Anti-Psychotic & Anti-Manic Drugs Part 1 Flashcards Preview

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Flashcards in Anti-Psychotic & Anti-Manic Drugs Part 1 Deck (24)
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What are the 4 main symptoms of Psychosis?

  • Derangement of personality
  • Loss of contact w/ reality
  • Delusions
  • Hallucinations


All disorders in this class (Schizophrenia) share some form of the syndrome psychosis w/ abnormalities in one or more domains. 

What are these 4 domains?

  • Delusions
  • Hallucinations
  • Disorganized thinking
  • Abnormal motor behavior & negative symptoms 


What is the criteria for Schizophrenia?

Core positive symptoms?

  • Central Criteria: 2 or more symptoms during a 1 mo period
    • At least 1 must be a core positive symptom; no subtypes
  • Core Positive
    • Delusions
    • Hallucinations
    • Disorganized speech


What are the other symptoms of Schizophrenia aside from positive? Negative symptoms?

Grossly disorganized or catatonic behavior

  • Negative symptoms
    • Blunted affect
    • Lack of spontaneity
    • Poor abstract thinking
    • Poverty of thought
    • Social withdrawal 


What is the Dopamine Hypothesis?

Schizophrenia results from hyperactivity of dopaminergic neurons or their receptors, particularly those w/ terminals in limbic areas of the brain 


What are the 4 Dopaminergic Pathways?

  • Mesolimbic tract
  • Mesocortical tract       
  • Nigrostriatal pathway
  • Tuberoinfundibular tract



Originates in A10
Arousal, memory, stimulus processing, locomotor activity, motivational behavior
Dopamine hyperactivity = positive symptoms 

Which tract?

Mesolimbic tract


Originates in A10
Cognition, communication, social activity
Diminished dopaminergic activity = negative symptoms 

Which tract?

Mesocortical tract


Originates in A9
Dopamine blockade = increased EPS
Blockade of 5-HT2a = decreased EPS, Parkinsonism 

Which tract?

Nigrostriatal Pathway


Dopamine blockade = increased prolactin release

Which tract? 

Tuberinfundibular tract


Dopamine Synapse

What are the pre-synaptic receptors? post-synaptic?

Which receptors are D1-like?

Which receptors are D2-like?

  • Pre-synaptic: D2/D3R
  • Post-synaptic: D2R, D1R
  • D1-like: D1, D5
    • + AC, increased cAMP
  • D2-like: D2, D3, D4
    • – AC, decreased cAMP


The better a drug can effectively _____ the dopamine receptor, the better it acts as an anti-psychotic. 



Anti-schizophrenic effects take time because....

the neuron senses less dopamine & wants to compensate to an extent 


What is the mechanism of Atypical Antipsychotic drugs?

  • Most of the newer drugs have an additional neurochemical effect in addition to DA receptor blockade
  • Block 5-HT2 receptors in the forebrain (often w/ greater potency than for DA receptors)


What are the pharmacokinetics of Atypical Antipsychotics?

  • Oral absorption (variable)
  • Lipid soluble (absorbed in the brain better/faster)
  • Protein binding (longer t1/2 – medicate less often)
  • Large volumes of distribution
  • Complex metabolism 


What are the 3 main actions of Antipsychotic Drugs?

  • Decrease in psychotic behavior
  • Sedation
  • Extrapyramidal effects


Atypical drugs, in addition to treating _______ symptoms, may be more effective in treating ________ symptoms 




What are the 4 main extrapyramidal effects of Antipsychotics?

  • Dystonias
  • Parkinsonism (early rxns – more w/ typicals)
  • Akathisia
  • Tardive dyskinesia (late rxn – may be less frequent w/ atypicals)


What are some other side effects of Antipsychotics? (7)

  • Anticholinergic
    • Dry mouth, blurred vision, urinary retention
  • Orthostatic hypotension
    • Blockage of alpha receptors on blood vessels
  • Neuroendocrine effects
    • Result of dopamine receptor blockade
    • Galactorrhea, gynecomastia
  • Allergic & idiosyncratic effects
    • Liver, blood, cutaneous
  • Cardiac effects
    • Thioridazine is the worst (limited daily dose)
  • Decreased seizure threshold (phenothiazines)
  • Weight gain
    • Diabetes related events more common w/ atypicals (olanzapine, risperidone, clozapine, quetiapine) 


What is the difference btwn early & late reactions of Antipsychotic drugs?


Neuroleptic Malignant Syndrome




  • Potentially lethal hypodopaminergic side effect of antipsychotic drugs
  • Symptoms
    • Hyperthermia
    • Parkinson-like symptoms (muscular rigidity & tremor)
    • Mutism
    • Possible death
  • Treatment
    • Cooling & hydration
    • Bromocriptine
    • Dantrolene (skeletal muscle relaxation; blocks Ca2+ channels)


What are the advantages of atypical antipsychotics over typical? (6)

  • Lower incidence of extrapyramidal symptoms (better compliance)
  • Possible lower incidence of tardive dyskinesia (TD)
  • Improve negative symptoms
  • Improve positive symptoms in many anti-psychotic-resistant or refractory patients
  • Less impact on cognitive functioning
  • More cost effective ? 


What are the uses for antipsychotic drugs? (7)

  • Acute psychotic episodes
  • Chronic Schizophrenia
  • Manic episodes, bipolar disorder
    • Aripiprazole, olanzapine, quetiapine, Ziprasidone, risperidone, Asenapine, Lurasidone
  • Schizoaffective disorder – Paliperidone
  • Augmentation in depression – aripiprazole, olanzapine, quetiapine
  • Tourette’s syndrome – haloperidol, pimozide
  • Anti-emesis – NOT Thioridazine 


What are the criteria for Bipolar Disorder? (DSM IV)

  • Inflated self-esteem/grandiosity
  • Decreased need for sleep
  • Talkativeness
  • Flight of ideas/racing thoughts
  • Distractibility
  • Increased goal-directed activity/psychomotor agitation
  • Excessive involvement in pleasurable activities w/ potential for adverse consequences