NURS 660 Exam 1 Flashcards
Dopamine Theory
Hyperactive dopamine at D2 receptors in the mesolimbic pathway
Glutamate Theory
N-Methyl-D-Aspertate (NMDA) receptor hypofunction
Serotonin Theory
5HT2A receptor hyperfunction in the cortex
What symptoms of schizophrenia are associated with this region of the brain -
Striatum
Agitation
Delusions
Hallucinations
Hostility
Impulsivity
What symptoms of schizophrenia are associated with this region of the brain -
Substantia nigra
Delusions
Hallucinations
What symptoms of schizophrenia are associated with this region of the brain -
Dorsolateral prefrontal cortex
Disorganized behavior
Disorganized thinking/speech
What symptoms of schizophrenia are associated with this region of the brain -
Ventromedial prefrontal cortex
Anhedonia
Apathy
What symptoms of schizophrenia are associated with this region of the brain -
Ventral tegmental area
Delusions
Hallucinations
Dopamine Hypothesis of Schizophrenia
Positive symptoms— hyperactivity of both the mesolimbic/nigrostriatal pathway (delusions, hallucinations, disorganized speech, catatonic behaviors)
Negative symptoms— hypoactivity of the mesocortical pathway (apathy, anhedonia, cognitive blunting)
Schizophrenia is primarily associated with
Dopamine dysfunction
All effective treatment for Schizophrenia targets____
Dopamine D2 receptors
Which cytochrome (CYP) enzyme is implicated as a tobacco inducer when an individual is treated on clozapine?
1A2
What is the Dopamine (DA) pathway and clinical symptoms of schizophrenia?
Negative symptoms are related to DA deficit in the cerebral cortex; positive symptoms are related to DA excess in the nucleus accumbens and mesolimbic system.
A patient with a diagnosis of schizophrenia has a history of suicidal ideation and suicide attempts. The PMHNP should consider which antipsychotic medication that is the only antipsychotic to reduce the risk of suicide in schizophrenia?
Clorazil (clozapine) is the only known antipsychotic medication that has been shown to reduce the risk of suicide in patients diagnosed with schizophrenia.
Which serotonin receptor antagonism makes an antipsychotic “atypical”?
5HT2A
The mechanism of action that makes an antipsychotic medication “atypical” is related to the 5HT2A receptor antagonism and D2 receptor antagonism.
When suspecting a patient with neuroleptic malignant syndrome (NMS), which lab values would help confirm diagnosis?
Leukocytosis and elevated creatinine phosphokinase
With NMS, a patient has an elevated CPK due to skeletal muscle breakdown and elevated white blood cell count (WBC).
What are two important things to measure when using Zyprexa (Olanzapine)?
Lipid level and abdominal circumference
If a patient takes Risperdal and develops NMS, which other atypical should you avoid in the future?
Zyprexa (Olanzapine)
Which dopaminergic pathway is most relevant for the negative symptoms of schizophrenia?
Mesocortical
Frank has been taking valbenazine for the treatment of tardive dyskinesia. In a 6-week, double-blind phase II trial of valbenazine for tardive dyskinesia, what percentage of patients showed a response (at least 50% improvement) on the Abnormal involuntary Movement Scale (AIMS)?
49%
All approved medications for schizophrenia bind to which receptor?
D2
A 43-year-old patient with tardive dyskinesia (TD) has been taking tetrabenazine to treat his symptoms. Tetrabenazine is approved in the United States for the treatment of which movement disorder?
Huntington’s disease
Which of the following investigational agents being tested for the treatment of schizophrenia binds primarily to serotonin 5HT2A receptors?
Roluperidone
Which medication(s) does/do not require CYP2D6 genotyping?
Valbenazine and Deutetrabenazine
A patient who has been taking an atypical antipsychotic for 6 months has experienced a 22-pound weight gain since baseline. Which of the following pharmacologic properties most likely underlies this patient’s metabolic changes?
Serotonin 2C antagonism
Joseph constantly shifts positions while standing and moves his feet while sitting. He also rocks back and forth and occasionally jumps out of the chair. When asked to describe his symptoms he has tremendous difficulty and says he “feels anxious and has constant itching.” Joseph most likely has which movement disorder?
Akathisia
A patient akathisia is otherwise doing well on antipsychotic treatment for schizophrenia. What would be an appropriate adjunct medication to manage the akathisia?
Beta blocker
Lu AF11167 may effectively reduce negative symptoms of schizophrenia, and control positive symptoms by:
Inhibiting activity of PDE-10 enzyme
A leading hypothesis of psychosis is:
Hypofunctioning NMDA receptors
Lumateperone (ITI-007) is a:
a. Dopamine phosphoprotein modulator (DPPM)
b. 5HT2A antagonist
c. Glutamate GluN2B receptor phosphoprotein modulator
d. Serotonin reuptake inhibitor
E. All of the Above
According to research, ______________ approach to cognitive remediation therapy is effective in treating cognitive impairment?
Strategy & Training
Antagonism of dopamine 2 receptors in the mesolimbic/mesostriatal pathway may lead to:
Improvement in positive symptoms of psychosis and development of secondary negative symptoms.
A 44-year-old male with schizophrenia has been treated with dopamine 2 receptor antagonist since initial diagnosis twelve years ago. He has recently begun experiencing difficulty with fluid movement of his arms as well as involuntary facial grimaces. Which of the following likely underlies these symptoms?
Upregulation of dopamine 2 receptors
A 44-year-old woman with schizophrenia has developed tardive dyskinesia after taking haloperidol 15 mg/day for 2 years. Which of the following would be the most appropriate pharmacologic mechanism to manage her tardive dyskinesia?
Inhibition of vesicular monoamine transporter 2
A 38-year-old woman was diagnosed with schizophrenia approximately two years ago and after multiple trials of different medications has been maintained on haloperidol for the last several months with good response. Two weeks ago, she began exhibiting mild motor symptoms representative of drug-induced parkinsonism. Which of the following would be the most appropriate adjunct medication for this patient?
Muscarinic 1 antagonist
Sam is a 76-year-old patient with Parkinson’s disease psychosis who demonstrated a reduction in psychotic symptoms with no exacerbation of motor symptoms following treatment with a dopamine 2/serptpmoc 1A partial agonist. Where on the dopamine agonist spectrum did her medication most likely fall?
Nearly full dopamine agonist
The majority of drugs used to treat psychosis:
Have a higher affinity for serotonin 2A receptors than for dopamine 2 receptors.
A 24-year-old schizophrenia patient with prominent cognitive symptoms and social impairment is being evaluated for treatment. Her care provider is considering initiating ziprasidone, quetiapine, or aripiprazole, all of which share the property of serotonin1A agonism. This receptor binding property is expected to have clinical effects in schizophrenia most similar to:
Serotonin 2A antagonism
A 34-year-old male recently began experiencing breast secretions while receiving amisulpride. After switching to quetiapine the secretions ceased. Which of the following is the most likely pharmacological explanation for the resolution of this side effect?
Serotonin 2A antagonism
Atypical antipsychotics
Term used for second generation antipsychotics (based on their shared pharmacological properties, these drugs are also called dopamine-serotonin antagonists.
typical antipsychotics
Term used for first generation antipsychotics
First generation drugs (typical antipsychotics)
D2 Antagonism
chlorpromazine (Thorazine)
haloperidol (Haldol)
fluphenazine
perphenazine (Trilafon)
loxapine
Second generation drugs (atypical antipsychotics)
5HT2A/D2 antagonism
clozapine (Clozaril)
risperidone (Risperdal)
paliperidone (Invega) * must be taken with food
iloperidone
quetiapine (Seroquel)
olanzapine (Zyprexa)
ziprasidone (Geodon) * must be taken with food 500 calories
asenapine
lurasidone (Latuda) *must be taken with food
First generation drugs (typical antipsychotics)
*D2 Antagonism
*Associated with higher risk of neurological side effects such as
TD, EPS, and dystonia
Second generation drugs (atypical antipsychotics)
*5HT2A/D2 antagonism
*Have a higher affinity for 5HT2A receptors than D2 receptors
*Lower risk of neurological side effects, but higher risk for metabolic
side effects such as - hyperglycemia, weight gain and dyslipidemia
Serotonin Syndrome - Causative agent
Serotonin Agonist
Serotonin Syndrome - Onset
Within 24 hours
Serotonin Syndrome - Treatment agents
Benzodiazepine, cyproheptadine
Serotonin Syndrome - Resolution
Within 24 hours
Neuroleptic Malignant Syndrome (NMS) - Causative agent
Dopamine Antagonist
Neuroleptic Malignant Syndrome (NMS) - Onset
Days to weeks
Neuroleptic Malignant Syndrome (NMS) - Treatment agent
Bromocriptine
Neuroleptic Malignant Syndrome (NMS) - Neuromuscular findings
hyporeflexia, severe muscular rigidity (lead pipe)
Neuroleptic Malignant Syndrome (NMS) - Resolution
Days to weeks
Serotonin Syndrome - Neuromuscular findings
Hyperreactivity (tremor, clonus) hyperreflexia
