Exam 4 - Watts Schizophrenia

Question 1

positive Sx of schoziphrenia
-things we can’t normally see

Answer 1

hallucinations
delusions
bizarre behavior
thought disorders

Question 2

negative Sx of schizophrenia
-things we can see

Answer 2

blunted emotion
poor self care
social withdrawal
poverty in speech

Question 3

In which do we see more of a response in treatment, negative sx or positive sx?

Answer 3

positive sx

Question 4

drugs that can exacerbate psychosis via glutamate hypothesis

Answer 4

ketamine
phencyclidine

Question 5

what is the major excitatory neurotransmitter?

Answer 5

glutamate

Question 6

drugs that can exacerbate schizophrenia sx via dopamine hypothesis

Answer 6

L-DOPA
amphetamine
bromocriptine

Question 7

which receptor that drugs act on, D1 or D2, shows great correlation between binding potency and clinical effectiveness?

Answer 7

D2

Question 8

roles of presynaptic terminals at synapse

Answer 8

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.

Question 9

actions of D2 antagonists in CNS on basal ganglia

Answer 9

motor effects and EPS

Question 10

actions of D2 antagonists in CNS on mesolimbic (most important)

Answer 10

primary therapeutic effects happen here

Question 11

actions of D2 antagonists in CNS on mesocortical

Answer 11

hypofunction in schizophrenia, antagonists may exacerbate cognitive deficits

Question 12

how common is EPS (%) and name its 4 Sx

Answer 12

30-50% of pts
increased muscle tone (dystonia)
muscle rigidity (pseudoparkinsonism)
restlessness (akathisia)
tremor

Question 13

Tx of EPS (7 agents)

Answer 13

benztropine (Cogentin)
trihexyphenynidyl (Artane)
akineton (Biperiden)
anticholinergic agents
diphenhydramine
amantadine (Symmetrel) (DA releasing agent)
propranolol (for akathisia)

Question 14

how common is tardive dyskinesia (%) and name its 4 Sx

Answer 14

20-40% (irreversible)
mouth: involuntary movements
choriform: irregular purposelessness
athetoid: worm like
axial hyperkinesias: to and fro movements

Question 15

Tx of tardive dyskinesia

Answer 15

Prevention!! - use least risky agent at lowest dose
newer antipsychotics (atypical)
use VMAT inhibitors
-valbenazine (Ingrezza)
-deutetrabenazine (Austedo)
remove anticholinergics

Question 16

NMS Sx

Answer 16

EPS w/ fever
impaired cognition
muscle rigidity

Question 17

Tx of NMS

Answer 17

dc drug
DA agonists, diazepam, or dantrolene

Question 18

pimozide indication(s)

Answer 18

tourette’s

Question 19

2 meds with increased risk for metabolic problems and diabetes

Answer 19

clozapine and olanzapine

Question 20

pathway involved in movement

Answer 20

nigrostriatal (NS)

Question 21

postsynaptic D2 blocking in NS pathway leads to what

Answer 21

movement disorders (typical antipsychotics)

Question 22

blocking presynaptic serotonin receptors leads to what

Answer 22

increase in synaptic DA

Question 23

describe atypical antipsychotic blocking in NS synapse

Answer 23

blocks serotonin receptors, which increases synaptic DA
drug competes with DA at D2 receptors which leads to less motor SE

Question 24

clozapine (Clozaril) SE

Answer 24

agranulocytosis
anticholinergic properties
antihistamine properties

Question 25

olanzapine (Zyprexa) SE

Answer 25

weight gain
risk of diabetes

Question 26

risperidone (Risperidal) SE

Answer 26

low EPS at <8mg/day
weight gain

Question 27

lurasidone (Latuda) SE

Answer 27

less weight gain and metabolic effects
fast onset (just days)

Question 28

antiadrenergic SE

Answer 28

bradycardia
hypotension
hyperglycemia

Question 29

aripiprazole (Abilify) SE

Answer 29

weight gain
low risk for motor SE
partial agonist

Question 30

low dopaminergic activity = ?

Answer 30

EPS

Question 31

high dopaminergic activity = ?

Answer 31

psychosis

Question 32

brexpiprazole (Rexulti) SE

Answer 32

less akathisia than aripiprazole

Question 33

cariprazine (Vraylar) SE

Answer 33

high risk of akathisia

Question 34

quetiapine (Seroquel) SE

Answer 34

hypotension
sedation (lower risk)