Pharmacology of Psychoses - Antipsychotic Agents

Question 1

what is the Mesolimbic pathway.

Answer 1

Tegmentum to nucleus accumbens

Question 2

Limbic structures are thought to subserve the integration of sensory input and motor responses with _________

Answer 2

affective or emotional data.

Question 3

Hyperactivity in Mesolimbic pathway is believed to contribute to the occurrence of _______ symptoms in Schizophrenia

Answer 3

positive

Question 4

_________ agents are most effective in reducing these positive symptoms - delusions, hallucinations, and disordered cognition

Answer 4

Antipsychotic (via D2 dopamine receptor blockade)

Question 5

what is the Mesocortical pathway

Answer 5

tegmentum to Cortical structures (dorsolateral prefrontal cortex and ventromedial prefrontal cortex)

Question 6

activation of _____ receptors is the basis for the hallucinatory effects.

Answer 6

5HT2A

Question 7

Typical antispsychotic agents are characterized by a _____ D2 / 5HT2A ratio corresponding to ______D2 block and good efficacy against _______ symptoms of schizophrenia.

Answer 7

high,
good,
positive

Question 8

Atypical agents are characterized by a _____ D2 / 5HT2A ratio corresponding to _____ D2 block and is thought to be associated with good efficacy against _______ symptoms of schizophrenia as well as efficacy in treatment-resistant individuals.

Answer 8

low,
poor,
negative

Question 9

Name 2 typical antipsychotic drugs

Answer 9

Chlorpromazine,

Haloperidol

Question 10

Name 4 atypical antipsychotic drugs

Answer 10

Aripiprazole,
Clozapine,
Olazapine,
Quetiapine

Question 11

what are Extrapyramidal symptoms (dopaminergic blockade) seen in antipsychotics (high with haloperidol).

Answer 11

Acute dystonia (Torticollis, swollen tongue, trismus, oculogyric crisis, opisthotonos)

Akathisia

Pseudoparkinsonism (Tremor, bradykinesia, rigidity, shuffling gait).

Tardive dyskinesias (Involuntary repetitive movement of lips, tongue, choreoathetoid movements of arms, legs)

Question 12

what is the Tx for Acute dystonia as seen in anti-psychotic drug use

Answer 12

Antimuscarinic agents (diphenhydramine, benztropine).

Question 13

what is the Tx for akathisia as seen in anti-psychotic drug use

Answer 13

Reduce dose or change drug; add anticholinergic and / or possibly β-blocker, benzodiazepines.

Question 14

What is the Tx for Pseudoparkinsonism as seen in anti-psychotic drug use

Answer 14

Anticholinergic agents or amantadine (dopamine agonist).

Question 15

The Greatest potential for QT prolongation is with the use of _____ ; least with ________

Answer 15

ziprasidone (atypical),

aripiprazole

Question 16

Sedation side effects with atypical antipsychotics is Minimal with aripiprazole, risperidone; use _____________ for patients with insomnia or agitation

Answer 16

quetiapine or olanzapine

Question 17

Weight gain and metabolic effects are: Highest with ___________; and minimal with aripiprazole, lurasidone

Answer 17

olanzapine, clozapine, quetiapine

Question 18

what is the Treatment of intractable hiccoughs

Answer 18

chlorpromazine

Question 19

this drug is used for Relief of pruritus / preoperative sedative (H1 blocking effect)

Answer 19

promethazine

Question 20

Limitations to the dopamine hypothesis include these 3 observations: ______

Answer 20

1) Postmortem and in vivo imaging studies show diminished DA activity in cortical and hippocampal regions that may underlie negative symptoms and cognitive impairment
2) Clozapine is weak D2 blocker but still is an effective antipsychotic agent
3) Evidence exists for role of serotonin (5-HT) and glutamate neurotransmitter systems