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Pharmacology III > Antipsychotics (Exam #1) > Flashcards

Antipsychotics (Exam #1) Flashcards

1
Q

“Positive” symptoms are due to ___-active DA in which specific pathway? What are two examples of these sxs?

A

OVER-active DA pathways in MESOLIMBIC system

  • Hallucinations
  • Delusions
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2
Q

“Negative” symptoms are due to ___-active DA in which specific pathway? What are two examples of these sxs?

A

UNDER-active DA pathways in MESOCORTICAL system (frontal cortex)

  • Withdrawn
  • Depressed
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3
Q

What is the start and end point of the Mesolimbic DA pathway, and what is it primarily involved in?

A

VTA → Limbic system

- Emotions

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4
Q

What is the start and end point of the Mesocortical DA pathway, and what is it primarily involved in?

A

VTA → Frontal cortex

- Cognition

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5
Q

What is the start and end point of the Nigrostriatal DA pathway, and what is it primarily involved in?

A

SN → Striatum

- Motor

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6
Q

What is the start and end point of the Tuberoinfundibular DA pathway, and what is it primarily involved in?

A

Hypothalamus → Pituitary

- Prolactin

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7
Q

What are the two classes of antipsychotics? What receptor type(s) does each act on, what DA pathway(s) are targeted, and what symptoms are alleviated with each?

A

“Classical” = “neuroleptics”

  • Block D2
  • Mesolimbic system = positive sxs

Atypical

  • Block 5-HT, D4 and D2
  • Mesolimbic AND Mesocortical systems = positive sxs AND negative sxs
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8
Q

What is an important characteristic that should be considered with all antipsychotics (and possibly relayed to the patient)?

A

Delayed onset of effects (~6 weeks)

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9
Q

Most antipsychotics also act on which three receptor types? How does this affect AEs?

A

Histamine
- Sedation

Muscarinic
- Anticholinergic = dry mouth, blurred vision, tachycardia, constipation

Adrenergic (alpha)
- CV (postural hypotension)

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10
Q

What is a major AE associated with antipsychotics, and what DA pathway does it work through? How do you treat these AEs?

Are classical or atypical antipsychotics more associated with this AE?

A 
Extrapyramidal sxs (EPS)
- Nigrostriatal pathway = Parkinson's-like sxs

Treat with anticholinergics (ex. Benztropine) to restore ACh/DA balance

Seen MORE with Classical

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11
Q

Are classical or atypical antipsychotics more associated with this EPS, and what type of sxs might be seen?

A

CLASSICAL = more EPS

- Parkinson’s-like (tremor, rigidity, dyskinesias, rocking, pacing)

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12
Q

What AE of antipsychotics involves choreiform? What two antipsychotics should be used because they are less likely to cause this AE?

A

Tardive Dyskinesia (TD)

Less TD:

  • Clozapine
  • Olanzepine
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13
Q

What is a life-threatening AE associated with antipsychotics, and what two symptoms might be seen? How do you treat these AEs?

A

Neuroleptic Malignant Syndrome (NMS)

  • Hyperpyrexia
  • Changes in BP/HR

Treat with Dantrolene

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14
Q

How does the level of anticholinergic effects of an antipsychotic affect the incidence of EPS?

A

HIGHER anticholinergic effects = less EPS incidence

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15
Q

What antipsychotic drug is associated with lower incidence of EPS, and why?

A

Chlorpromazine

- HIGH anticholinergic effects = less EPS

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16
Q

What is the primary AE associated with Chlorpromazine?

A

Retinal deposits

- “Browning of vision”

17
Q

What is the primary use of Haloperidol? What is the primary AE associated with this drug, and why?

A 
Acute situations (psychotic episode in ED)
- AE = EPS (NO anticholinergic effects)
18
Q

What are the two “Classical” antipsychotics? What is the MOA for these drugs?

A

Block D2 receptors

  • Chlorpromazine
  • Haloperidol
19
Q

What is the drug of LAST choice of the atypical antipsychotics, and why?

A

Clozapine = last choice

- AE of agranulocytosis

20
Q

Many antipsychotics will continue to have effect even after D/C (good), but what is one exception to this?

A

Clozapine

- RAPID relapse of psychosis if D/C abruptly (bad)

21
Q

Why would you use Olanzapine over Clozapine? What AE is associated with Olanzapine?

A

Olanzepine = NO agranulocytosis

- AE: “Zyprexa Diabetes” (hyperglycemia)

22
Q

What is the DOC for psychosis? What AE is RARE with this drug, and why?

A

Risperidone (Risperdal)

- EPS rare because NO effect on nigrostriatal DA pathway

23
Q

What two AEs are associated with Ziprasidone? What other use does this antipsychotic have?

A
  • QT prolongation
  • Sedation

Can also be used for depression

24
Q

What antipsychotic drug does NOT elevate prolactin? When might this drug be considered for use based on its AE?

A

Quetiapine (Seroquel)

- AE = VERY sedating so good for insomnia + psychosis

25
Q

What two drug are similar to Clozapine but have NO agranulocytosis?

A
  • Olanzapine

- Quetiapine (Seroquel)

26
Q

What is the MOA of Aripiprazole (Abilify)?

A

“DA system stabilizer”

  • If DA low → DA receptors activated
  • If DA high → DA receptors blocked
27
Q

Which antipsychotic drug acts as a “DA system stabilizer”? How does it work if DA is low vs. if DA is high?

A

Aripiprazole (Abilify)

  • If DA low → DA receptors activated
  • If DA high → DA receptors blocked
28
Q

What is the primary AE associated with Aripiprazole (Abilify)?

A

Decreased esophageal motility

29
Q

Which antipsychotic drug is newer, and might be considered for a patient with psychosis and depression-associated bipolar?

A

Lurasidone (Latuda)

30
Q

What is the DOC for Bipolar Disorder?

A

Lithium

31
Q

Lithium has NO metabolism, so how is it reabsorbed? What does it compete with?

A

Reabsorbed by kidney in PT

- Competes with Na

32
Q

How do low levels of Na affect Lithium? How do higher levels of Na affect Lithium?

If high levels of Lithium are present (overdose), what sign/sxs may present?

A
  • Low Na → Lithium toxicity
  • High Na → Lithium excreted faster = less effective

Lithium overdose = hyponatremia (less Na absorbed)

33
Q

What are is the major CI of Lithium, and why? How do you treat this?

A

Diabetes Insipidus = Lithium inhibits ADH

- Treat with Amiloride

34
Q

What drug should be avoided with use of Lithium, and why?

A

NSAIDS

- Increase Lithium toxicity

35
Q

What class of drugs is used as an alternative to Lithium in treatment of Bipolar disorder, and what are three examples?

A

Anticonvulsants

  • Valproate (Valproic Acid)
  • Carbamazepine
  • Gabapenitn

Pharmacology III (25 decks)

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