Schizophrenia Flashcards
Positive symptoms of schizophrenia
Psychosis, hallucinations, delusions
Negative symptoms of schizophrenia
withdrawl, reduced speech, attention, pleasure
What is the Dopamine Hypothesis?
Psychosis/Psychotic symptoms of schizophrenia are due to hyperactive DA system/signalling
First antipsychotic? First atypical?
antipsy – Chloepromazine
athypical – Clozapine
Five perks of atypical antipsychotics
- Better D2 affinity
- 5HT2A pharmacology
- Favorable PK
- Activity against neg. Sx
- Lower Extrapyramidal sx risk
How do antipsychotics typically work?
They are Dopamine D2 receptor antagonists
What is haldol? downside?
2nd generation typical
Notable extrapyramidal symptoms
Neurological pathways involved in the therapeutic and cognitive activities of D2 antagonists
Mesocortical pathway + Mesolimbic pathway
Involvedment with nigrostriatal DA pathway triggeres extrapyramidal symptoms
Adaptive changes known to occur with antipsychotic administration
D2 receptor upregulrion
Who are the first generation antipsychotics?
Phenothiazines and Haloperidol
Important details about 1st gen anti-psychotics (phenothiazines + haloperidol)
Strong D2 antagonism
Variable off target effects
Long Halflife (20-40 hrs)
Only manage positive symptoms
Prototype of 2nd generation antipsychotics
Clozapine
IMportant details abut clozapine
D2 selectivity 5HT2A pharmacology better management of cognitive Sx lower risk of EPS Still hits other receptors
Difference int he mechanism of action of aripirazole and haloperidol
Aripirazole – D2 partial agonist
Haloperidol – D2 antagonist
List the six atypicals with 5HT activity
Clozapine Aripiprazole Risperidone Olanzapine Quetiapine Ziprasidone
Describe the process of manageming schizo
1st few day – Control agitation w/ Haldol
Day 7-14 – Begin to address + symp, switch to PO
Long term – Address negative symptoms, compliance
Non schizophrenia uses for atypicals?
Refractory depression Bipolar (Quietapine + olanzapine) Tourettes (Fluphenazine - a 1st gen) Autism Agitation in dementia
Extrapyramidal symptoms associated with antipsychotic use
- Dystonia (muscle spasms of neck, eyes)
- Akathesia (motor restlessness)
- Parkinsonism (rigidity, shuffling, dec. facial expression)
- Tardive dyskinesias (delayed, severe, irreverdible uncontrolled movements)
- Neuroleptic Malignant Syndrome
Symptoms of Neuroleptic Malignant Syndrome
EPS, Fever, Cognitive Impairment
Treat w/ DA agonists, muscle relaxants
Neuroleptic side effects of antipsychotics
Apathy, Dysphoria, Impaired thinking
Endocrine side effects of antipsychotics
Prolactin mediated
Metabolic side effects of antipsychotics
Weight gain, diabetes
Replacing EPS
Hematologic side effects of antipsychotics
Agranulocytosis
Important side effects of haloperidol
Severe EPS
Moderate sexual dysfxn
Important side effects of Olanzapine
Weight Gain
Important side effcets of clozapine
Weight gain, sedation, anticholinergic, adrenergic
