Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharmacology > Lecture 10 - Antipsychotics > Flashcards

Lecture 10 - Antipsychotics Flashcards

1
Q

Typical = __ gen

A

1st

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Atypical = ___ gen

A

2nd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Drugs used in as antipsychotics?

A 
clorpromazine
haloperidol
clozapine
quetiapine
aripiprazole
risperidone
olanzapine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Two common types of symptoms in schizophrenia?

A

positive

negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Positive symptoms are associated with what pathway?

A

dopamine mesolimbic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Negative symptoms are associated with what pathway?

A

dopamine mesocortical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

_% lifetime risk of schizophrenia

A

1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which gender is more at risk?

A

males 1.4 times more at risk than females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Onset in males ?

A

15-24 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Onset in females ?

A

25-34 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Is there a genetic predisposition to schizophrenia?

A

yes

-if you have a first degree relative your changes go from 1% to 10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

_____ symptoms = excess cognition

A

positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

_____ symptoms = deficits in behaviour

A

negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

List some positive symptoms

A

hallucinations
delusions
disorganized speech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

List some negative symptoms

A

avolition - lack of initiative or motivation
anhedonia - lack of pleasure
blunted affect - lack of mood, lack of expression
alogia - poverty of speech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

____ symptoms - their presence is abnormal

A

positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

____ symptoms - the absence of normal characteristics

A

negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe cognitive symptoms

A

-declines in attention, language, memory, executive function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe affective symptoms

A

-blunted, inappropriate, odd expression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Cognitive or affective:

often lead to social stigmatization

A

affective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Cognitive or affective:

probably present from birth

A

cognitive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What leads to positive symptoms?

A

too much mesolithic dopamine pathway activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What leads to negative symptoms?

A

low dopaminergic activity in the mesocortical pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe the mesolimbic pathway

A

Starts - VTA (ventral tegmental area)
Ends - NAcc (Nucleus Accumbens)
NT = Dopamine D2

Positive symptoms!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the NAcc (Nucleus Accumbens) associated with?
Motivation Reward Addiction Reinforcing behavior
26
Describe the mesocortical pathway
Starts - VTA Ends - PFC (prefrontal cortex) NT = Dopamine D1 Negative symptoms!
27
What is the PFC (pre frontal cortex) associated with?
cognition communication social function stress response
28
Overactivity of Da from VTA to NAcc = ?
- positive symptoms - D2 - mesolimbic
29
Overactivity of Da from VTA to PFC = ?
- negative symptoms - D1 - mesocortical
30
How do antipsychotics work?
they strongly block D2 dopamine receptors
31
What 2 key points support the dopamine hypothesis?
1 - most antipsychotics strongly block D2 dopamine receptors 2 - drugs that increase dopaminergic activity can produce psychosis
32
What do typical (1st gen) antipsychotics work on?
Mesolimbic pathway
33
What do atypical (2nd gen) antipsychotics work on?
Mesolimbic pathway | Mesocortical pathway
34
How do typical antipsychotics work?
- antagonism of D2 receptors in the mesolimbic pathway | - relief from positive symptoms
35
Examples of typical antipsychotics
Chlorpromazine Fluphenazine Haloperidol Thiothixene Chlorpromazine and Haloperidol - 2 most common
36
What are the adverse effects of typical antipsychotics related to?
1 - receptor non-selectivity (blocks other receptors other than the D2 receptors) 2 - blockade of non-mesolimbic D2 dopaminergic pathways
37
What adverse effects result from receptor non-selectivity in typical antipsychotics?
- tosic confusional state, dry mouth, urinary retention (antimuscarinic) - orthostatic hypotension, dizziness, tachycardia, impotence (alpha 1 blockade) - weight gain (histamine H1 blockade) - sedation (histamine H1 blockade)
38
What are the off target receptors in receptor non-selectivity of typical antipsychotics?
- alpha 1 adrenergic receptors - muscarinic receptors - histamine receptors
39
Blockade of non-mesolimbic D2 dopaminergic pathways: | nigrostriatal pathway
Starts - SN (substantia nigra) Ends - STR (striatum) NT = dopamine D2 blocks D2 - results in EPS (extrapyramidal side effects): - parkinson's syndrome - akathisia (pacing, shifting, shuffling) - acute dystonic rxns (abnormal muscle spasms) - tardive dyskinesia (no reliable treatment, can be irreversible) - abnormal involuntary muscle movements
40
Blockade of non-mesolimbic D2 dopaminergic pathways: | Tuberoinfundibular pathway
Starts - HYPO Ends - PIT NT = dopamine D2 Blocks D2 - results in increased prolactin production Side effects for women: - lactation - amenorrhea (abnormal absence of menstruation) - infertility Side effects for men: - lactation - impotence - decreased libido - gynecomastia (developing female like features)
41
List some other adverse effects of typical antipsychotics
- pseudodepression related to drowsiness, restlessness, and autonomic effects - corneal and lens deposits (chlorpromazine) - retinal deposits (thioridizine) - cardiac arrhythmias in overdose (thioridazine) - neuroleptic malignant syndrome
42
Describe neuroleptic malignant syndrome
- severe muscle rigidity - impaired sweating - fever - autonomic instability - severe agitation
43
Why are atypical antipsychotics an advantage over typical antipsychotics?
Just like typical: -they block D2 in NAcc and cause decreased positive symptoms BUT ALSO: -have reduced D2 affinity for nigrostriatal pathway = decreased EPS symptoms -block 5-HT2 receptors = decrease negative symptoms
44
In what type of antipsychotics do you have a wider window between the antipsychotic effect and EPS side effects?
atypical
45
How do you decrease negative symptoms?
*increased serotonin affinity decrease negative symptoms by increasing mesocortical dopamine Remember mesocortical pathway: VTA ----D1-----> PFC *you are improving low levels of dopaminergic activity
46
List some atypical antipsychotics
``` risperidone olanzapine quetiapine Ziprasidone clozapine aripiprazole ```
47
What is the common theme of atypical antipsychotics? Exceptions?
- bind to serotonin - bind to D2 Exceptions: 1 - clozapine binds to D4 not D2 2 - aripiprazole - partial agonist of D2 receptors
48
Adverse effects of atypical antipsychotics?
- generally, same as typical antipsychotics with lower risk, especially of EPS - risk of seizures in 2-5% in patients receiving clozapine - weight gain, hyperlipidemia, hyperglycaemia associated with 5-HT2 blockade (clozapine, olanzapine) - agranulocytosis (low white blood cell count) (1-2%) in its taking clozapine - higher death rate in elderly its with dementia
49
slide 29 for adverse effects
ok man
50
Aripiprazole metabolized by?
CYP 3A4, 2D6
51
Clozapine metabolized by?
CYP 1A2, 3A4, 2C19
52
Olanzapine metabolized by?
1A2, 3A4, FMO3
53
Quetiapine metabolized by?
3A4
54
Risperidone metabolized by?
2D6
55
Ziprasidone metabolized by?
3A4
56
What increases CYP 3A4 (clozapine, quietipaine, ziprasidone, aripiprazole) metabolism?
St john's wort
57
What decreases CYP 3A4 (clozapine, quietipaine, ziprasidone, aripiprazole) metabolism?
``` nefazodone erythormycin fluoxetine cimetidine grapefruit juice ```
58
What increases CYP 1A2 (clozapine, olanzapine, typicals) metabolism?
smoking
59
What decreases CYP 1A2 | (clozapine, olanzapine, typicals) metabolism?
fluvoxamine cimetidine ciprofloxacine
60
What decreases CYP 2D6 (risperidone, phenothiazine, typicals) metabolism?
paroxtein ketokonazole quinidine
61
Drug interactions: | What drug interactions with antipsychotics would cause excess sedation?
anxiolytics alcohol antidepressants antihistamines
62
Drug interactions: | Antipsychotics and another antimuscarinic have ?
additive antimuscarinic effects | amplify the effects
63
Drug interactions: | antipsychotics and metoclopramide = ?
D2 antagonist, EPS
64
Drug interactions: | antipsychotics and SSRI antidepressants ?
dopamine suppression in NGS and EPS
65
dopamine ____ in mesolimbic pathway = positive symptoms
hyperactivity
66
dopamine _____ in mesocortical pathway = negative symtpoms
hypoactivity
67
Key points about typical antipsychotics
-block D2 in mesolimbic (decrease positive symptoms), nigrostriatal (EPS) and tuberoinfundibulnar (hyper-prolactin) pathways
68
Key points about atypical antipsychotics
- lower affinity block of D2 = decrease positive symptoms, decrease EPS and prolactin - block 5-HT2 receptors = decrease negative symptoms - EPS replaced by weight gain, hyperglycaemia as dominant adverse effect
69
Briefly describe the stages of dosing for Pts with schizophrenia
``` Stage 1 - single SGA Stage 2 - switch SGA Stage 3a - FGA or switch SGA Stage 3b - clozapine Stage 4 - switch FGA or SGA Stage 5 - Combination therapy ```

Pharmacology (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions