Schizophrenia Treatment Flashcards
Typically how long does drug treament for SCH take before symptoms are relieved? [1]
What is key to note about drug treatment and SCH? [1]
Improvement of symptoms takes 2-3 weeks
30% of patients do not respond to treatment - drug resistance.
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The drugs used to treat schizophrenia are [] receptor antagonists [1]
They can be divided into typical and atypical drug treatments; what are the difference between them?
The drugs used to treat schizophrenia are D2 (dopamine) receptor antagonists
Typical:’ are older and cause generalised dopamine receptor blockade.
Atypical: are more selective in their dopamine blockade and also block serotonin 5-HT2 receptors.
Atypical antipsychotic drugs target which receptor/s
D1 receptors
D2 receptors
D1 & D2 receptors
D1 & 5-HT2 receptors
D2 & 5-HT2 receptors
Atypical antipsychotic drugs target which receptor/s
D1 receptors
D2 receptors
D1 & D2 receptors
D1 & 5-HT2 receptors
D2 & 5-HT2 receptors
Name 5 typical antipyschotics
chlorpromazine, thioridazine,
fluphenazine, haloperidol, flupenthixol
Why are typical anti-pyschotics commonly have poor compliance? [1]
The lack of selectivity of action of the drugs used, results in a wide range of unwanted effects, which decrease compliance.
Describe the effect of typical anti-physchotics on positive and negative symptoms [1]
Improve positive symptoms
Little/no efficacy on negative symptoms
Name 6 atypical anti-psychotics used to treat SCH [6]
risperidone, olanzapine, clozapine, quetiapine, paliperidone, aripiprazole
Atypical anti-psychotics target which receptors? [2]
Antagonists at:
- D2 receptors
- 5-HT2A receptors
Clozapine blocks [] receptors with high affinity
Aripiprazole is a partial [] at presynaptic D2 receptors but an [] at D2 postsynaptic receptors
Clozapine blocks D4 receptors with high affinity
Aripiprazole is a partial agonist at presynaptic D2 receptors but an antagonist at D2 postsynaptic receptors
Name 3 extrapyramidal effects that occur due to antipsychotic drugs. [3]
Why do these occur? [1]
Extrapyramidal effects (EPS):
* acute dystonias
* parkinsonism
* tardive dyskinesia
Approx. 60% D2 receptor occupancy required for
antipsychotic efficacy; if >80% D2 receptors are blocked, then potential for EPS
Explain why antipsychotic drugs may cause sexual dysfunction, galactorrhoea or amenorrhoea?
Block dopamine receptors; causes a rise in prolactin
30% schizophrenic patients do not respond to treatment. Which drug would you provied for those who have drug resistance? [1]
Clozapine
Name a risk of clozapine treatment [2]
agranulocytosis: increases chance of infection
Which anti-psychotics can be adminstered by IM injections? [2]
fluphenazine decanoate
haloperidol decanoate
Describe the difference in AEs between atypicals and typical anti-pyschotics
Atypicals
* Less EPS
* Less cardiac toxicity (QT segment prolongation)
* Less hyperprolactinaemia
* Weight gain
* Hyperglycaemia, diabetes
* Insulin resistance
* Dyslipidaemia
* Cardiovascular disease
Typicals:
EPS (dystonia, parkinsonism…)
Tardive dyskinesia
Weight gain
QT interval prolongation
Sudden death
Hyperprolactinaemia
Explain what tardive dyskinesia is and the length of the AE [2]
Involuntary movements of the lips, jaw, face; grimacing, constant chewing, tongue thrusting; rapid involuntary limb movements
typical antipsychotics,
taken for longer than a few months/years
In some patients it may be possible to overcome it
Describe what neuroleptic malignant syndrome is a combination of [6]
Due to typical anti-psychotics
hyperpyrexia
muscle rigidity
tremor
confusion
autonomic instability
