?

A

Psychosis associated with mania and drugs of abuse

Pre-anesthetic

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17
Q

Do classical or atypical antipsychotics tend to cause more extrapyramidal sx?

A

Classical

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18
Q

Which classical antipsychotic has the highest anticholinergic effects and lowest incidence of EPS?

A

Chlorpromazine

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19
Q

What classical antipsychotic may cause retinal deposits “browning of vision?”

A

Chlorpromazine

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20
Q

What is the use of Haloperidol?

A

Acute situations (can be injected)

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21
Q

Which classical antipsychotic has no anticholinergic effects and high incidence of EPS?

A

Haloperidol

22
Q

What is the MOA of atypical antipsychotics?

A

Block 5-HT2A and DA D4 receptors; target the Mesocortical and Mesolimbic system (alleviate both negative and positive sx)

23
Q

What is the first-line drugs for psychosis?

A

Risperidone

24
Q

Which 2 antipsychotics can prolong QT interval?

A

Risperidone and Ziprasidone

25
Q

Which antipsychotic is drug of last choice due to risk of agranulocytosis?

A

Clozapine

26
Q

Which antipsychotic causes hyperglycemia and can lead to Type II DM?

A

Olanzapine

27
Q

Which antipsychotic can also be used for bipolar disorder?

A

Olanzapine

28
Q

Which antipsychotic is used to promote sleep onset and maintenance?

A

Quetiapine

29
Q

Which 2 antipsychotics do not elevate prolactin?

A

Quetiapine and Aripiprazole

30
Q

Which antipsychotic has some antidepressant activity?

A

Ziprasidone

31
Q

What are the uses of Ziprasidone?

A

Tourette’s syndrome

Acute mania

32
Q

What is the MOA of Lurasidone?

A

Partial agonist for 5-HT1A; antagonist for D2 and 5-HT2A

33
Q

What drugs are classified as atypical psychotics?

A 
“ZAC QORL”
Z- ziprasidone
A- aripiprazole
C- clozapine
Q- quetiapine
O- olanzapine
R- risperidone
L- lurasidone
34
Q

What is the use of Lurasidone?

A

Depression with bipolar disorder

35
Q

What are SE of Lurasidone?

A

Agranulocytosis, neutropenia

36
Q

What antipsychotic is a DA stabilizer?

A

Aripiprazole
Dopaminergic tone is low- DA receptors are activated
Dopaminergic tone is high- DA receptors are blocked

37
Q

What are SE of Aripiprazole?

A

Hyperglycemia

Decreased esophageal motility

38
Q

What is the treatment of Bipolar Affective Disorder

A

Lithium or anticonvulsants

39
Q

What is the MOA of lithium?

A

Suppresses 2nd messengers (IP3)

40
Q

Lithium is competes with what for reabsorption by the PT in the kidney?

A

Na+

41
Q

How do low levels of Na+ affect Li?

A

Li absorption increases (toxicity)

42
Q

How do high levels of Na+ affect Li?

A

Li absorption decreases (excretion increases)

43
Q

How do high levels of Li affect Na+?

A

Na+ absorption decreases (hyponatremia)

44
Q

What is important about the SE and toxicity potential for Lithium?

A

Li has a small therapeutic window

45
Q

What are SE of Lithium?

A

Hypothyroidism

Diabetes insipidus

46
Q

Should Lithium be used in pregnancy?

A

No

47
Q

What are some possible drug interactions of Lithium?

A

Antidepressants
Diuretics
NSAIDs
Sodium

48
Q

Lithium does not have drug interactions with what two classes of drugs?

A

BZs and antipsychotics

49
Q

Which 2 anticonvulsants are used for rapid cycling manic/depressive phases? (alternative to Li for tx of Bipolar)

A

Valporic Acid

Gabapentin

50
Q

Which anticonvulsant is used for refractory bipolar disorder or in combination with Lithium?

A

Carbamazepine

51
Q

Which anticonvulsant is used for prevention of relapse, depressive state following mania, and acute mania? (alternative to Li for tx of Bipolar)

A

Lamotrigine

Pharmacology 3 (10 decks)

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