Pharmacology of Psychoses - Antipsychotic Agents Flashcards
what is the Mesolimbic pathway.
Tegmentum to nucleus accumbens
Limbic structures are thought to subserve the integration of sensory input and motor responses with _________
affective or emotional data.
Hyperactivity in Mesolimbic pathway is believed to contribute to the occurrence of _______ symptoms in Schizophrenia
positive
_________ agents are most effective in reducing these positive symptoms - delusions, hallucinations, and disordered cognition
Antipsychotic (via D2 dopamine receptor blockade)
what is the Mesocortical pathway
tegmentum to Cortical structures (dorsolateral prefrontal cortex and ventromedial prefrontal cortex)
activation of _____ receptors is the basis for the hallucinatory effects.
5HT2A
Typical antispsychotic agents are characterized by a _____ D2 / 5HT2A ratio corresponding to ______D2 block and good efficacy against _______ symptoms of schizophrenia.
high,
good,
positive
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.
low,
poor,
negative
Name 2 typical antipsychotic drugs
Chlorpromazine,
Haloperidol
Name 4 atypical antipsychotic drugs
Aripiprazole,
Clozapine,
Olazapine,
Quetiapine
what are Extrapyramidal symptoms (dopaminergic blockade) seen in antipsychotics (high with haloperidol).
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)
what is the Tx for Acute dystonia as seen in anti-psychotic drug use
Antimuscarinic agents (diphenhydramine, benztropine).
what is the Tx for akathisia as seen in anti-psychotic drug use
Reduce dose or change drug; add anticholinergic and / or possibly β-blocker, benzodiazepines.
What is the Tx for Pseudoparkinsonism as seen in anti-psychotic drug use
Anticholinergic agents or amantadine (dopamine agonist).
The Greatest potential for QT prolongation is with the use of _____ ; least with ________
ziprasidone (atypical),
aripiprazole
Sedation side effects with atypical antipsychotics is Minimal with aripiprazole, risperidone; use _____________ for patients with insomnia or agitation
quetiapine or olanzapine
Weight gain and metabolic effects are: Highest with ___________; and minimal with aripiprazole, lurasidone
olanzapine, clozapine, quetiapine
what is the Treatment of intractable hiccoughs
chlorpromazine
this drug is used for Relief of pruritus / preoperative sedative (H1 blocking effect)
promethazine
Limitations to the dopamine hypothesis include these 3 observations: ______
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
