Watts Schizophrenia Flashcards
Positive symptoms examples
symptoms that respond well to drug therapy:
-hallucinations
-delusions
-bizarre behavior
-thought disorders
Negative symptoms examples
symptoms with little response to drug therapy:
-blunted emotion
-poor self care
-social withdrawal
-poor speech
Cognitive symptoms involve what receptors? (two different receptors)
D1 and glutamate
Name 3 components of the serotonin hypothesis of schizophrenia (6 total)
- Pharmacological studies with 5HT receptors identified 5HT2A receptor as mediator of hallucinations
- 5HT2A receptors modulate dopamine release in the cortex, limbic region, and the striatum
- 5HT2C agonists may be beneficial in schizophrenia
Name 4 components of the dopamine hypothesis of schizophrenia
- D2 receptor antagonists - strong correlation between binding affinity and clinical effectiveness
- dopaminergic agents exacerbate symptoms
- increased D2 receptor density in patients with schizophrenia
- Imaging studies showed increased DA release and receptor occupancy in patients
Most antipsychotic drugs are receptors __________
antagonists
In which region of the CNS do D2 antagonists have their primary therapeutic effects?
Mesolimbic region
In which region of the CNS do D2 antagonists cause EPS?
Basal ganglia (nigrostriatal pathway)
Extrapyramidal symptoms (EPS) examples
- Dystonia - increased muscle tone
- Pseudoparkinsonism - muscle rigidity
- Tremor
- Akathisia - restlessness
What are the four types of drugs used as treatment for EPS?
- Anticholinergic agents (Benztropine, Trihexyphenidyl, Akineton)
- Antihistamines (Benadryl)
- DA releasing agent (Amantadine)
- Propranolol (used for akathisia)
Tardive dyskinesia symptoms
- Mouth - rhythmic involuntary movements
- Choreiform - irregular purposelessness
- Athetoid - worm-like
- Axial hyperkinesias - to and fro movements
Name 5 examples of tardive dyskinesia treatment
first - it’s irreversible
1. PREVENTION
2. Reduce dose of current agent
3. Switch drug, possibly newer agent
4. Eliminate anticholinergics
5. VMAT2 inhibitors (tetrabenazine)
What was the first antipsychotic?
Chlorpromazine
How do you treat NMS?
Restore dopamine balance:
2. D/c drug
3. DA agonists, diazepam, or dantrolene (skeletal muscle relaxant)
Neuroleptic malignant syndrome (NMS) symptoms
- EPS with fever
- Impaired cognition - agitation, delirium
- Muscle rigidity
Aliphatic phenothiazines are used for their ______ antagonist properties
H1
Example of a thioxanthine antipsychotic
Thiothixene (Navane)
Example of a butyrophenone antipsychotic
Haloperidol (Haldol)
Atypical (2nd generation) antipsychotics have reduced _____ but more ______ _________
EPS
metabolic problems
Atypical antipsychotics have similar or enhanced antagonism at which receptor vs. D2?
5HT2A
What was the first atypical antipsychotic?
Clozapine
What can clozapine cause that requires weekly blood monitoring for first 6 months of therapy?
Agranulocytosis
T/F: Clozapine has both anticholinergic and antihistaminic side effects
TRUE
Clozapine, olanzapine, and quetiapine have a risk of __________
Diabetes
Loxapine and quetiapine both have metabolites that act as an ___________
antidepressant
Which of the “dones” is very potent at a1 receptors?
Iloperidone
Which receptors is quetiapine potent at? (Hint: there are 4)
- 5HT2A and D2 mostly
- a1 (hypotension)
- H1 (sedation)
***LOW antimuscarinic
Risperidone and lurasidone are antagonists at which two receptors?
5HT2A and D2
Risperidone shows relatively low EPS at < _____mg/day
8mg
Pimavanserin is an inverse agonist of _________
5HT2A
