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D&T2 Exam 2 > Treatment of Psychosis - Egleton > Flashcards

Treatment of Psychosis - Egleton Flashcards

1
Q

when patients exhibit gross disturbances in their comprehension of reality, as evidence by false perceptions ( hallucinations) and False beliefs (delusions

A

psychoses

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2
Q

abnormalities in dopamine neurotransmission occur in what pathways

A

mesocrotical

mesolimbic

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3
Q

how does ampthetamine impact dopamine

A

increases dopamine release

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4
Q

what happens to the nigrostriatal pathway during psyhcosis

A

no change

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5
Q

what happens to the mesolimbic pathway during psyhcosis

A

hyperactive- positive symptoms

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6
Q

what happens to the mesocortical pathway during psyhcosis

A

hypoactive
DLPFC- negative and cognitive symptoms
VMPFC - negative and effective symptoms

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7
Q

what happens to the tuberoinfundibular pathway during psyhcosis

A

no change

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8
Q

what types of withdrawel can cause acute psychosis

A

amphetamines/cocaine
alcohol
sedative-hypnotic

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9
Q

what heavy metal can cause acute pyshosis

A

Mercury

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10
Q

what vitamin deficiencies can cause acute psychosis

A

thiamin- B1
niacin - B3
vitamin B 12

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11
Q

what are two types of psychosis disorders

A

affective disorders

manic depressive disorders

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12
Q

what are 2 category of drugs that treat psychosis

A

antidepressants

mood stabilizers

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13
Q

what might cause positive symptoms

A

excessive neural activity

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14
Q

positive symptoms of Schizophrenia respond well to what class of drugs

A

neuroleptics

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15
Q

negative symptoms do not respond well to what class of drugs? which ones do

A

neuroleptics

atypical antipsychotics more effective

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16
Q

what type of symptoms is associated with poor prognosis for Schizophrenia

A

negative symptoms

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17
Q 
what type of symptoms are theses
agitation
delusions
disorganized speech
disorganized thinking
hallucinations
insomnia
A

positive

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18
Q 
what type of symptoms are these
apathy
affective flattening
lack of motivation
lack of pleasure
poverty of speech
social isolation
A

negative

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19
Q

For Schizophrenia, in clinical settings the primary objective thing to treat is

A

active psychosis

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20
Q

For Schizophrenia, outside the hospital what needs to be treated

A

preventing relapses

maintaining social adjustment

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21
Q

MOA for antipsychotic drug

A

competitive blockade of DA and 5-HT receptors

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22
Q

what is the receptor affinity for typical antipsyhotics

A

D2 greater than 5-HT2

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23
Q

what is the receptor affinity for atypical antipsyhotics

A

5-HT2 greater than D2

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24
Q

why do atypical antipsychotics give you less Parkinson symptoms

A

selectivity for mesolimbic over nigro-striatal region for DA

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25
Q

which antipsychotic drug is likely to improve both positive and negative symptoms

A

atypical antipsychotics

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26
Q

what are antipsychotics used for

A 
psychosis
Tourette's
Huntington's 
Hicup
nausea
motion sickness
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27
Q

Adverse effects of antipsychotics are attributed to blockade of what receptors

A

alpha1- adrenergic
histamine H1
muscarinic

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28
Q

what is seen in the urine if one takes antipyschotics

A

glucouronide conjugates

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29
Q

when do positive symptoms subside when take antipsychotics

A

1-3 weeks

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30
Q

what happens to impulse behavior when taking antipsychotics

A

decreases

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31
Q

what happens to motor when taking atypicals

A
  • no motor incoordination at usual doses
  • spontaneous activity diminished
  • akathisia
  • catatonic signs relieved or rigidity induced
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32
Q

akathisia

A

state of agitation, distress, restlessness

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33
Q

D2 receptors are coupled with what kind of G protein

A

Gi or G0

34
Q

blocking D2 receptors results in what

A
  • increase DA synthesis and release
  • increase cAMP
  • decrease K+ currents
35
Q

what is the dopaminergic neurotransmission presynaptic effect of short term treatment

A

activated neurons

36
Q

what is the dopaminergic neurotransmission presynaptic effect of long term treatment

A

inactivated neurons

37
Q

what is the dopaminergic neurotransmission postsynaptic effect of short term treatment

A

receptor blockade

38
Q

what is the dopaminergic neurotransmission postsynaptic effect of long term treatment

A

receptor supersenitivity

39
Q

what happens to the patient 1-3 days of therapy

A

decrease agitation/hostility, aggression/combativeness, anxiety
normalization of eat/sleep patterns

40
Q

what happens to the patient 1-2 weeks of therapy

A

increase socialization, self care habits, mood

41
Q

what happens to the patient 3-6 weeks of therapy

A

increase thought disorder,
decrease delusions/hallucinations
appropriate conversations

42
Q

what antipsychotic is used to treat Gilles de la Tourette’s syndrome and Huntington’s disease

A

Haloperidol

43
Q

What drug is used for intractable hiccup

A

Chlorpromazine

44
Q

what are contraindications of Chlorpromazine

A

don’t give to patients with seizures

deposits in lens and cornea

45
Q

what drug deposits in retina at higher doses

A

Thioridazine

46
Q

what drugs can treat anti-emetics? how do they work

A

all except aripiprazole and
thioridazine
- block D2 receptor in CTZ

47
Q

anti-emetics

A

drug that is effective against vomiting and nausea.

48
Q

what drug is useful in treatment of “drug induced” nausea (chemotherapy)

A

Prochlorperazine

49
Q

what is the drug of choice for motion sickness

A

Scopolamine

50
Q

what drug is a component of neuroleptanesthesia

A

Droperidol

51
Q

pseudoparkinsonism

A

rigidity/tremor at rest;
akinesia
pill-rolling movements
masked face

52
Q

dystonias

A

facial grimacing

torticollis

53
Q

which antipsychotic has lower incidence of extrapyramidal side effects

A

atypicals

54
Q

name the different kinds of side effects blocking the D2 receptor can create

A

extrapyramidal
tardive dyskinesia
neuroleptic malignant syndrome
prolactin

55
Q

what drugs block D2 and cause extrapyramidal side effects

A

Haloperidol
Fluphenazine
Thiothixene

56
Q

what drugs are used to treat the extrapyramidal side effects of D2

A

Trihexyphenidyl
Benztropine mesylate
Procyclidine HCl
Biperidin

57
Q

what drugs can cause tardive dyskinesia? what drug has a low incidence

A

all, more common in typical

Clozapine

58
Q

when do tardive dyskinesia symptoms appear and what is the MOA that causes this

A
  • develops after months/years of treatment

- results from “supersensitivity” to DA

59
Q

what type of drug causes neuroleptic malignant syndrome

A

typicals

60
Q

what is the outcome if a patient gets neuroleptic malignant syndrome

A

potentially fatal

61
Q

how does one treat neuroleptic malignant syndrome

A

stop antipsychotic immediately

administer Bromocriptine and Dantrolene

if high temp maintained, cool down patient

62
Q

what drug causes an increase in prolactin production

A

Phenothiazines

chlorpromazine, Fluphenazine, Thioridazine, trifluoperazine, mesoridazine, perphenazine

63
Q

what are cholinergic side effects of antipsychotics

A

dry mouth
blurred vision
urinary retention

64
Q

what drugs cause M1 cholinergic side effects? special case?

A

Thioridazine
Chlorpromazine
Olanzapine
Clozapine - also increases salvation

65
Q

what are side effects of adrenergic

A

orthostatic hypotension

66
Q

what drugs cause adrenergic side effects

A

chlorpromazine

Mesoridazine

67
Q

what is a side effect of blocking histamine

A

sedation

68
Q

what drugs give histamine side effects

A

Chlorpromazine
Olanzapine
Quetiapine
Clozapine

69
Q

which class of drug has more metabolic side effects

A

atypicals

70
Q

what does Clozapine and Olanzapine do to weight gain, lipids and gluose

A

increase all

71
Q

what does Chlorpromazine do to weight gain, lipids and gluose

A

increase all but not as much as Clozapine and Olanzapine

72
Q

what does Risperidone do to weight gain, lipids and gluose

A

increae weight gain

no changes in lipids and glucose

73
Q

what drug causes Leukpenia and agranulocytosis

A

Clozapine

74
Q

what is “rabbit syndrome”

A

perioral tremor
rare
prolong drug use
treat with anticholinergic antiparkinson rugs

75
Q

what drugs what cardiac effects? what do they do?

A

Thioridazine: minor T wave abnormality
Ziprasidone: QT prolongation

76
Q

who should never use antipsychotics in what patients

A

pregnant and nursing mothers

77
Q

drug interactions: amphetamines

A

antagonize antipsyhcotics

78
Q

drug interactions: anticholinergics

A

worsen tardive dyskinesia

79
Q

drug interactions: SSRI

A

worsen extrapyramidal symptoms

80
Q

drug interactions: antihypertensives

A

more hypotensive

D&T2 Exam 2 (14 decks)

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