Pharmacology of Psychotic Disorders Flashcards
Hypofunctioning of this pathway is believed to cause negative schizophrenia symptoms.
Dopamine mesocortical pathway
What is neuroleptic malignant syndrome?
A rare, but life-threatening ADR of typical antipsychotics characterized by fever, muscle rigidity, mental status changes, autonomic dysfunction, elevated creatine kinase, and elevated white blood cells
What are the common typical/1st generation antipsychotics?
Chlorpromazine, thioridazine, fluphenazine, haloperidol, pimozide
What first-generation antipsychotic is least likely to cause prolactin elevation?
Chlorpromazine
What is the most fatal antipsychotic?
Clozapine - also the most effective
What antipsychotic is the only drug approved for suicide risk in patients with schizophrenia?
Clozapine
For what non-psychiatric conditions may antipsychotics be used?
Nausea, intractable hiccups, pruritus (severe itching)
Hyperfunctioning of this pathway is believed to be one cause of psychosis.
Dopamine mesolimbic pathway
Many antipsychotics are indicated in weight gain. What antipsychotics are most indicated for use in obese patients and patients at increased risk of diabetes?
Aripiprazole, Pimavanserin, Ziprasidone
What is the most effective atypical antipsychotic?
Clozapine - considered last line due to risk of death
What are the high potency first-generation antipsychotics?
Fluphenazine, haloperidol, pimozide
What is the MOA of clozapine?
Blocks D2 and 5-HT2A receptors
What antipsychotic is associated with deposits on the retina?
Thioridazine
Atypical antipsychotics target primarily D2 and 5-HT2A receptors. What other receptors may be targeted?
Alpha1, muscarinic, H1 receptors
What antipsychotics are available in IM formulations for immediate/emergent use?
Olanzapine, haloperidol, ziprasidone
What antipsychotics are most associated with metabolic ADRS, including weight gain and diabetes?
Clozapine, olanzapine
What antipsychotic is associated with deposits on the cornea and lens?
Chlorpromazine
What antipsychotics are most associated with sedation?
2nd generation - clozapine, olanzipine, quetiapine
What chronic ADR of typical antipsychotics may appear months to years after beginning the medication?
Tardive dyskinesia
For what other psychiatric conditions may antipsychotics be used?
Intense anxiety, Tourette’s, bipolar disorder, major depressive disorder
What antipsychotics are available in long-lasting injectable formations to increase medication adherence?
Haloperidol, risperidone, olanzapine, aripiprazole
This atypical antipsychotic has no D2 binding and may be used to treat Parkinson’s-related psychosis.
Pimavanserin
What ADRs are associated with typical antipsychotics?
Extrapyramidal side effects, hyperprolactinemia, neuroleptic malignant syndrome
What atypical antipsychotic has the highest risk of Parkinsonism and prolactin elevation?
Risperidone
What potentially fatal ADR is associated with Clozapine that prevents its widespread use?
Agranulocytosis - dangerously low WBC that increases risk of infection and death
What antipsychotics are available as oral-dissolving tablets to increase medication adherence?
Olanzapine, risperidone
What first-generation antipsychotic is least likely to cause Parkinsonism-like symptoms?
Thioridazine
What class of antipsychotics are generally not recommended for use in patients with dementia?
Atypical antipsychotics
Atypical antipsychotics have some D2 binding. To what receptor do most atypical antipsychotics bind?
5-HT2A
What is the MOA of typical/1st generation antipsychotics?
D2 receptor antagonists
According to this serotonin hypothesis, what receptor is hyperfunctioning to cause hallucinations in patients with schizophrenia?
5-HT2A
What adverse effect have some antipsychotics been shown to have on cardiovascular function?
QT prolongation
True/False. The effectiveness of antipsychotics is generally similar in treating positive symptoms.
True - drug choice comes down to ADRs and treatment of negative symptoms
What antipsychotics are known to have higher risk of QT prolongation?
Ziprasidone (2nd gen), Chlorpromazine, haloperidol, pimozide, thioridazine
What is the most common type of ADRs associated with typical antipsychotics?
Extrapyramidal side effects - dystonia, akathisia, pseudoparkinsonism due to blockage of D2 receptors
According to the glutamate hypothesis, what is the cause of psychosis and other positive symptoms?
Hypofunctioning of NMDA receptors on GABAnergic interneurons
According to this psychotic hypothesis, agonism of D2 receptors causes psychosis and other positive symptoms.
Dopamine hypothesis
