Exam 4 - Watts Schizophrenia Flashcards
positive Sx of schoziphrenia
-things we can’t normally see
hallucinations
delusions
bizarre behavior
thought disorders
negative Sx of schizophrenia
-things we can see
blunted emotion
poor self care
social withdrawal
poverty in speech
In which do we see more of a response in treatment, negative sx or positive sx?
positive sx
drugs that can exacerbate psychosis via glutamate hypothesis
ketamine
phencyclidine
what is the major excitatory neurotransmitter?
glutamate
drugs that can exacerbate schizophrenia sx via dopamine hypothesis
L-DOPA
amphetamine
bromocriptine
which receptor that drugs act on, D1 or D2, shows great correlation between binding potency and clinical effectiveness?
D2
roles of presynaptic terminals at synapse
safety switches for synthesis and release of dopamine
-normally, if there is too much dopamine, it leaks around the synapse and binds to presynaptic terminal to tell it to stop producing dopamine. If we block these, dopamine will continue to be synthesized and released into the synapse, causing schizophrenia.
actions of D2 antagonists in CNS on basal ganglia
motor effects and EPS
actions of D2 antagonists in CNS on mesolimbic (most important)
primary therapeutic effects happen here
actions of D2 antagonists in CNS on mesocortical
hypofunction in schizophrenia, antagonists may exacerbate cognitive deficits
how common is EPS (%) and name its 4 Sx
30-50% of pts
increased muscle tone (dystonia)
muscle rigidity (pseudoparkinsonism)
restlessness (akathisia)
tremor
Tx of EPS (7 agents)
benztropine (Cogentin)
trihexyphenynidyl (Artane)
akineton (Biperiden)
anticholinergic agents
diphenhydramine
amantadine (Symmetrel) (DA releasing agent)
propranolol (for akathisia)
how common is tardive dyskinesia (%) and name its 4 Sx
20-40% (irreversible)
mouth: involuntary movements
choriform: irregular purposelessness
athetoid: worm like
axial hyperkinesias: to and fro movements
Tx of tardive dyskinesia
Prevention!! - use least risky agent at lowest dose
newer antipsychotics (atypical)
use VMAT inhibitors
-valbenazine (Ingrezza)
-deutetrabenazine (Austedo)
remove anticholinergics
NMS Sx
EPS w/ fever
impaired cognition
muscle rigidity
Tx of NMS
dc drug
DA agonists, diazepam, or dantrolene
pimozide indication(s)
tourette’s
2 meds with increased risk for metabolic problems and diabetes
clozapine and olanzapine
pathway involved in movement
nigrostriatal (NS)
postsynaptic D2 blocking in NS pathway leads to what
movement disorders (typical antipsychotics)
blocking presynaptic serotonin receptors leads to what
increase in synaptic DA
describe atypical antipsychotic blocking in NS synapse
blocks serotonin receptors, which increases synaptic DA
drug competes with DA at D2 receptors which leads to less motor SE
clozapine (Clozaril) SE
agranulocytosis
anticholinergic properties
antihistamine properties
olanzapine (Zyprexa) SE
weight gain
risk of diabetes
risperidone (Risperidal) SE
low EPS at <8mg/day
weight gain
lurasidone (Latuda) SE
less weight gain and metabolic effects
fast onset (just days)
antiadrenergic SE
bradycardia
hypotension
hyperglycemia
aripiprazole (Abilify) SE
weight gain
low risk for motor SE
partial agonist
low dopaminergic activity = ?
EPS
high dopaminergic activity = ?
psychosis
brexpiprazole (Rexulti) SE
less akathisia than aripiprazole
cariprazine (Vraylar) SE
high risk of akathisia
quetiapine (Seroquel) SE
hypotension
sedation (lower risk)
