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Therapeutics III > Watts Schizo > Flashcards

Watts Schizo Flashcards

1
Q

Etiology of schizophrenia

A

-Neurodevelopmental/anatomical
-Genetics-neuronal growth, migration of neurons
-Environmental-birth complications, infections
-Gene-environment interaction
-Neurodevelopment-environment interaction

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2
Q

What are positive symptoms of schizophrenia?

A

-Respond well to drug therapy
-Hallucinations
-Delusions
-Bizarre behavior
-Thought disorder

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3
Q

What are negative symptoms of schizophrenia?

A

-Little response to drug therapy, newer agents are better
-Blunted emotion
-Poor self-care
-Social withdrawal
-Poverty in speech

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4
Q

What are the receptors antagonized by antipsychotics?

A

-Dopamine
-Serotonin
-Norepinephrine
-Acetylcholine
-Histamine

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5
Q

What is the major receptor antagonized by antipsychotics?

A

Dopamine

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6
Q

What is the newer receptor antagonized by antipsychotics?

A

Serotonin

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7
Q

What has more predictable dosing, D2 or D1?

A

D2

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8
Q

Actions of D2 antagonists on the basal ganglia (nigrostriatal pathway)

A

-Motor effects
-Extrapyramidal symptoms

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9
Q

Actions of D2 antagonists on the mesolimbic

A

Primary therapeutic effects

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10
Q

Actions of D2 antagonists on the mesocortical

A

-Hypofunction in schizophrenia
-Antagonists may exacerbate cognitive deficits

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11
Q

Actions of D2 antagonists on the Hypothalamus and endocrine systems

A

D2 receptor blockade in endocrine system

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12
Q

Actions of D2 antagonists on the medulla

A

-Chemoreceptor trigger zone
-D2 antagonists are anti-emetics

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13
Q

Drug-induced movement disorders (D2 antagonism)

A

-Extrapyramidal symptoms (EPS) (30-50%)
-Tardive dyskinesia (20-40%)
-Neuroleptic malignant syndrome (NMS)

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14
Q

When do extrapyramidal symptoms appear?

A

Occur early, days/weeks, reversible

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15
Q

What are the extrapyramidal symptoms?

A

-Dystonia - increased muscle tone
-Pseudoparkinsonism - muscle rigidity
-Tremor
-Akathisia - restlessness

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16
Q

Drug therapy for EPS

A

-Anticholinergic agents
-Antihistamines
-Dopamine-releasing agents
-Used for akathisia

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17
Q

When does tardive dyskinesia appear

A

Occur late, months to a year, IRREVERSIBLE

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18
Q

Symptoms of tardive dyskinesia

A

-Mouth - rhythmic involuntary movements
-Choreiform - irregular purposelessness
-Athetoid - worm-like
-Axial hyperkinesias - “to-and-fro” movements

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19
Q

Monitoring of tardive dyskinesia

A

AIMS (abnormal involuntary movement scale) rating scale; check every 6 months

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20
Q

Treatment of tardive dyskinesia

A

-Prevention! Use the least risky agent at the lowest dose possible and monitor
-Reduce dose of current agent
-Change to a different drug; possibly a newer agent
-Eliminate anticholinergic drugs
-VMAT inhibitors

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21
Q

What are the VMAT inhibitors for tardive dyskinesia

A

-Tetrabenazine (Xenazine) for Huntington’s chorea
-Valbenazine (Ingrezza) for TD
-Deutetrabenazine (Austedo) for TD and Huntington’s chorea

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22
Q

When does neuroleptic malignant syndrome appear?

A

Immediately and serious; 10% fatality

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23
Q

What are the symptoms of neuroleptic malignant syndrome?

A

-EPS symptoms with fever
-Impaired cognition - agitation, delirium, coma
-Muscle rigidity

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24
Q

Treatment of neuroleptic malignant syndrome

A

-Restore dopamine balance
-Discontinue drug
-DA agonists, diazepam, or dantrolene (skeletal muscle relaxant)

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25
Q

How long does it take for antipsychotic drugs to take effect when treating psychosis?

A

-2-3 weeks for effectiveness
-6 weeks to 6 months maximal efficacy

26
Q

Pharmacological effects of the antipsychotic drugs

A

-Behavioral effects: Unpleasant in normal subjects or reversal of signs and symptoms of psychosis in affected individual
-“Neuroleptic” syndrome: Suppress emotions, reduce initiative and interest, affect; may resemble negative symptoms
-Block conditioned avoidance responses in animal studies
-Decreased spontaneous activity, aggressive, and impulsive behavior

27
Q

Manifestations associated with muscarinic cholinoreceptor blockade

A

-Loss of accommodation
-Dry mouth
-Difficulty urinating
-Constipation

28
Q

Manifestations associated with alpha adrenoreceptor blockade

A

-Orthostatic hypotension
-Impotence
-Failure to ejaculate

29
Q

Manifestations associated with dopamine receptor blockade

A

-Parkinson’s syndrome
-Akathisia
-Dystonias

30
Q

Manifestations associated with supersensitivity of dopamine receptors

A

Tardive dyskinesia

31
Q

Manifestations associated with muscarinic blockade

A

Toxic-confusional state

32
Q

Manifestations associated with histamine receptor blockade

A

Sedation

33
Q

Manifestations associated with dopamine receptor blockade resulting in hyperprolactinemia

A

-Amenorrhea-galactorrhea
-Infertility
-Impotence

34
Q

Manifestations associated with combined histamine and serotonin blockade

A

Weight gain

35
Q

Precautions/contraindications associated with antipsychotic drugs

A

-Cardiovascular (hypotension and QT interval prolongation)
-Parkinsons disease
-Epilepsy (clozapine will lower seizure threshold)
-Diabetes (contraindicated for newer agents)

36
Q

What does a drug that has high serotonin/dopamine ratio cause?

A

EPS

37
Q

What are the aliphatic phenothiazines?

A

-Chlorpromazine (Thorazine) - no longer first-line therapy
-Promethazine (Phenergan) - more likely to be used for N/V

38
Q

Which aliphatic phenothiazine is more likely to be used for H1 antagonist properties?

A

Promethazine

39
Q

What are the piperidine phenothiazines?

A

Thioridazine (Mellaril) - sedation, hypotension; anticholinergic, many SE

40
Q

What are the piperazine phenothiazines?

A

-Fluphenazine (Permtil, Prolixin) - EPS
-Prochlorperazine (Compazine) - antiemetic
-Perphenazine (Trilafon) - just as effective as newer agents

41
Q

What are the thioxanthines?

A

-Thiothizene (Navane) - modest EPS

42
Q

What are the butyrophenones?

A

-Haloperidol (Haldol) - EPS

43
Q

Miscellaneous antipsychotics

A

-Molindone (Moban) - moderate EPS
-Pimozide (Orap) - Tourette’s disease-tics, vocalizations

44
Q

Key points of chlorpromazine (Thorazine)

A

-First antipsychotic
-Antihistamine side effects

45
Q

Key points of promethazine (Phenergan)

A

-Antihistamine
-Antiemetic

46
Q

Key points of thioridazine (Mellaril)

A

-Many side effects: anticholinergic, sexual dysfunction, cardiovascular

47
Q

Key points of perphenazine (Trilafon)

A

CATIE studies: combination with anticholinergic

48
Q

Key points of thiothixene (Navane)

A

Modest EPS

49
Q

Key points of haloperidol (Haldol)

A

EPS

50
Q

Key points of molindone (Moban)

A

Moderate EPS

51
Q

Key points of pimozide (Orap)

A

Tourette’s disease, suppress motor and vocal tics

52
Q

Atypical/second generation antipsychotics

A

-Clozapine
-Olanzapine
-Loxapine
-Quetiapine
-Risperidone
-Paliperidone
-Iloperidone
-Ziprasidone
-Asenapine
-Lurasidone
-Pimavanserin
-Aripiprazole

53
Q

D2/D3 partial agonists

A

-Brexpiprazole
-Cariprazine
-Lumateperone

54
Q

Clozapine key points

A

-First atypical antipsychotic
-Agranulocytosis
-Risk of diabetes
-Superior efficacy

55
Q

Olanzapine key points

A

-Weight gain
-Risk of diabetes

56
Q

Quetiapine key points

A

-Metabolite with antidepressant activity
-Hypotension
-Sedation

57
Q

Risperidone key points

A

-Serotonin/dopamine receptor antagonist

58
Q

Ziprasidone key points

A

-Serotonin/dopamine, alpha 1 affinity
-prolongs QT interval

59
Q

Lurasidone key points

A

-Serotonin/dopamine receptor affinity
-Reduced metabolic effects
-Rapid titration

60
Q

Aripiprazole key points

A

-High serotonin/dopamine receptor affinity
-Partial agonist activity

61
Q

Drugs in development/under investigation

A

Dual M1/M4 muscarinic agonist combined with peripheral muscarinic antagonist (KarXT)

Therapeutics III (42 decks)

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