Antipsychotics

Question 1

Where do negative symptoms and cognitive disorders arise from?
- what does this mean the problem is for the patient?

Answer 1

MESOCORTICAL - ventral tegmentum (brain stem) to the cerebral cortex

• too little dopamine

Question 2

Where do positive symptoms and cognitive disorders arise from?
- what does this mean the problem is for the patient?

Answer 2

Mesolimbic - projects from the dopaminergic cell bodies in the spinal cord to the limbic system

hallucinations, delusions and thought disorders

too much dopamine

Question 3

what is the nigrostriatal pathway and where does it project from?

• what is this pathway responsible for?

Answer 3

dopaminergic cell bodies in the substantia nigra to the basal ganglia
- movement regulation

Question 4

what does dopamine suppress?

Answer 4

acetylcholine activity

Question 5

what can dopamine hyperactivity cause?

Answer 5

parkinsonian movements ie rigidity, bradykinesia tremors, dystonia, akathisia

Question 6

Tuberoinfundibular pathway projects from?

Answer 6

hypothamus to anterior pituitary

Question 7

dopamine inhibits/regulates whats release?

Answer 7

prolactin

Question 8

Blocking dopamine in the Tuberoinfundibular pathway causes?

Answer 8

hyperprolactinemia

• reduced libido
• gynecomastia

Question 9

high potency typical antipsychotics bind to?

Answer 9

D2 receptor with high affinity

= extrapyramidal side effects

Question 10

typical antipsychotics examples

Answer 10

Haloperidol, Pimozide, Fluphenazine

Question 11

low potency typical antipsychotics tend to interact more with?

Answer 11

nondopaminergic receptors

cardiotoxic and anticholinergic side effects such as
- dry mouth, blurred vision , hypertension, sedation

Question 12

low potency typical antipsychotic example?

Answer 12

chlorpromazine

Question 13

what are atypical antipsychotics?

Answer 13

they are SDA antagonists

• affect dopamine and serotonin neurotransmission in the 4 dopamine pathways

Question 14

most likely atypical to cause extrapyramidal effect?

Answer 14

risperidone

- weight gain and sedation (at high doses)

Question 15

Olanzapine can be given ..?

Answer 15

rapid IM injection - useful for patents who refuse medication

Question 16

Olanzapine side effects?

Answer 16

significant weight gain

• hypertriglyceridemia, hypercholersterolemia and hyperglycaemia

lft’s

Question 17

Quetiapine use in?

Answer 17

patients with depression and problems with sleep

Question 18

Quetiapine side effects.. it is most likely to cause?

Answer 18

raised lft’s

• orthostatic hypotension

Question 19

Aripiprazole mechanism of action

Answer 19

d2 partial agonist - balancing - less sedation and extra pyramidal side effects

Question 20

benefits of Aripiprazole

Answer 20

low EPS, no QT prolongation, low sedation

- not associated with much weight gain

Question 21

cons of using Aripiprazole

Answer 21

can cause potential intolerability due to akathisia/activation

Question 22

good choice in first episode?

Answer 22

Aripiprazole

Question 23

treatment resistant medication?

Answer 23

clozapine

Question 24

clozapine is associated with and what does it require?

Answer 24

agranulocytosis
- weekly bloods for 6 months
then every 2 weeks for 6 months

looks for any induction of neutrophils

Question 25

clozapine use has an increased risk of?

other side effects?

Answer 25

seizures- especially if using lithium

• weight gain, abnormal lft’s
• nonketotic hyperosmolar coma and death

Question 26

antipsychotics adverse effects - typically with the typical antipsychotics?

Answer 26

Tardive dyskinesia

- involuntary movements that might not resolve with discontinuation

Question 27

Neuroleptic malignant syndrome is characterised by?

Answer 27

severe muscle rigidity, fever, altered menta status , elevated WBC, creatine lfts

Question 28

Agents for extrapyramidal side effects?

Answer 28

Benztropine, trihexyphenidyl, diphenhydramine , amantadine

beta blockers - propanolol, diazepam (akatthisia)

Question 29

most common psychotic symptom?

Answer 29

lack of insight

- no compliance

Question 30

after a 3rd episode of schizophrenia there is a link to?

- what might you need to consider?

Answer 30

reduced functioning, Lower IQ and negative symptoms

• long acting IM

Question 31

WHAT BLOOD WORK would you obtain before starting on an antipsychotic?

Answer 31

• CBC
• LFTS
• fasting blood sugar
• fasting lipid profile

Question 32

atypical antipsychotics can be linked to causing?

Answer 32

dyslipidemia, abnormal let’s , elevate blood sugars, weight Gai.