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M2.4 Flashcards

1
Q
  • are used primarily to treat SCHIZOPRENIA
  • also effective in other psychotic and manic states
A

antipsychotics

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2
Q

ANTIPSYCHOTICS are also called

A

NEUROLEPTICS or MAJOR TRANQUILIZERS

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3
Q

the use of these medications involves a difficult trade-off between the BENEFIT of alleviating psychotic symptoms and the risk of a wide variety of troubling ADVERSE EFFECTS

A

ANTIPSYHOTICS

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4
Q

ANTIPSYCHOTICS are ____ and DO NOT eliminate chronic thought disorders

A

NOT CURATIVE

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5
Q

ANTIPSYCHOTICS | CLASSIFICATION

1st gen

A

Classic drugs
azine & haloperidol

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6
Q

ANTIPSYCHOTICS | CLASSIFICATION

1st gen:
acts on ____

A

DOPAMINE receptor
DA antagonist

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7
Q

ANTIPSYCHOTICS | CLASSIFICATION

2nd gen

A

Newer agents
zapine, done

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8
Q

ANTIPSYCHOTICS | CLASSIFICATION

2nd gen:
acts on ____

A

5HT2 receptor (Serotonin)
5HT2 antagonist

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9
Q
  • mental disorder which involves BREAKDOWN of PERSONALITY
  • presence of delusions (false beliefs)
  • halluciantions
  • grossly disorganized thinking in a clear sensorium
A

PSYCHOSIS

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10
Q

PSYCHOSIS

various types of hallucinations

A

auditory
visual
tactile
olfactory

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11
Q

PSYCHOSIS

MOST COMMON type of hallucination

A

auditory

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12
Q

PSYCHOSIS | TYPES

typical baliw

A

schizophrenia

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13
Q

PSYCHOSIS | TYPES

Depression and Mania

A

affective disorders

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14
Q

PSYCHOSIS | TYPES

  • has other causes
  • mental disturbances caused by head injury, alcoholism, or other kinds of organic diseases
A

organic psychosis

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15
Q

PSYCHOSIS | TYPES

  • a psychotic disorder characterized by DISTORTIONS in thinking, perception, emotions, language, sense of self, and behavior
  • symptoms are grouped as positive symptoms and negative symptoms
A

SCHIZOPRENIA

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16
Q

PSYCHOSIS | TYPES

the SYMPTOMS of schizophrenia are grouped as ____ and ____

A

positive and negative symptoms

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17
Q

PSYCHOSIS | TYPES

SCHIZOPHRENIA:
* USUAL symptoms
* DELUSIONS (often paranoid in nature)
* HALLUCINATIONS, usually in the form of voices, and often exhortatory in their message (paranoia)
* THOUGHT disorder, comprising of wild trains of taught and IRRATIONAL conclusions (leads to irrational actions)

A

POSITIVE SYMPTOMS

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18
Q

PSYCHOSIS | TYPES

SCHIZOPHRENIA:
POSITIVE symptoms affect ____

A

MESOCORTICAL SYSTEM

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19
Q

PSYCHOSIS | TYPES

SCHIZOPHRENIA:
* ANTISOCIAL symptoms
* WITHDRAWAL from social contacts
* Flattening of emotional responses

A

NEGATIVE SYMPTOMS

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20
Q

PSYCHOSIS | TYPES

SCHIZOPHRENIA:
NEGATIVE symptoms affect the ____

A

MESOLIMBIC SYSTEM

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21
Q

PSYCHOSIS | TYPES

THEORIES | SCHIZOPHRENIA:
schizophrenic gene can be ____

A

inherited
(HEREDITARY)

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22
Q

PSYCHOSIS | TYPES

THEORIES | SCHIZOPHRENIA:
Neurodevelopmental disorder

A
  • Cortical atrophy (certain part of the brain is small)
  • Maternal virus during pregnancy
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23
Q

PSYCHOSIS | TYPES

THEORIES | SCHIZOPHRENIA:
certain chemical causes a defect in “SELECTIVE ATTENTION”

A

NEUROCHEMICAL THEORY

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24
Q

PSYCHOSIS | TYPES

THEORIES | SCHIZOPHRENIA:
____ or ____ has been proposed to be the cause of schziophrenia and is used as a basis for pharmacotherapy

A

biochemical imbalances or abnormality in the brain

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25
Q

PSYCHOSIS | TYPES

THEORIES | SCHIZOPHRENIA:
BIOCHEMICAL IMBALANCES

A

increased SEROTONIN
increased DOPAMINE
decreased GLUTAMATE

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26
Q

PSYCHOSIS | SCHIZOPHRENIA

Hallucinatory effects could be associated with 5-HT2A recpetor and possible 5-HT2C stimulation

A

SEROTONIN theory (hypothesis)

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27
Q

PSYCHOSIS | SCHIZOPHRENIA

SEROTONIN THEORY:
* modulate the RELEASE of dopamine, norepinephrine, glutamate, GABA, and acetylcholine in the cortex, limbic region, and striatum

A

5-HT2A & 5-HT2C receptors

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28
Q

PSYCHOSIS | SCHIZOPHRENIA

SEROTONIN THEORY:
* leads to DEPOLARIZATION of GLUTAMATE neurons (only in specific region of the brain) but also STABILIZATION of NMDA receptors

A

5-HT2A receptor stimulation

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29
Q

PSYCHOSIS | SCHIZOPHRENIA

SEROTONIN THEORY:
* leads to INHIBITION of CORTICAL and LIMBIC dopamine release

A

5-HT2C receptor stimulation

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30
Q

PSYCHOSIS | SCHIZOPHRENIA

major action

A

increase DA, SE

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31
Q

PSYCHOSIS | SCHIZOPHRENIA

inhibitory or excitatory

A

inhibitory effect

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32
Q

PSYCHOSIS | SCHIZOPHRENIA

DOPAMINE THEORY:
* many antipsychotic drugs strongly BLOCK ____ in thee CNS, especially in the mesolimbic and striatal-frontal system

A

postsynaptic D2 receptor

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33
Q

PSYCHOSIS | SCHIZOPHRENIA

DOPAMINE THEORY:
* drugs that ____ either AGGRAVATE schizophrenia psychosis or produce PSYCHOSIS DE NOVO in some patients

psychosis de novo - cause psychosis in healthy patients

A

increase dopaminergic activity

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34
Q

PSYCHOSIS | SCHIZOPHRENIA

DOPAMINE THEORY:
* dopamine-receptor density has been found postmortem to be ____ in the brains of schizophrenic

A

increased

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35
Q

PSYCHOSIS | SCHIZOPHRENIA

GLUTAMATE THEORY:
* hypofunction of ____ located on GABAergic internuerons, leads to DIMINISHED INHIBITORY influences on neuronal function

A

NMDA receptors

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36
Q

PSYCHOSIS | SCHIZOPHRENIA

GLUTAMATE THEORY:
* an ____ of downstream glutamatergic activity, which can lead to HYPERSTIMULATION of cortical neruons through non-NMDA receptors

A

induce disinhibition

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37
Q

PSYCHOSIS | TYPES

  • characetrized primarily by CHANGES OF MOOD rather than by thought disorder
  • Depression
  • Mania
A

AFFECTIVE DISORDERS

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38
Q

PSYCHOSIS | AFFECTIVE DISORDERS

DOWN phase

A

depression

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39
Q

PSYCHOSIS | AFFECTIVE DISORDERS

HYPERACTIVE

A

mania

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40
Q

PSYCHOSIS | AFFECTIVE DISORDERS

TYPES OF DEPRESSIVE SYNDROME

A

Unipolar
Bipolar

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41
Q

PSYCHOSIS | AFFECTIVE DISORDERS | TYPES OF DEPRESSIVE SYNDROME

  • Reactive depression
  • Endogenous depression
A

UNIPOLAR

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42
Q

PSYCHOSIS | AFFECTIVE DISORDERS | TYPES OF DEPRESSIVE SYNDROME

UNIPOLAR:
* caused by external factors clearly associated with STRESSFUL LIFE EVENTS, and accompanied by symptoms of anxiety and agitation
* characterized by a PERIOD OF SHOCK and DEPRESSION which is followed by a period of READJUSTMENT and resolve that life must go on

A

REACTIVE depression

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43
Q

PSYCHOSIS | AFFECTIVE DISORDERS | TYPES OF DEPRESSIVE SYNDROME

UNIPOLAR:
* UNRELATED to external stress
* may involve psychological DISTURBANCES and MALADJUSTMENTS or BICOHEMICAL DEFECTS in the brain

A

ENDOGENOUS depression

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44
Q

PSYCHOSIS | AFFECTIVE DISORDERS | TYPES OF DEPRESSIVE SYNDROME

  • characterized by ALTERNATING CYCLES of depression and mania
  • weeks of depression, then mania
A

BIPOLAR AFFECTIVE DISORDER

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45
Q

PSYCHOSIS | AFFECTIVE DISORDERS | TYPES OF DEPRESSIVE SYNDROME

BIPOLAR:
____ is the OPPOSITE of depression, with excess exuberance, enthusiasm and self-confidence, accompanied by impulsive actions

A

MANIA

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46
Q

DRUGS FOR PSYCHOSIS

ANTIPSYCHOTICS:
blockers of ____

A

DOPAMINE receptors

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47
Q

DRUGS FOR PSYCHOSIS

MOST antipsychotics are ____ in action, meaning they block other receptors such as alpha adrenergic, hsitamine, and serotonin receptors in addition to dopamine receptor

A

NONSELECTIVE

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48
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

  • MOA: block D2 receptors
  • ADDITONAL EFFECTS: anti-HAM (Histamine, Alpha1, Muscarinic)
  • USE: for POSITIVE symptoms only
A

1st gen / Classical / Traditional / Typical antipsychotics

49
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

1st gen:
azine

A

phenothiazine

50
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

1st GEN:
peridol

A

Butyrophenones

51
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

1st GEN | PHENOTHIAZINE:
aliphatic

52
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

1st GEN | PHENOTHIAZINE:
piperazine

53
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

1st GEN | PHENOTHIAZINE:
piperidine

54
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

1st GEN:
* for MANIC phase

A

BUTRYOPHENONES - “peridol”

55
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

DOC for PEHNCYCLIDINE overdose and is clinically used also in HUNTINGTON’S disease and TOURETTE’S syndrome

A

HALOPERIDOL

56
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

1st GEN:
thix

A

thioxanthenes
thiothixine

57
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

POTENCY

A

butyrophenos = piperazines > piperidine . thioxanthenes > aliphatic

58
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

increase HAM affinity

A

Aliphatic > Thioxanthenes > Piperadine > Piperazine = Butyrophenone

59
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

  • MOA: block 5HT receptor more than D2 receptor, block D4
  • USE: for NEGATIVE symptoms
  • LESS binding to DA = LESS EPS
A

2nd gen / ATYPICAL antipsychotics

60
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

the ONLY atypical WITHOUT EPS effect

EPS - extrapyrimidal syndrome

61
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

POSITIVE symptoms

A

1st gen = 2nd gen

62
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

NEGATIVE symptoms

A

2nd gen > 1st gen

63
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

ATYPICAL:
* no EPS
* only antipsychotic that REDUCE SUICIDE EFFECT
* causes seizure, agranulocytosis, myocarditis

64
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

ATYPICAL:
CLOZAPINE causes

A

seizures
agranulocytosis
myocarditis

65
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

ATYPICAL:
* NEWEST
* partial D2 agonist
* LEAST sedating

A

ARIPIPRAZOLE

prazole but not PPI

66
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

ATYPICAL:
* causes OVERWEIGHT or OBESITY

A

Olanzapine

67
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

ATYPICAL:
* used for INTRACTABLE HICCUPS

A

Risperidone

68
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

ATYPICAL:
* causes QT prolongation

A

Ziprasidone

69
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

ATYPICAL:
* watch out for sedation (VERY SEDATING)

A

QUETIAPINE

70
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

ADVERSE EFFECTS:
decrease level of DA = increase Ach

71
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

ADVERSE EFFECTS:
management for EPD

A

anticholinergics

72
Q

antiCHOLINERGICS

A

Biperiden
Benztropine
Trihexylphenidyl

73
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

ADVERSE EFFECTS:
* LOW DA = HIGH PROLACTIN
* galactorrhea, amenorrhea, infertility, decrease libido

A

HYPERPROLACTINEMIA

74
Q

a PROLACTIN INHIBITING hormone

75
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

ADVERSE EFFECTS:
* rare life threatening
* idiosyncratic
* fever, muscle rigidity, altered mental status, unstable vital sign

A

MALIGNANT HYPERTHERMIA

76
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

DOC for MALIGNANT HYPERTHERMIA

A

DANTROLENE

77
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

ADVERSE EFFECT:
due to H1 receptor blockade

78
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

ADVERSE EFFECTS:
due to alpha1 blocker

A

orthostatic hypotension
failure to ejaculate

79
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

ADVERSE EFFECTS:
due to M receptor blockade

A

anticholinergic effects

80
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

ADVERSE EFFECT:
by CLOZAPINE

A

seizure
agranulocytes

81
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

ADVERSE EFFECT:
CARDIAC: Clozapine

A

myocarditis

82
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

ADVERSE EFFECT:
CARDIAC: Thioridazine, Ziprasidone

A

QT prolongation

83
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

ADVERSE EFFECTS:
by THIORIDAZINE

may cause blindness

A

RETINAL DEPOSITS

84
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

ADVERSE EFFECTS:
by CHLORPROMAZIE

does NOT cause blindness

A

CORNEAL DEPOSITS

85
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

ADVERSE EFFECT:
common in 2nd gen antipsychotics except in Amilsupride, Molindone, Aripiprazole

A

weight gain

86
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

ADVERSE EFFECT:
by OLANZAPINE

A

risk for DM

87
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

PROTOTYPE

88
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

ADVERSE EFFECTS:
* occurs with the CHRONIC USE of antipsychotics
* has two main kinds: Acute Dystonias, Tardive Dyskinesia

A

EXTRAPYRIMIDAL MOTOR DISTURBANCES

89
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

AE | EPMD:
* are involuntary movements (muscle spasm, protruding tounge, torticollis, and often a PArkinson-type syndrome)
* REVERSIBLE

A

ACUTE DYSTONIAS

90
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

AE | EPMD:
* consist of involuntary movements, often of theFACE and the TOUNGE, but also of the TRUNKS and LIMBS
* IRREVERSIBLE

A

TARDIVE DYSKINESIA

91
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

AE | EPM:
incidence of extrapyrimidal effects is LESS with ____

A

ATYPICAL

bcs they bind to SE

92
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

ONSET OF ACTION

A

may not be effective for several weeks

93
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS

ONSET OF ACTION:
sedation and side effects

94
Q

PHARMACOLOGY | NEUROLEPTICS

AE:
* Hyperprolactinemia
* Endocrine effects
* Gynecomastia
* Galactorrhea
* Sexual dysnfunction

A

DOPAMINE-receptore blockade

95
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

AE:
* difficulty micturition
* constipation
* blurred vision
* dry mouth (xerostomia)

A

CHLONIERGIC-receptor blockade

96
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

AE:
* failure to ejaculate
* orthostatic hypotension
* light headedness

A

ALPHA-ADRENOCEPTOR blockade

97
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

AE:
* sedation

A

HISTAMINE blockade

98
Q

DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL

AE:
* hypothermia
* hyperthermia

A

SEROTONIN blockade

99
Q

PHARMACOLOGY | NEUROLEPTICS

  • primarily indicated for schizophrenia
  • CATATONIC forms of schizo
  • best managed by IV benzodiazepines
  • also indicated fro schizoaffective disorders
  • therapy of psychotic depression and bipolar affective disorder
A

PSYCHIATRIC INDICATONS

100
Q

PHARMACOLOGY | NEUROLEPTICS

MONOtherapy of ACUTE BIPOLAR depression

A

QUETIAPINE
IURASIDONE
OLANZAPINE (in combination with Fluoxetine)

101
Q

PHARMACOLOGY | NEUROLEPTICS

adjunct to antidepressants in the treatment of UNIPOLAR depression

A

Aripiprazole
Quetiapine
Olanzapine

102
Q

PHARMACOLOGY | NEUROLEPTICS

indicated in HIGHLY AGITATED and MANIC patients

A

haloperidol

103
Q

PHARMACOLOGY | NEUROLEPTICS

have a specific antidepressant action

104
Q

PHARMACOLOGY | NEUROLEPTICS

tx of HUNTINGTON’S chorea

uncontrollable DANCE-like movements

A

HALOPERIDOL

105
Q

PHARMACOLOGY | NEUROLEPTICS

NONpsychiatric:
NOT an anti-emetic

A

THIORIDAZINE

106
Q

PHARMACOLOGY | NEUROLEPTICS | NONPSYCHIATRIC

anti-emetic

A

Prochlorperazine
Benzquinamide

107
Q

PHARMACOLOGY | NEUROLEPTICS | NONPSYCHIATRIC

used in combination with NARCOTIC analgesics for the tx of CHRONIC PAIN with SEVERE ANXIETY

A

Droperidol & Fentanyl citrate

108
Q

PHARMACOLOGY | NEUROLEPTICS | NONPSYCHIATRIC

for relief of PRURITUS

A

Phenothiazines

109
Q

PHARMACOLOGY | NEUROLEPTICS | NONPSYCHIATRIC

as PREOPERATIVE sedatives

A

Promethazine

110
Q

CLINICAL EFFICACY OF ANTIPSYCHOTICS

____ may be needed in controlling symptoms of ACUTE schizophrenia

A

large doses

111
Q

CLINICAL EFFICACY OF ANTIPSYCHOTICS

____ antipsychotic treatment is often effective in PREVENTING RECURRENCE of schizophrenic attacks

112
Q

CLINICAL EFFICACY OF ANTIPSYCHOTICS

____ are effective only in 70% of schizophrenic patients

A

typical antipsychotics

113
Q

CLINICAL EFFICACY OF ANTIPSYCHOTICS

30% are classes as

A

treatment resistant

114
Q

CLINICAL EFFICACY OF ANTIPSYCHOTICS

TYPICAL antipsychotics effectively control the ____ symptoms

115
Q

CLINICAL EFFICACY OF ANTIPSYCHOTICS

TYPICAL antipsychotics are INEFFECTIVE in relieving ____ symptoms

116
Q

CLINICAL EFFICACY OF ANTIPSYCHOTICS

____ overcome theb SHORTCOMINGS of typical antipsychotics, showing efficacy in “treatment resistant” patient and improving negative & positive symptoms

117
Q

CLINICAL EFFICACY OF ANTIPSYCHOTICS

the ONLY ATYPICAL antipsychotic drug indicated to REDUCE the RISK of SUICIDE

PCOL (10 decks)

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