Anti-Psychotic Drugs Flashcards
(25 cards)
How does the mesolimbic pathway contribute to symptoms of disease?
Positive symptoms
Place where cocaine and amphetamine hpgereate psychosis
What are the four dopaminergic systems?
- Mesolimbic (VTA –> nucleus accumbens)
- Mesocortical (VTA –> frontal and limbic cortex)
- Nigrostriatal (SN –> basal nuclei)
- Tuberoinfundibular (hypothalamus –> Anterior pituitary)
How does the mescortical pathway contribute to symptoms of a disease?
Proposed area of negative symptoms (possibly cognitive also)
Increase 5-HT inhibits DA release here
How does the Nigrostriatal pathway contribute to symptoms of a disease?
Therapeutic blocking results in Parkinsonism like syndrome
How does the tuberoinfundibular pathways contribute to symptoms of a disease?
Less prolactin (DA inhibits prolactin release)
Blocking this leads to galactorrhea, amenorrhea, sexual dysfunction
How does each dopaminergic pathway contribute to the adverse side effects after treatment with an anti-psychotic?
- Mesolimbic -
- Mesocortical - worsening neg effects with D2 only blockage
- Nigrostriatal - Parkinsonism
- Tuberoinfundibular - galactorrhea, amenorrhea, sexual dysfunction
How does the proposed mechanism of FGA antipsychotic drugs account for both the therapeutic and extrapyramidal effects of this class of drugs?
Therapeutic:
Extrapyramidal:
How does the proposed mechanism of SGA antipsychotic drugs account for clinical improvement in both positive and negative symptoms?
Positive:
Negative:
Compare and contrast the early and late onset symptoms of toxicity seen with some antipsychotic drugs.
A
What are the most common adverse effects of FGA?
- Parkinsonism
- worse neg symptoms
What are the most common adverse effects of SGA?
Clozapine - agranulocytosis (death)
- weight gain (clozapine and olanzapine)
- increased risk for type 2 diabetes mellitus
- increased LDL - myocarditis and cardiomyopathies
What are the three classes of symptoms of schizophrenia?
Positive (gain): delusions, disorganized speech, weird behavior, catatonic, auditory hallucinations
Negative (lost): lack of emotions, social isolation, flat affect, alogia (speaking), cannot keep friends
Cognitive: disorganized thinking, slow thinking, poor concentration, poor memory, diff integrating thoughts and feelings into behavior
What symptoms of schizophrenia respond to meds?
Positive (not really negative)
What is the Goldilocks principle of dopaminergic dysfunction?
- up DA, limbic –> psychosis
- down DA, striatum –> Parkinsonism
How do you treat psychosis?
Block D 2 receptors
What does D2 activation lead to?
Downstream G-protein activation
What does chlorpromazine do?
FGA
Block D2 in limbic system
Most effective against positive symptoms
Sometime worsen negative symptoms
Causes Parkinsonism by blocking DA in striatum (extrapyramidal SE EPSE)
What normally inhibits DA release?
5-HT
What are typical endings of FGA?
-zine
Except for haloperidol
What are typical endings for SGA or atypicals?
- pine
- done
- zole
What do FGAs do?
Mesolimbic: decrease positive symptoms
Mescortical: worsens negative symptoms
Nigrostriatal: causes Parkinsonism
Tuberoinfundibular: galactorrhea, amenorrhea, sexual dysfunction
Blocks D2 everywhere thereby increasing 5-HT
What does clozapine do?
Treats both positive and negative symptoms
No Parkinsonism
Block D2 and 5-HT2a receptors
What do SGAs affect in dopamine pathways?
Mesocortical pathway is no longer as targeted formdecreased D2, a little more than before
What is Tardive Dyskinesia?
- DA receptor disuse supersensitivity
- irreversible or lasts for years
- 5% for FGA
- 1% for SGA
