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Psychiatry > Neuropsychopharm Antipsychotics > Flashcards

Neuropsychopharm Antipsychotics Flashcards

1
Q

What is the most common part of the body involved in tardive dyskinesia? Where else can be involved less commonly?

A

Face/mouth most common (75% of cases)

Extremities (50%) and trunk (25%) can also be seen

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2
Q

What atypical antipsychotic(s) may be useful in bipolar depression?

A

Quetiapine (Seroquel)

Also approved as monotherapy mood stabilizer

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3
Q

How strongly do chlorpromazine, fluphenazine, haloperidol, and perphenazine each block D2, M1, H1, and alpha1 receptors?

A

Haloperidol: specific high-potency D2 block
Fluphenazine: similar to haloperidol
Perhpenazine: high-potency D2 block, also significant H1 and alpha1 block, but low M1 block
Chlropromazine: moderate potency D2 block, significant block of M1, H1, and alpha1.

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4
Q

What are the types of extrapyramidal side effects?

A
  1. Dystonia
  2. Dyskinesia/akinesia/bradykinesia
  3. Akathisia
  4. Tremor
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5
Q

What atypical antipsychotic(s) is most associated with akathisia?

A

Aripiprazole (Abilify)

The atypical antipsychotic that is activating rather than sedating

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6
Q

What secondary target of some antipsychotics leads to reduced EPS?

A

Muscarinic receptors

ACh neurons modulate DA neurons in the nigrostriatal pathway only

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7
Q

What is the origin of dopaminergic neurons in the brain?

A

Ventral tegmental area and substantia nigra

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8
Q

What are symptoms of hyperprolactinemia in women? Men?

A

Women: amenorrhea, galactorrhea
Men: decreased libido (early sign), gynecomastia

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9
Q

What are the two hypotheses as to why atypical antipsychotics tend to have fewer EPS and more efficacy for negative symptoms?

A

Serotonin-dopamine antagonism theory: 5-HT2 receptor blockage
“Fast off” theory: rapid dissociation from D2 receptors

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10
Q

What are the significant monoamines?

A

Catecholamines: Dopamine, NE, Epi
Tryptamines/indoleamines: 5-HT, melatonin
Histamine

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11
Q

What types of extremity movements can be seen in tardive dyskinesia?

A
  1. Tremors
  2. Rhythmic movements
  3. Choreoathetoid movements:
    a. Choreiform: jerky, spasmodic, quasi-purposeful
    b. Athetoid: slow, writhing, twisting
    c. Ballismus: violent sudden motions
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12
Q

What is the origin of norepinephrinergic neurons in the brain?

A

Locus coeruleus

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13
Q

Which atypical antipsychotic(s) is more weight neutral?

A

Aripiprazole (Abilify), Ziprasidone (Geodon)

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14
Q

What types of facial/oral movements can be seen in tardive dyskinesia?

A

Frowning, grimacing, puckering, lip smacking, chewing, teeth grinding, tongue tremor, tongue protrusion, tongue rolling

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15
Q

What atypical antipsychotic(s) is associated with drooling?

A

Clozapine (Clozaril)

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16
Q

What is the dopaminergic pathway involved in prolactin regulation?

A

Tuberoinfundibular: hypothalamus to anterior pituitary (inhibits prolactin release)

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17
Q

According to the dopamine hypothesis of schizophrenia, what dysfunction in what area of brain is responsible for positive symptoms? Negative symptoms?

A

Positive: Hyperactivity of mesolimbic pathway (VTA to nucleus accumbens)
Negative: Hypoactivity of mesocortical system (VTA to PFC)

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18
Q

Which antipsychotics have the highest incidence of EPS?

A

Typicals: haloperidol, fluphenazineAtypical: Risperidone

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19
Q

What is the dopaminergic pathway involved in cognition and executive function?

A

Mesocortical, VTA to dorsolateral prefrontal cortex

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20
Q

What atypical antipsychotic(s) significantly lowers the seizure threshold?

A

Clozapine (Clozaril)

Effective but dangerous - also leads to agranulocytosis

21
Q

What typical antipyschotic(s) has the least EPS?

A

Chlorpromazine (thorazine) - because of ACH block

22
Q

What atypical antipsychotic(s) is associated with agranylocytosis?

A

Clozapine (Clozaril)

Effective but dangerous - also decreases seizure threshold

23
Q

What is the effect of D2 blockage on the tuberoinfundibular pathway in a schizophrenic patient( According to the dopamine hypothesis)

A

Can lead to hyperprolactinemia and potentially prolactinoma

24
Q

Which antipsychotics have long-acting forms?

A

Typicals:

  1. Haloperidol deconoate
  2. Fluphenzaine decanoate

Atypicals:

  1. Risperidone consta
  2. Aripiprazole lauroxil
25
Q

What is the origin of serotonergic neurons in the brain?

A

Dorsal raphe nucleus

26
Q

What medication can be used for akathisia?

A

Propanolol (one of few lipophilic beta blockers that crosses the blood-brain barrier)

27
Q

What atypical antipsychotic is by far the worse for QT prolongation?

A

Ziprasidone (Geodon)(Rarely used for this reason as well as needed to be taken with a meal)

28
Q

What can be involved in acute dystonic reaction EPS?

A

All are forms of involuntary increased muscle tone.

  1. Blepharospasm (involuntary eye closure)
  2. Oculogyric crisis (fixed upward or disconjugate gaze)
  3. Torticollis (twisted neck)
  4. Opisthonos (arching back)
  5. Layngospasm
29
Q

What are the key dopaminergic pathways in the brain?

A
  1. Mesocortical: VTA to dorsolateral PFC
  2. Mesocortical: CTA to ventromedial PFC
  3. Mesolimbic: VTA to nucleus accumbens (limbic area)
  4. Nigrostriatal: Substantia nigra to basal ganglia and striatum
  5. Tuberoinfundibulur: hypothalamus to anterior pituitary
30
Q

What is the only antipsychotic also approved as an adjunct antidepressant?

A

Aripiprazole (Abilify)

31
Q

Which typical antipsychotic(s) has the most anti-cholinergic side effects?

A

Chlorpromazine (thorazine)

32
Q

What atypical antipsychotic(s) is more activating rather than sedating?

A

Aripiprazole (Abilify)

Can activate too much and lead to akathisia

33
Q

What did the CATIE trial show about typical vs. atypical antipsychotics?

A

Perphenazine (Trilafon), the only typical studied, was as efficacious and well-tolerated as the atypicals

34
Q

What is the effect of D2 blockage on the nigrostriatal pathway in a schizophrenic patient? (According to the dopamine hypothesis)

A

Extrapyrimadial side effects / parkinsonism

35
Q

What atypical antipsychotic(s) is most associated with hyperprolactinemia?

A

Risperidone (Risperdal)

36
Q

What is the dopaminergic pathway involved in motivation, pleasure, and reward?

A

Mesolimbic, VTA to nucleus accumbens (limbic area)

37
Q

Which antipsychotics are most sedating?

A

Typical: Chlorpromazine (thorazine)
Atypical: Quetiapine (seroquel)

38
Q

What types of side effects can be seen from antipsychotics in general?

A
  1. Extrapyramidal side effects (some typicals and atypicals)
  2. Metabolic syndrome (atypicals)
  3. Anti-HAM symptoms:
    a. H1 block: sedation, weight gain
    b. Alpha-1 adrenergic block: orthostatic hypotension
    c. Antimuscarinic block: Memory impairment, confusion, cardiac (e.g. tachycardia), blurred vision, dry mouth, constipation.
39
Q

What atypical antipsychotic(s) can be useful as a sleep aid?

A

Quetiapine (Seroquel)

Also approved as a mood stabilizer

40
Q

What atypical antipsychotic(s) is most associated with metabolic syndrome?

A

Olanzapine (Zyprexa), Clozapine (Clozaril)

41
Q

What atypical antipsychic(s) is approved as a monotherapy mood stabilizer?

A

Quetiapine (Seroquel)

Also can be used as sleep aid

42
Q

What are 4 typical antipsychotics?

A

Haloperidol (Haldol)
Fluphenazine (Proloxin)
Perphenazine (Trilafon)
Chlorpromazine (Thorazine)

43
Q

What is the dopaminergic pathway involved in emotions and affect?

A

Mesocortical, VTA to ventromedial PFC

44
Q

What receptors are potentially involved in antipsychotic-related weight gain?

A

H1 and 5-HT2C blockage

45
Q

What types of trunk movements can be seen in tardive dyskinesia?

A

Twisting, rocking, gyrating

46
Q

What is the dopaminergic pathway involved in movement?

A

Nigrostriatal: Substantia nigra to basal ganglia and striatum

47
Q

What atypical antipsychotic is most associated with orthostatic hypotension?

A

Quetiapine (Seroquel)

48
Q

What is the effect of D2 blockage on the mesocortical pathway in a schizophrenic patient? (According to the dopamine hypothesis)

A

No benefit to negative symptoms

49
Q

What is the effect of D2 blockage on the mesolimbic pathway in a schizophrenic patient? (According to the dopamine hypthesis)

A

Reduction in positive symptoms

Psychiatry (9 decks)

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