Anti-Psychotics

Question 1

Main neurotransmitters in schizophrenia

Answer 1

Serotonin

Dopamine

Question 2

Psychosis

Answer 2

Inability to think or comprehend reality

Question 3

Schizophrenia

Answer 3

Withdrawal, disordered thought process, delusions, auditory hallucinations

Question 4

Schiz positive s/s

Answer 4

Hallucinations
Delusions
Behavioral disorg
Thought disorder

Question 5

Schiz neg s/s

Answer 5

Alogia
Affective blunting
Avolition
Asociality
Anhedonia
Attention impairment

Question 6

Schiz

DA hypothesis

Answer 6

• All antipsycs block D2 receptor
• up synaptic DA= psychosis (amphetamine, L-DOPA)
• DA receptor changes
• successful Tx increases DA metablites

Question 7

Amphetamine DA release

Answer 7

Up via reversal of transporter

Question 8

Serotonin

Answer 8

• new Rx block 5HT recepotor

* clin correlation poor

Question 9

Glutamate

Answer 9

• NMDA receptor
• can induce psychosis with this
• no Rxs

Question 10

Acute psychotic episode

Answer 10

Antispyc in ER (haloperidol?)

*long term tx 4-6 weeks (depolarization inactivation)

Question 11

Depolarization Inactivation

Answer 11

After overfiring DA neuron due to presynaptic receptor stimulation, whole neuron wears out in 4-6 weeks

Question 12

Acute tx

Answer 12

Block post synaptic receptor

Presynaptic sees less, fires more

Question 13

Frontal cortex in Schiz

Answer 13

Too LITTLE DA = negative symptoms

VTA to cortex degraded (prefrontal neurons),
no feedback mech to Accumbens,
Accumbens ramps up dopamine release

W too much acivity in accumbens

Question 14

D2 blockers = blocking in nigrostriatal pathway

Answer 14

Parkinson’s s/s

EPS symptoms = extra-pyramidal

Question 15

Prolonged treatment w/ D2 blockers

Answer 15

D2 post synaptic receptors up regulate =

Tardive Dyskinesia (activity)

• Short-term = movement poverty (EPS)
• Long-term = too much movement

Question 16

Where = Endocrinological S.E.

Answer 16

Arcuate nucleus (hypothalamus) –> pituitary

DA suppresses PRL release
UP PRoLactin = gynecomastia

Question 17

Neuroleptic

Answer 17

“Clamp the neuron” = EPS s/s

Don’t say this, old term

Question 18

Schiz tx

1st generation

Answer 18

Butyrophenones (haloperidol)

Question 19

2nd gen

Rxs

Answer 19

Clozapine
Risperidone
Olanzapine
Ziprasidone
Aripiprazole

Question 20

Clorpromazine (thorazine)

Answer 20

• anethesia
• d2 blocker
• sometimes in acute

Question 21

Butyrophenones

Haloperidol

Answer 21

Lower sedation + less alpha block than phenothiazines

Question 22

Atypical Rxs/ 2nd gen

Answer 22

More 5HT receptor blocking (serotonin)

Question 23

2nd gen

Clozapine

Answer 23

• 1st
• NO EPS
• DPI ONLY in mesolimbic pathway (NOT striatum, NOT frontal cortex)= no neg/ EPS symptoms

Question 24

2nd Gen

Clozapine

S.E.

Answer 24

*Agranulocytosis risk (bone marrow/blood)
(Compliancy/cost)

**DM risk

Question 25

Blocking serotonin

Answer 25

Facilitate Dopamine release in FRONTAL CORTEX *serotinin blocking dopa neuron ONLY in FRONTAL CORTEX

Question 26

2nd gen Risperidone

Answer 26

*low dose = low EPS (Dose-dependent atypical) *NO agranulocytosis risk

Question 27

2nd gen Olanzepine

Answer 27

* NO agranulocytosis * *DM risk/weight gain risk * LESS serum prolactin release than haloperidol

Question 28

2nd gen Ziprasidone

Answer 28

*QT interval widening

Question 29

2nd gen Aripiprazole

Answer 29

* partial agonist at D2 receptor (block where high, increase where low) * modest 5HT2 block * partial 5HT1A agonist * no DM

Question 30

Partial D2 agonist

Answer 30

* down dopa in accumbens | * UP dopa in frontal cortex

Question 31

Anti-psych Neuro S.E. Early

Answer 31

* ACUTE DYSTONIA = Spastic retrocollis/torticollis * AKATHISIA = reduce rx/benzo/propanolol * EPS. = bradykinesia, rigidity, gait * NMS Neuroleptic Malignant Syndrome - can be fatal, stop Rx NOW * Sedation * Lower seizure threshold (older Rx, clozapine, epileptic) REVIEW SLIDE

Question 32

Anti-psych Neuro S.E. Later

Answer 32

* Perioral syndrome (rabbit syndrome) - D2 blocked - give anti-Parkison Rx - anticholinergic * ***Tarditive dyskinesia - D2 super-sensitivity - NO ANTICHOLINGERGICs MUST PREVENT THESE

Question 33

Anti-Psycs : Autonomic S.E.

Answer 33

* Ortho HypoHTN (a1 block) * Altered sexual function * Anticholinergic

Question 34

Anti-psych. S.E. Endocrine

Answer 34

*Up prolactin (D2 block in pituitary)

Question 35

Other Anti-psych S.E.

Answer 35

* Blood dyscrasias (clozapine-agranulocytosis) * Metabolic - up weight gain, DM/Hyperlipid *Skin *Cardio toxicity Thioridazine - T wave Ziprasidone QT prolong

Question 36

Anti-psychs ADME

Answer 36

A = erratic, down w/ food , antacid, anticholinergic * goes in fat (brain) * hepatic metab, glucuronic acid conjugation

Question 37

Anti-psychs Rx interaction

Answer 37

* up CNS depressants * Quinidine-effect bad w/ Digitalis * no w/ antiHTN * barbituates = up metab * Musc block = confusion

Question 38

DM risk

Answer 38

Olanzapine | Clozapine

Question 39

Where = Weight gain S.E.

Answer 39

Motor nucleus (vagus) --> area around ventricles D2 block = hunger

Question 40

Where = anti-emetic S.E.

Answer 40

Chemotrigger zone (CTZ)

Question 41

1st gen S.E.

Answer 41

ASK teacher

Question 42

2nd gen DM risk

Answer 42

* Clozapine * Olanzapine * Risperidone * Ziprasidone

Question 43

2nd gen EPS s/s

Answer 43

Risperidone

Question 44

2nd Gen QT prolongation

Answer 44

Ziprasidone

Question 45

2nd gen PRL s/s

Answer 45

Risperidone

Question 46

2nd gen Weight gain S/s

Answer 46

Clozapine Olanzapine Risperidone

Question 47

Ach block

Answer 47

Clozapine | Olanzapine

Question 48

Anti-psycs Other uses

Answer 48

* Organic brain syndrome * Acute mania * Tourette's Syndrome * Bipolar * NO DEMENTIA in ELDERLY