module 3 antipsychotics

Question 1

D2 receptor family

Answer 1

medications that work here are used to tx schizophrenia

Question 2

positive schizophrenia symptoms

Answer 2

things that are there that shouldnt be

• delusions
• hallucinations
• disorganized speech
• catatonic behavior
  inc. activity of mesolimbic dopaminergic pathway

Question 3

negative schizophrenia s/s

Answer 3

absence of things that should be there
- flat affect
- alogia (lack of speech)
- avolition 
hypoactive to mesocortical dopaminergic pathway

Question 4

mesolimbic pathway

Answer 4

excess DA -> positive s/s

Question 5

mesocortical pathway

Answer 5

dec. DA -> negative s/s

can also cause ADHD

Question 6

nigrostriatal pathway

Answer 6

dec. DA -> EPS, motor s/s

Question 7

tuberinfundibular pathway

Answer 7

dec. DA -> inc. prolactin levels
- sexual dysfunction
- gynecomastia
- milk secretion
- menstrual cycle disturbances

Question 8

typical antipsycholitcs

Answer 8

antagonize D2 receptors in all CNS dopaminergic pathways

- dec. positive s/s

Question 9

typical antipsychotic AE on target

Answer 9

EPS: parkinsonian s/s
tardive dyskinesia: after chronic use
- repetitive involuntary movements of face, arms, trunk
neuroleptic malignant syndrome: rare, life-threatening
- catatonia, stupor, fever
inc. prolactin secretion
- amenorrhea, galactorrhea, false-positive pregnancy tests, gynecomastia, dec. libido

Question 10

typical antipsychotic AE off target

Answer 10

muscarinic and A-antagonism

• anticholingergic
• orthostatic hypoTN
• failure to ejaculate
• sedation

Question 11

typical antipsychotic AE and dose

Answer 11

higher potency: on target effects

lower potency: off target effects

Question 12

atypical antipsychotics

Answer 12

more effective at tx negative s/s

- exception: risperidone

Question 13

atypical antipsychotics MOA

Answer 13

hypothesized:
- 5HT2 and D2 antagonism
- D4 antagonism
relatively fast dissociation from D2: less EPS

Question 14

typical antipsychotic low potency meds

Answer 14

chlorpromazine
thioridazine
mesoridazine
- inc H1 and M1 effects (off target)

Question 15

typical antipsychotic middle meds

Answer 15

perphenazine

loxapine

Question 16

typical antipsychotic high potency meds

Answer 16

haloperidol
fluphenazine
thiothixene
- dec. H1 and M1 effects

Question 17

D2 saturation levels

Answer 17

40%: -> akathisia
60% -> improved + s/s
80% -> dystonias

Question 18

typical antipsychotic DI

Answer 18

CYP2D6

Question 19

tx muscle rigidity with

Answer 19

dantrolene

bromocriptine

Question 20

tx dystonia with

Answer 20

anticholinergics

benzos

Question 21

tx akathisia with

Answer 21

B-blockers: propranolol

benzos

Question 22

tx parkinsonism with

Answer 22

anticholinergics: amantadine

Question 23

neuroleptic malignant syndrome

Answer 23

rare, life-threatening
analogous to serotonin syndrome
- fever
- muscle rigidity
- inc. CPK, myoglobin (renal failure)
- delirium
- catatonia/stupor

Question 24

atypical antipsychotic meds

Answer 24

aripiprazole
olanzapine
quetiapine
risperidone
ziprasidone
clozapine
haloperidol