Schizophrenia

Question 1

Positive symptoms of schizophrenia

Answer 1

Psychosis, hallucinations, delusions

Question 2

Negative symptoms of schizophrenia

Answer 2

withdrawl, reduced speech, attention, pleasure

Question 3

What is the Dopamine Hypothesis?

Answer 3

Psychosis/Psychotic symptoms of schizophrenia are due to hyperactive DA system/signalling

Question 4

First antipsychotic? First atypical?

Answer 4

antipsy – Chloepromazine

athypical – Clozapine

Question 5

Five perks of atypical antipsychotics

Answer 5

1. Better D2 affinity
2. 5HT2A pharmacology
3. Favorable PK
4. Activity against neg. Sx
5. Lower Extrapyramidal sx risk

Question 6

How do antipsychotics typically work?

Answer 6

They are Dopamine D2 receptor antagonists

Question 7

What is haldol? downside?

Answer 7

2nd generation typical

Notable extrapyramidal symptoms

Question 8

Neurological pathways involved in the therapeutic and cognitive activities of D2 antagonists

Answer 8

Mesocortical pathway + Mesolimbic pathway

Involvedment with nigrostriatal DA pathway triggeres extrapyramidal symptoms

Question 9

Adaptive changes known to occur with antipsychotic administration

Answer 9

D2 receptor upregulrion

Question 10

Who are the first generation antipsychotics?

Answer 10

Phenothiazines and Haloperidol

Question 11

Important details about 1st gen anti-psychotics (phenothiazines + haloperidol)

Answer 11

Strong D2 antagonism
Variable off target effects
Long Halflife (20-40 hrs)
Only manage positive symptoms

Question 12

Prototype of 2nd generation antipsychotics

Answer 12

Clozapine

Question 13

IMportant details abut clozapine

Answer 13

D2 selectivity
5HT2A pharmacology
better management of cognitive Sx
lower risk of EPS
Still hits other receptors

Question 14

Difference int he mechanism of action of aripirazole and haloperidol

Answer 14

Aripirazole – D2 partial agonist

Haloperidol – D2 antagonist

Question 15

List the six atypicals with 5HT activity

Answer 15

Clozapine
Aripiprazole
Risperidone
Olanzapine
Quetiapine
Ziprasidone

Question 16

Describe the process of manageming schizo

Answer 16

1st few day – Control agitation w/ Haldol
Day 7-14 – Begin to address + symp, switch to PO
Long term – Address negative symptoms, compliance

Question 17

Non schizophrenia uses for atypicals?

Answer 17

Refractory depression
Bipolar (Quietapine + olanzapine)
Tourettes (Fluphenazine - a 1st gen)
Autism
Agitation in dementia

Question 18

Extrapyramidal symptoms associated with antipsychotic use

Answer 18

1. Dystonia (muscle spasms of neck, eyes)
2. Akathesia (motor restlessness)
3. Parkinsonism (rigidity, shuffling, dec. facial expression)
4. Tardive dyskinesias (delayed, severe, irreverdible uncontrolled movements)
5. Neuroleptic Malignant Syndrome

Question 19

Symptoms of Neuroleptic Malignant Syndrome

Answer 19

EPS, Fever, Cognitive Impairment

Treat w/ DA agonists, muscle relaxants

Question 20

Neuroleptic side effects of antipsychotics

Answer 20

Apathy, Dysphoria, Impaired thinking

Question 21

Endocrine side effects of antipsychotics

Answer 21

Prolactin mediated

Question 22

Metabolic side effects of antipsychotics

Answer 22

Weight gain, diabetes

Replacing EPS

Question 23

Hematologic side effects of antipsychotics

Answer 23

Agranulocytosis

Question 24

Important side effects of haloperidol

Answer 24

Severe EPS

Moderate sexual dysfxn

Question 25

Important side effects of Olanzapine

Answer 25

Weight Gain

Question 26

Important side effcets of clozapine

Answer 26

Weight gain, sedation, anticholinergic, adrenergic