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69:252 Psychopharmacology > Lecture 3 > Flashcards

Lecture 3 Flashcards

1
Q

__________ = Neuroleptic =
Major Tranquilizer

A

Antipsychotic

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2
Q

is a syndrome – and can be associated with numerous different psychiatric disorders.

A

Psychosis

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3
Q

Disorders in which Psychosis is a ________ Feature:
Schizophrenia
Substance Induced Psychosis
Schizophreniform Disorder
Schizoaffective Disorder
Delusional Disorder
Brief Psychotic Disorder
Psychotic Disorder due to a general medical condition

A

Defining

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4
Q

Disorders in which Psychosis is an ___________ Feature:
Mania
Depression
Neurocognitive disorders
Acquired brain injuries
Delirium

A

Associated

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5
Q

Positive Symptoms of schizophrenia spectrum

A

Delusions
Hallucinations

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6
Q

Distortions or exaggerations in language and communication
Disorganized speech
Disorganized behavior

are examples of

A

Cognitive Symptoms

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7
Q

Affective flattening
Avolition – difficulty with self-directed behaviours
Alogia – reduced speech
Anhedonia – reduced pleasure
Asociality – reduced socialization
Anosognosia – lack of insight
Apathy – lack of interest
Catatonia – abnormal movements

are all examples of

A

Negative Symptoms

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8
Q

difficulty with self-directed behaviours

A

Avolition

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9
Q

reduced speech

A

Alogia

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10
Q

reduced pleasure

A

Anhedonia

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11
Q

reduced socialization

A

Asociality

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12
Q

lack of insight

A

Anosognosia

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13
Q

lack of interest

A

Apathy

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14
Q

abnormal movements

A

Catatonia

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15
Q

Brand name: Thorazine, Largactil, CPZ
Oral and short acting injectable drug

A

chlorpromazine

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16
Q

Brand name: Nozinan
Chemical class: Phenothiazine (aliphatic)
Potency: Low
Oral dosage: 10-200 mg/day PO

A

methotrimeprazine

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17
Q

Brand Name: Fluanxol

A

flupenthixol

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18
Q

Brand name: Clopixol
C: Thioxanthene
P: Low
D: 10-70 mg/day PO

A

zuclopenthixol dihydrochloride

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19
Q

Brand Name: Haldol
Checmical Class: Butyrophenone
Potency: High
Oral Dosage: 0.5-20 mg/day PO

A

haloperidol

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20
Q

Brand Name: Clozaril
Chemical Class: Dibenzodiazepine
Dosage: 75-900 mg/day
(common: 300 mg/day) PO

A

clozapine

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21
Q

Brand Name: Zyprexa
Oral and short acting injectable

A

olanzapine

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22
Q

B: Risperidal
C: Benzisoxazole
D: 0.5-16 mg/day PO

A

risperidone

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23
Q

B: Invega
C: Benzisoxazole
D: 3-12 mg/day PO

A

paliperidone

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24
Q

B: Zeldox
Comes in PO and short acting injectable drug

A

ziprasidone

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25
Q

B: Saphris

D: 5-20 mg daily PO

A

asenapine

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26
Q

B: Seroquel
C: Dibenzothiazepine
D: 50-800 mg/day PO

A

quetiapine

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27
Q

Dopamine pathways:
Mesolimbic & Mesocorticol lead to ________

A

Negative symptoms

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28
Q

brain stem to the limbic areas of the brain
Function: control behaviours, reward system

A

Mesolimbic

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29
Q

brainstem to the frontal cortex
Function: control cognition, emotion and behavior

A

Mesocortical

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30
Q

B: Abilify
C: Dihydrocarbostyril
D: 10-30 mg daily PO

A

aripiprazole

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31
Q

Are effective in treating positive symptoms – because they are potent dopamine antagonists in the mesolimbic pathway

A

Typical antipsychotics

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32
Q

Have an affinity for dopamine receptors

A

Typical antipsychotics

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33
Q

Some side effects are caused because they are potent dopamine antagonists in the other brain pathways

A

Typical antipsychotics

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34
Q

Hyperactivity in this pathway lead to positive symptoms
Typical antipsychotics medication lower dopamine in this pathway

A

Mesolimbic

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35
Q

Hyperactivity leads to negative symptoms
Typical medications lower dopamine in this pathway

A

Mesocorticol

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36
Q

Typical antipsychotic - lower dopamine in pathway
Function - control movement

A

Nigrostriatal

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37
Q

Typical lower dopamine in this pathway
Function: control endocrine hormones

A

Tuberoinfundibular

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38
Q

are more likely to produce postural hypotension and sedation than other drugs

A

Aliphatic Phenothiazines

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39
Q

These are the most likely drugs to cause extrapyramidal side effects

A

Piperazine Phenothiazine

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40
Q

Short acting injectable drug
Clopixol Acuphase
50-150 mg q 1-3 days
(max 150mg q 3 days)

A

zuclopenthixol Acetate

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41
Q

Short acting injectable drug
Clopixol Depot
150-300 mg q 2-4 weeks

A

zuclopenthixol decanoate

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42
Q

Short acting injectable drug
Haldol
2.5-5 mg q 4-6 h

A

haloperidol

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43
Q

Depot & long acting injectable drug
Haldol LA
50-400 mg q 3-4 weeks

A

haloperidol decanoate

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44
Q

Short acting injectable drug
Zyprexa
5-10mg q 2-4 h
(max 20 mg daily or 3 injections)

A

olanzapine

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45
Q

Depot & long acting injectable drug
Risperidal Consta
25-50 q 2 weeks

A

risperidone

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46
Q

Injectable depot & long lasting drug given deltoid

A

risperidone

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47
Q

Depot & long acting injectable drug
Invega Sustenna
50-150 q 4 weeks

A

paliperidone palmitate

48
Q

Depot & long acting injectable drug
Invega Trinza
175-525 q 3 months

A

paliperidone palmitate

49
Q

Depot & long acting injectable drug
Abilify Maintena
300-400 mg q 4 weeks

A

aripiprazole monohydrate

50
Q

B: Rexulti
C: Dihydrocarbostyril
D: 1-3 mg daily PO

A

brexpiprazole

51
Q

Depot & long acting injectable drug
Invega Sustenna
50-150 q 4 weeks

A

paliperidone palmitate

52
Q

Latuda
Oral medication

A

lurasidone

53
Q

Fluanxol Decanoate
Depot and Long Acting Injectable

A

flupenthixol decanoate

54
Q

Clopixol Depot
Depot and Long Acting Injectable

A

zuclopenthixol decanoate

55
Q

Haldol LA
Depot and Long Acting Injectable

A

haloperidol decanoate

56
Q

Two findings contribute to this theory:
1. Antipsychotic drugs decrease dopamine activity by blocking receptors
2. Signs and symptoms of psychosis occur with drugs that increase dopamine levels in the brain (ex. Cocaine and Amphetamines)

A

Dopamine Hypothesis and Schizophrenia

57
Q

Serotonin deficiency results in symptoms of depression and major depressive disorder
Serotonin deficiency may lead to cognitive symptoms
Excess serotonin can lead to positive and negative symptoms
Serotonin inhibits dopamine

A

Serotonin Hypothesis

58
Q

Positive, negative, and cognitive symptoms to inactive or deficient glutamate receptors

A

Glutamate Hypotheses

59
Q

Predispositions and vulnerabilities for schizophrenia (diatheses)
People’s vulnerabilities must interact with life stresses to trigger the onset of the illness
Vulnerability + Stress

Stressors can include:
Trauma
Virus
Prenatal and perinatal complications
Substance use

A

Diathesis-stress models

60
Q

Typical (First Generation) & Atypical (Second Generation; Third Generation)
Potency (high, medium or low)
Chemical Class

A

Antipsychotic classification

61
Q

Usually require small amounts to work
They are associated with lower levels of sedation, weight gain, and anticholinergic activity
May have a high risk for extrapyramidal side effects

A

High potency antipsychotics

62
Q

Are dosed in the 100’s of milligrams
High levels of sedation and anticholinergic effects
Low risk of extrapyramidal side effects

A

Low potency antipsychotics

63
Q

These are all ______ antipsychotics:
Phenothiazines
- Aliphatic
- Piperidine
- Piperazine
Nonphenothiazines
- Thioxanthenes
- Dibenzoxazepine
- ButyrophenoneT

A

Typical Antipsychotics

64
Q

Have and affinity for dopamine receptors

A

Typical Antipsychotics

65
Q

Are effective in treating positive symptoms – because they are potent dopamine antagonists in the mesolimbic pathway

A

Typical Antipsychotics

66
Q

Some side effects are caused because they are potent dopamine antagonists in the other brain pathways

A

Typical Antipsychotics

67
Q
  1. Mesolimbic – Behaviours, reward system
    - Hyperactivity in mesolimbic pathway leads to positive symptoms
  2. Mesocortical – Cognition, emotion and behavior
    - Hypoactivity in mesocortical pathway leads to negative symptoms
  3. Nigrostriatal – Movement
  4. Tuberoinfundibular – Endocrine hormones
A

Dopamine Pathways

68
Q

________ – Behaviours, reward system
- Hyperactivity in this pathway leads to positive symptoms

A

Mesolimbic

69
Q

_______ – Cognition, emotion and behavior
- Hypoactivity in this pathway leads to negative symptoms

A

Mesocortical

70
Q

Movement pathway

A

Nigrostriatal

71
Q

Endocrine hormones pathway

A

Tuberoinfundibular

72
Q

Decrease dopamine
Decrease positive symptoms
(Atypical)

A

Mesolimbic

73
Q

Decrease dopamine
Increase negative symptoms
(Atypical)

A

Mesocortical

74
Q

Decrease dopamine
Increase acetylcholine
Increase Extrapyramidal symptoms
(Atypical)

A

Nigrostriatal

75
Q

Decrease dopamine
Increase prolactin
Increase feminization effects
(Atypical)

A

Tuberoinfundibular

76
Q

Nigrostriatal – EPSE/TD (contains ___ of brains dopamine)

A

80%

77
Q

Mesolimbic + symptoms (increase in ______)

A

dopamine

78
Q

restricts prolactin release… therefore the less ______ = more prolactin

A

dopamine

79
Q

________ and Ach have an inverse relationship – decrease ____ = increase Ach – increase Ach – increase EPS

A

Dopamine; Dopamine

80
Q

endocrine and prolactin release

A

Tuberoinfundibular

81
Q

symptoms and cognitive (hypo function of pathway)

A

Mesocortical

82
Q

These are all _______ antipsychotics: Dibenzodiazepine
Thienobenzodiazepine
Benzisoxazole
Benzothiazolyl Piperazine
Dibenzothiazepine
Benzisothiazol
Dihydrocarbostyril

A

Atypical Antipsychotics

83
Q

Serotonin – Dopamine Antagonists
Treat positive symptoms by blocking dopamine in the mesolimbic pathway
Treat negative symptoms by blocking serotonin and increasing dopamine in the mesocortical pathway
Reduce negative side effects because they block serotonin and increase dopamine in the other pathways.

A

Atypical Antipsychotics

84
Q

Decrease dopamine
Decrease positive symptoms
(Atypical)

A

Mesolimbic

85
Q

Decrease serotonin
Increase dopamine
Decrease negative symptoms
(Atypical)

A

Mesocortical

86
Q

Decrease serotonin
Increase dopamine
Decrease risk of extrapryramidal symptoms
(Atypical)

A

Nigostriatal

87
Q

Decrease serotonin
Increase dopamine
Decrease prolactin
Increase feminization effects
(Atypical)

A

Tuberoinfundibular

88
Q

Atypical antipsychotics are _____ and ______ antagonists.

A

dopamine; serotonin

89
Q

Clozapine is the ______ atypical antipsychotic

A

prototype

90
Q

Olanzapine and clozapine commonly associated with ________ and metabolic syndrome

A

weight gain

91
Q

Clozapine associated with _______

A

agranulocytosis

92
Q

Abilify & Rexulti

A

3rd generation Antipsychotics

93
Q

should NEVER be used for maintenance treatment

A

Short Acting antipsychotic injections

94
Q

Should only be used for short periods of time in acute situations

A

Short Acting antipsychotic injections

95
Q

Always start with _____ before using depot

A

oral

96
Q

Typically do a test dose which is ¼ to ½ dose – monitor for _____ before the full dose

A

7 days

97
Q

All given dorsal gluteal except _____- – deltoid

A

risperidone

98
Q

Many antipsychotics require a low dose with monitoring upon initiation of a new drug.
During this low dose monitoring the client has to be carefully monitored for side effects.
The drug is slowly titrated up over a period of time until therapeutic effects are reached.
Do not allow clients to crush or chew sustained release capsules – this will speed up the absorption and may cause toxicity.
All antipsychotics should be titrated down over a 6- 8 week period

A

Administration Considerations for Oral Antipsychotics

99
Q

Anxiety
Insomnia
Gastritis
Nausea and vomiting
Dizziness
Dystonia
Dyskinesia
Paresthesia
Tremulousness
Rebound psychosis

These are all signs of…

A

Abrupt discontinuation

100
Q

The drug bypasses gastrointestinal absorption
No first- pass metabolism effect
Lower rates of relapse

A

Advantages of Depot Medications

101
Q
  1. Need to be administered deep into muscle tissue
  2. Can irritate the skin and cause pain at the injection site
  3. Hold the risk of severe and long long-lasting side effects if not screened properly
A

Disadvantages of Depot Medications

102
Q

Administered as a deep Intramuscular injection

A

Depot medication

103
Q

Gluteal sites are the preferred sites for injection (unless the package indicates differently ex Palliperidone - deltoid)

A

Depot medication

104
Q

Always check the site for masses
abscesses or scar tissue may have formed from previous IM’s and can cause problems with absorption

A

Depot medication

105
Q

Inject slowly to allow the drug a chance to absorb

A

Depot medication

106
Q

The dosage for _______ injectable antipsychotic medication often differs from the therapeutic dosage of a depot medication

A

short-acting

107
Q

You can tell the difference by:
Label
Dosage
Thickness – the ______ will be thicker than the regular IM medication.

A

depot

108
Q

are absorbed through the Gastrointestinal Tract

A

Oral antipsychotics

109
Q

Antipsychotic medications are highly lipophilic (stored in fat tissues) (distribution)

A

Oral antipsychotics

110
Q

are absorbed from the injection site

A

Intramuscular (IM) antipsychotics

111
Q

Distribution can occur for up to 6 months after a drug has been stopped

A

Intramuscular (IM) antipsychotics

112
Q

are metabolized in the liver

A

Oral antipsychotics

113
Q

Antipsychotics are excreted in urine and bile

A

Oral antipsychotics

114
Q

enter the bloodstream directly and do not experience a “first pass” through the liver
(metabolism)

A

Intramuscular (IM) antipsychotics

115
Q

Antipsychotics cross the placenta and enter breast milk
(excretion)

A

Intramuscular (IM) antipsychotics

69:252 Psychopharmacology (14 decks)

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