EXAM #3: ANTIPSYCHOTICS Flashcards
What is psychosis?
Variety of mental disorders that are characterized by:
1) Delusions– false beliefs
2) Hallucinations– auditory, visual, tactile, and olfactory
What is Schizophrenia?
A neurodevelopmental disorder characterized by severe psychosis
What are “positive” symptoms in Schizophrenia?
Manifestations of abnormal behavior including:
- Delusions
- Hallucinations
- Agitation
- Paranoia
- Aberrant thinking
- Intrusion of throughts
What are the “negative” symptoms of Schizophrenia?
Absence of normal behavior including:
- Flat affect
- Social withdrawal
- Inattentiveness
What is the “Dopamine Hypothesis” of Schizophrenia?
HYPERACTIVITY of the mesolimibic/ mesocortical DA system causes psychosis
What NTs have been implicated in Schizophrenia aside from DA?
1) 5-HT hyperactivity
2) Hypofunction of Glutamate (NMDA) receptors
What is the main mechanism of action of antipsychoitc drugs?
D2 receptor blockers (antagonists)
What is the main side effect of antipsychotic medications?
Extraparyamidal Symptoms
What are the two categories of antipsychotics?
Typical vs. Atypical
What are the clinical indications for antipsychotic agents?
1) Schizophrenia
2) Psychotic behavior
3) Severe mania (Bipolar)
4) Antiemetic
List the typical antipsychotics.
Chlorpromazine
Thioridazine
Fluphenazine
Haloperidol
List the atypical antipsychotics.
Clozapine Olanzapine Risperiodone Aripiprazole Quetiapine Ziprasidone
What is the difference between the metabolism of the typical and atypical antipsychotics?
Typical= metabolism into INACTIVE metabolite
Atypical= metabolism into ACTIVE metabolite
What receptor do the antipsychotics block?
D2 (mainly)
How does the mechanism of action of atypical antipsychotics differn from typical?
Atypical agents antagonize D2 AND 5-HT2A receptors
What is the relationship between D2 affinity and potency antipsychotic drugs?
Higher affinity for D2= more potent
What antipsychotic has high 5-HT affinity?
Clozapine
What is the relationship between receptor binding and EPS?
D2 antagonism is associated with more EPS
What receptor is associated with orthostatic hypotension?
Alpha-1
What receptor is associated with sedation in antipsychotics?
Histmaine
What can be expected from a drug with a high D2/5-HT2A ratio?
EPS symptoms
Antipsychotic action in what part of the brain produces antiemetic effects?
Medullary periventricular area
What are the different types of EPS?
1) Parkinson-like Syndrome
2) Akathesia (motor restlessness and anxiety)
3) Dystonia
4) Tardive Dyskinesia
What are the endocrine effects of antipsychotics?
Hyperprolactinemia
Males:
- Gynecomastia
- Decreased libido
What two antipsychotics are highly associated with weight gain?
Clozapine and Olanzapine
What type of antipsychotics are associated with weight gain?
Atypical/ newer antipsyhotics
What is Neuroleptic Malignant Syndrome?
Life-threatening HTN and Hyperthermia seen with antipsychotic administration
What type of antipsychotic is associated with LESS orthostatic hypotension/ alpha-1 effects?
Atypical antipsychotics
What atypical antipsychotic is most associated with EPS?
Risperidone
What atypical agents are least associated with EPS?
Clozapine
Quetiapine
What patients are more susceptible to tardive dyskinesia?
Elderly patients i.e. older than 65
What type of antipsychotics are associated with the development of Parkinson-like symptoms?
Typical antipsychotics
Which atypical antipsychotics are associated with an increased risk of DM?
Clozapine
Olanzapine
These are the drugs that are also most associated with weight gain
What are the common reasons that patients will stop taking antipsychotic medications?
1) Lack of efficacy
2) Unwilling to tolerate side effects
3) Weight gain
4) Sexual side effects
