Psychotherapeutic Drugs

Question 1

Central Nervous System

Answer 1

Excitatory NT : 5-HT (serotonin), glutamate, NE
Inhibitory NT : GABA, glycine
Both NT : Dopamine (major NT)

Question 2

Psychosis

Answer 2

Increase Serotonin and Dopamine

Question 3

Dopamine Hypotheses in Mesocortical Pathway

Answer 3

Dopamine → from brain to prefrontal lobe cortex
LOW transmission of Dopamine
Result: Negative Symptoms

Question 4

Dopamine Hypotheses in Mesolimbic pathway

Answer 4

Dopamine → midbrain to nucleus accumbens
High neurotransmission of Dopamine
Result: Positive Symptoms

Question 5

Nigrostriatal Pathway

Answer 5

Substantia nigra to Striatum
Inhibition of this pathway → Extrapyramidal side effects

Question 6

Tuberoinfundibular Pathway

Answer 6

Hypothalamus to the pituitary inhibits release of prolactin
Inhibition leads to hyperprolactinemia

Question 7

Negative Symptoms

Answer 7

Alogia (low verbal output)
Anhedonia - unable to feel pleasure
Avolition - lack of motivation / drive
Associality
Apathy
Flattening of affect - monotonous voice / one facial expression

Question 8

Positive Symptoms

Answer 8

Hallucination (auditory)
Delusions (false belief)
Paranoia
Persecutory
Grandiose
Disorganized thoughts / speech
Bizarre behavior

Question 9

Typical Anti-Psychotics

Answer 9

Receptor blockade: D2 > 5HT2
Positive symptoms: Effective
Negative symptoms: Less Effective
EPS: More
Tardive dyskinesia: More

Question 10

Atypical Anti-psychotics

Answer 10

Receptor blockade: 5HT2 > D2
Positive symptoms: Effective
Negative symptoms: More effective
EPS: Less
Tardive dyskinesia: Less

Question 11

First Generation / Typical Antipsychotics / Traditional

Answer 11

a. Phenothiazines (-azine)
Aliphatic (-promazine)
eg. Chlorpromazine

*Piperazines (-phenazine)
eg Fluphenazine

Piperidines (-ridazine)
eg.Thioridazine

b. Butyrophenones
* Haloperidol
* Droperidol

c. Thioxanthines (-thix)

Question 12

High Potency 1st gen Typical

Answer 12

Fluphenazine
Trifluoperazine
Thiothixene
Haloperidol

Question 13

Low potency typicals

Answer 13

Chlorpromazine

Question 14

Intermediate Potency

Answer 14

Loxapine

Question 15

Most cardiotoxic and can cause blindness

Answer 15

Thioridazine

Question 16

Adverse Effects of Typical Antipsychotics

Answer 16

EPS
Tardive dyskinesia
Anticholinergics (Chlorpromazine, Thioridazine, Prochlorperazine, Clozapine)
Neuroleptic Malignant Syndrome

Question 17

Atypical Antipsychotics Agents MOA

Answer 17

MOA: blocks D4 receptors & 5-HT
receptors

Question 18

Second Generation / Atypical Antipsychotics

Answer 18

a. -zapine
* Clozapine
* Olanzapine
* Quetiapine

b. -xapine
* Loxapine

c. -peridone
* Risperidone - first line; does not have muscarinic effects
* Paliperidone
* Ziprasidone

Others
* Apipiprazole
* Amisulpride
* Molindole

Question 19

First atypical antipsychotic drugs

Answer 19

Clozapine
-less EPS

Question 20

Adverse Effects of Clozapine

Answer 20

Sedation, ANS
Fatal Agranulocytosis (monitor for 6 mos.)

Question 21

Olanzapine

Answer 21

Fewer ANS
No Agranulocytosis reports

SE: Sedation, Wt gain

Question 22

Risperidone S/Es

Answer 22

Orthostatic hypotension
Cardiotoxic (QT interval prolongation)

Question 23

First drug approved to treat irritability in autistic children

Answer 23

Aripiprazole

Question 24

Partial agonist at dopamine and 5-HT1A receptors

Answer 24

Aripiprazole

Question 25

EPS

Answer 25

a. Akathisia (uncontrolled restlessness)
b. Dystonia / Retrocollis / Torticollis /
Twisting of the neck
c. Pseudoparkinsonism

Question 26

Management of Neuroleptic Malignant Syndrome (NMS)

Answer 26

Dantrolene
Bromocriptine

Question 27

Other effects of Antipsychotics

Answer 27

1. Seizure - Clozapine
2. Agranulocytosis
   * low basophil, neutrophil, eosinophil count!
   * Neutropenia effect : (bacterial infection)
   * ***Clozapine - requires WBC monitoring
   every week for the 1st 6 months of therapy and every 3 weeks thereafter
3. Cardiac Effects
   * myocarditis - Clozapine
   * QT prolongation: Thioridazine, Ziprasidone
4. Corneal/Lens deposit
5. Retinal deposit
   * Thioridazine (can cause blindness)
6. Weight gain
   * common to 2nd generation antipsychotics except AMA: Aripiprazole, Molindole, Amsulpride
7. Increased risk of DM