Psychopharm Test 2 Schizo/anxiety/ADHD Flashcards
Mesolimbic area and Schizophrenia
too much dopamine = psychosis and positive symptoms such as delusions/hallucinations/psychosis
Mesocortical Pathway and schizophrenia
When you treat schizophrenia with a D2 blocker/antagonis/ partial D2 agonist you end up blocking dopamine in other pathways such as mesocortical. when you block dopamine in mesocortical area it produces negative symptoms such as apathy adedonia inability to concentrate etc.
Tuberoinfundibular Dopamine pathway and Schizophrenia
When you treat schizophrenia with a D2 blocker the tuberoinfundibular area lacks dopamine which causes prolactin levels to rise = hyperprolactin.
Elevated prolactin causes gynecomastia/amenorrhea and fertility issues, and can rapidly demoralize bones. Sexual dysfunction and weight gain also possible.
** This area is normally normal in schizophrenia but when youg give the D2 blocker it’s normal.
Nigrostriatal area and Schizophrenia
This pathway is unaffected in schizophrenia. When you give a D2 antagonist/partial D2 agonist it blocks D2 receptors from binding in the nigrostriatal area and can cause motor side effects such as drug-induced parkinsonism (tremor, muscle rigidity, slowing/loss of movement, akathisia - motor restlessness, and dystonia -involuntary twisting contractions). Together these sx are called extrapyramidial symptoms (EPS). also can cause TARDIVE DYSKINESIA - BUT THIS ONLY OCCURS AFTER CHRONIC USE
What medication can be prescribed to combat drug induced parkinsonism?
Anticholinergic -
**When dopamine is blocked in nigrostriatial area it also allows for more acetylcholine to be around which creates the effects of parkinsonism. You will need to prescribe an anticholinergic (ex. amantidine)
What is dystonia?
intermittent spasmodic or sustained involuntary contraction of the muscles in the face, neck, trunk, pelvis,extremities, or even eyes.
Will need to give IM anticholinergic for first exposure. If late onset, consider treatment for tardive dystonia.
What is akathesia
Syndrome of motor restlessness that occurs after D2 blockers. There are restless movements like rocking from foot to foot or pacing,as well as inner restlessness, mental unease/dysphoria.
Treatment is aimed at using a B-adrenergic blocker or benzodiazepine. Serotonin 2 Antagonists can also be helpful.
What is a major medical emergency/side effect that can occur after you give a D2 blocker/antagonist?
Neuroleptic Malignant Syndrom
**NEED TO STOP THE D2 ANTAGONIST ASAP
What are prodrugs
They are drugs that turn into active forms once they enter the body.
Ex. Tetrabenazine
Name the 1st generation antipsychoitics aka D2 blockers
Chlorpromazine
Droperidol
Fluphenazine
Haloperidol
Loxapine
Perphenazine
Pimozide
Prochlorperazine
Thioridazine
Thiothixene
Trifluoperazine
2nd Generation/Atypical Antipsychotics (5ht2a & D2 antagonists)
Aripiprazole
Clozapine
Iloperidone
Lurasidone
Olanzapine
Paliperidone
Quetiapine
Risperidone
Ziprasidone
When would you use clozapine (atypical antipsychotic)
it is not a first line treatment, but used when other antipsychotics fail
Clozapine - gold standard for treatment of Schizophrenia
Does not seem to cause Tardive dyskinisia or hyper prolactin, but pts will need to have their CBC done since it causes neutropenia (agranulocytosis- low levels of WBCs)
Increased risk of seizures at high doses.
Sedating, increased risk of myocarditis and causes WEIGHT GAIN
What area of brain manages worry
Cortico-striato-thalmic-cortico Loop (CSTC)
What area of brain deals with the fear circuit?
Amygdala (PBN, LOCUS CERULEAN, PAG, HIPPOCAMPUS, OFC)
What are the 4 treatment medications for anxiety
SSRi/SNRI
Benzo
Anticholinergics
alpha2delta ligands
Short acting benzos
flurazapam
chlordiazepam
clorazepate
clonazapam
diazepam
Long acting benzos
alprazolam (Xanex)
oxazepam
triazolam
Which benzo can be used in children?
lorazapam (Ativan)
** lorazapam is also good for pts with liver issues bc the medicaiton is intermediate acting and metabolized outside the liver.
What is the only benzo/med used for catonia
lorazapam (Ativan)
How do benzos work?
Benzos are postive allosteric modulators (PAMs), so when they bind to the receptor they bind to an alternate site. This makes GABA want to bind more and when GABA binds to the receptor the Chloride channels open. It lengthens the amount of time the channels are open
Anxiogenic
Anxiety producing
Anxiolytic
Antianxiety
What is the name of the date rape drug Rohphynal?
flunitrazepam
What is the only 5Ht1a agonist approved for anxiety at this time
Buspirone
Dopamine Theory of ADHD
Decreased dopamine activity in the caudate nucleus and frontal cortices may contribute to cortical hypoarousal.
Increased DAT (dopamine transporters) in ADHD pts in caudate nucleus.
Increased DAT decreases dopamine availability
n ADHD THE reticular activating system is hypoactive = inhibition of sensory thalamus and projections to cortex are now inhibited = cortical hypoarousal (and what we see in th eEEG pattern characterized by abnormal theta activity).
What scale is used to assess changes in ADHD function?
Connors Global Index
What meds are used to treat ADHD?
Stimulants (amphetamine/methamphetamine)
Non stimulants
(Atomoxetine & viloxezine & Modafinil)
How does Atomoxetine (strattera) work?
non-stimulant that increase dopamine in the prefrontal cortex
cathecolamine agonist
How does viloxazine work? What enzyme does it effect?
Which ADHD medication is a prodrug?
VYVANSE
aka Lisdexamfetamine
(long acting stimulant)
If a medication is a pro drug and you give them an inhibitor what is going to happen to the medication?
It’s not going to be metabolized/not going to work
(normally if you give inhibitor with a regular medication (not prodrug) then it will increase the effects of the medications).
If you give a patient an inducer with a pro drug what will happen
its going to convert the drug to the active state and you will see more of a response to it.
Giving an inducer with a regular medication will cause ______?
the medication to be eaten up and to be less effective on the body.
