Psychopharm of Psychotic Disorders

Question 1

Problems associated with

1. Mesocortical
2. Mesolimbic
3. Nigrostriatal
4. Tuberoinfundibular

Answer 1

1. Associated with cognition and motivation (negative symptoms)
2. Associated with memory and emotional problems (positive symptoms)
3. Motor movement
4. PRL secretion

Question 2

First generation antipsychotics

Answer 2

Block D2 receptors in mesolimbic pathway

Side effects from H1, a1, and M1 receptors

Question 3

How much D2 antagonism do you have to have to stop psychosis

Answer 3

> 65%

Question 4

Side effects from blocking
1. H1
2. a1
3. M1
receptors

Answer 4

1. Sedation, weight gain
2. Decreased BP, dizziness, drowsiness
3. Dry mouth, urinary retention, blurred vision, constipation

Question 5

What is the difference in side effects between
1. Low affinity
2. High affinity
for D2 receptors?

Answer 5

1. More side effects from H1, a1, M1 receptors

2. More side effects from D2 receptors (extrapyramidal symptoms)

Question 6

Second generation antipsychotics

Answer 6

Also block the 5HT2a receptor

First line

Question 7

Third generation antipsychotics

Answer 7

Partial agonists at the same receptors

Question 8

Effects of D2
1. Agonism
2. Antagonism
on PRL release

Answer 8

1. Decrease

2. Increase

Question 9

Effects of 5HT2A
1. Agonism
2. Antagonism
on PRL release

Answer 9

1. Increase

2. Decrease

Question 10

Acute dystonia

Answer 10

Involuntary contraction of muscles causing uncontrollable repetitive or twisting movements of affected body part
May involve neck, eyes, jaw, tongue, and back
Can be very painful and frightening
Can occurs within hours of starting antipsychotics
Treat with benztropine and diphenhydramine

Question 11

Pseudo-Parkinsonism

Answer 11

Adverse effect of drugs that cause symptoms resembling PD (tremors, rigidity, hypomimia, slow thinking, salivation)
Can occur days to weeks after an antipsychotic is started or dose increase
Treatment: reduce dose, change antipsychotic, treat with oral anticholinergic

Question 12

Akathisia

Answer 12

Movement disorder characterized by an inner restlessness and a strong need to be in constant motion
Occurs within hours to weeks of starting an antipsychotic or increasing the dose
May be misinterpreted as psychotic agitation
Treatment: reduce dose, propanolol (*), mirtazapine

Question 13

Tardive dyskinesia

Answer 13

Disorder that involves involuntary movements, most commonly of the lower face
Repetitive purposeless movements may include lip smacking/checking, tongue protrusion, choreiform hands, pelvic thrusting
Occurs in months to years
From taking away the blocker and having hypersensitivity