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neurology/psychiatry > Gibbs Antipsychotics > Flashcards

Gibbs Antipsychotics Flashcards

1
Q

positive symptoms

A

delusions
hallucinations
disorganized speech
unusual behavior
psychomotor agitation

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2
Q

negative symptoms

A

flat affect
poverty of speech (alogia)
lack of energy
lack of interest
social withdrawal
avolition (inability to follow through with activities)
anhedonia (lack of pleasure)

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3
Q

cognitive symotoms

A

attention
memory
executive dysfunction
skill acquisition

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4
Q

mood symptoms

A

depression
anxiety
aggression
hostility
hopelessness
suicidality

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5
Q

occupational and social dysfunction

A

social isolation
unemployment
poor relationships
poor self care

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6
Q

schizophrenia definition

A

a debilitating disease of neuronal connectivity and function in which patients experience and interpret reality abnormally

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7
Q

schizophrenia epidemiology

A

no gender, racial differences
strong genetic component

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8
Q

difference of age onset in males vs females

A

males 17-27
females 20-37

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9
Q

schizophrenia cost to society

A

very high
mostly indirect costs

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10
Q

initial diagnostic presentation of schizophrenia

A

positive symptoms

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11
Q

early onset means ___ prognosis

A

worse

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12
Q

women tend to have ___ onset and ___ prognosis

A

later onset, better prognosis

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13
Q

life expectancy schizophrenia

A

may be reduced 20-30 years

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14
Q

DSM-V diagnostic criteria for schizophrenia

A

at least two of the following for over a month: delusion, hallucination, disorganized speech, disorganized behavior, negative symptoms
ONE OF THE TWO MUST INCLUDE DELUSION, HALLUCINATION, DISORGANIZED SPEECH
must cause social dysfunction
symptoms for at least 6 months
rule out schizoaffective, mood disorder, substance use

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15
Q

1 cause of premature death in schizophrenia

A

suicide

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16
Q

suicide risk is ___ higher than the general population

A

50X

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17
Q

schizophrenia therapeutic phases

A

acute, stabilization, maintenance

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18
Q

goals of acute phase

A

reduce acute symptoms, reduce threat to self or others

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19
Q

goals of stabilization phase

A

minimize, prevent symptom relapse
optimize therapeutic dose & minimize side effects

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20
Q

goals of maintenance phase

A

improve functioning, QOL
monitor for prodrome and adverse effects
promote medication compliance

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21
Q

classes of FGAs

A

phenothiazines, thioxanthenes, butyrophenones

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22
Q

phenothiazines

A

chlorpromazine, promazine
trifluopromazine
fluphenazine
perphenazine
thioridazine
mesoridazine

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23
Q

chlorpromazine dose

A

200-900 mg/day
LOW POTENCY

24
Q

chlorpromazine side effects

A

sedation, hypotension due to alpha1 adrenergic blockade
EPS due to dopamine D2 receptor blockade in basal ganglia

25
Q

thioxanthenes

A

thiothixene
flupentixol

26
Q

butyrophenones

A

haloperidol
droperidol
benperidol

27
Q

haloperidol dose

A

5-40 mg/day
HIGH POTENCY

28
Q

haloperidol side effects

A

significant EPS

29
Q

all of the FGAs mechanistically act as ___

A

antagonist at dopamine receptors

also bind with varying degrees of potency to 5HT, cholinergic, histamine receptors

30
Q

antipsychotic binding to __ receptors correlates with clinical potency

A

D2

31
Q

dopamine hypothesis

A

excessive dopaminergic activity underlies schizophrenia

32
Q

3 key points to know for FGAs

A

1) efficacy correlates w/ D2 blockade
2) alleviate mainly positive symptoms
3) high risk of EPS and tardive dyskinesia with high dose, long term use

33
Q

modified dopamine hypothesis

A

schizophrenia is associated with hyperdopamine function in the subcortical regions of the brain (positive symptoms) and hypodopamine function in the prefrontal cortex (negative symptoms)

34
Q

serotonin hypothesis

A

hallucinogens (LSD) are 5HT2a agonists
atypical antipsychotics are inverse 5HT2a agonists
5HT2a receptors modulate DA release
risperidone/olanzapine (5HT2a blocking activity) have greater efficacy for treating NEGATIVE SYMPTOMS/produce fewer EPS

35
Q

glutamate hypothesis

A

NMDAR antagonists (PCP, ketamine) produce sensory hallucinations
changes in glutamate receptor binding found in brains of subjects with schizophrenia
reduced NMDA receptor binding in med-free patients (chronic overactivation of the receptors)

36
Q

4 defining features of SGAs

A

1) block more than one type of receptor
2) greater affinity for serotonin receptors
3) more effective at alleviating negative symptoms than FGAs, improve cognitive function
4) less movement disordersS

37
Q

SGAs (drug names)

A

clozapine
risperidone
olanzapine
quetiapine
ziprasidone
paliperidone
asenapine
iloperidone

38
Q

clozapine is associated with

A

significant risk of neutropenia (loss of neutrophils) which can develop into agranulocytosis (loss of WBCs)
requires extensive blood monitoring

39
Q

third generation agent?

A

aripiprazole

40
Q

aripiprazole mechanism

A

acts as D2 partial agonist (instead of antagonist)
stabilizes dopamine hyperactivity and hypoactivity

41
Q

aripiprazole is an antagonist where ___

A

DA levels high (limbic regions)

42
Q

aripiprazole is an agonist where ___

A

DA levels low (prefrontal cortex)

43
Q

aripiprazole is also involved in serotonin receptors how

A

partial agonist 5HT1a
antagonist 5HT2a

44
Q

many side effects of antipsychotics

A

EPS
metabolic
cardiac
endocrine
adrenergic
anticholinergic
antihistaminergic
akathisia
neuroleptic malignant syndrome

45
Q

EPS

A

parkinsonism, dystonias, tardive dyskinesia

46
Q

metabolic effects

A

weight gain, hyperglycemia, dyslipidemia, diabetes

47
Q

cardiac effects

A

QT prolongation

48
Q

endocrine effects

A

hyperprolactinemia
gynecomastia men, amenorrhea women

49
Q

adrenergic effects

A

orthostatic hypotension

50
Q

anticholinergic effects

A

dry eye, dry mouth, constipation, blurred vision, cognitive impairment

51
Q

antihistaminergic effects

A

weight gain, sedation

52
Q

akathisia

A

feeling of internal restlessness

53
Q

neuroleptic malignant syndrome

A

muscular rigidity, fever, severe EPS, potentially fatal

54
Q

definition of extrapyramidal side effects

A

movement disorders caused by D2 receptor blockage in the extrapyramidal motor system
referred to as pseudoparkinsonism

55
Q

tardive dyskinesia definition

A

severe abnormal movements, typically involve face, neck, tongue

neurology/psychiatry (22 decks)

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