Antipsychotics Flashcards by Kaitlyn K Richardson

When is the onset of schizophrenia?

Late adolescence or early adulthood

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Which kind of symptoms respond the best to antipsychotic medications?

Positive symptoms

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What are the three kinds of symptoms schizophrenics have?

Positive, Negative, Cognitive

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What are the positive symptoms?

Those that appear to reflect an addition to or an excess of normal functions
-Hallucinations
-Delusions
-Disorganized thinking

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What are negative symptoms?

Those that are absent from normal behavior
-Flat affect
-Anhedonia
-Social Withdrawal

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What re the cognitive symptoms?

Altered thinking, concentration and memory
-Slowed thinking
-Difficulty understanding
-Poor concentration
-Poor working memory

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What are the etiologies of schizophrenia?

Genetics, neurons, systems, behavior

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What are the genetical information regarding schizophrenia?

Identical twins have a 50% chance of also being schizophrenic.
However, if the parent has it, only 10% of children have it.

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What are the environmental etiologies that have been associated with schizophrenia?

-Prenatal infections
-Perinatal hypoxia
=Adolescent drug abuse
=Stress

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Who is neurologist Ugo Cerletti?

Italian neurologist Ugo Cerletti who developed electroconvulsive therapy ECT (electroshock therapy)

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Describe the Lobotomy

Anestesia using 2 quick shots to the head.
Insert an ice pick through the upper eyelid in the pt’s head
Use hammer to position device into frontal lobe
Move icepick back and forth

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Did anyone improve from lobotomy?

only 1/3 improved, and by improved they were left unresponsive, lethargic, and in a vegetative state

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What does the lobotomy aim to do?

Disconnect the connection of the frontal lobe

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How many lobotomies were done?

40-50,000

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When were lobotomies done?

1940-1950s

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What is methylene blue?

Biological stain that had clinical utility for malaria

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Who first synthesized methylene blue and when?

Heinrich Caro 1976

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Who started making derivatives of methylene blue and when?

Paul Charpentier in 1940s

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What was a potent, centrally activing H1 antagonist derivative found from methylene blue?

Promethazine- it causes extreme sedation and prompted use as an adjunt anesthetic

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What medication was discovered in the late 1940’s that produced a more “calming” effect than promethazine?

Chlopromazine- the first antipsychotic

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What are the first generation of antipsychotics? How do they work?

Phenothiazines-
-Haloperidol
-Chlorpromazine
-Perpehazine

Block DOPAMINE D2R -> treats POSITIVE symptoms of schizophrenia

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What is one of the older hypotheses of schizophrenia?

Increased dopamine transmission

How long does it take for first generation antipsychotics to work?

Weeks for maximum therapeutic efficacy, but the D2 blockade occurs rapidly

Postsynaptic D2 receptors are what?

The target of dopamine transmission

Presynaptic D2 receptors do what?

Regulate dopamine transmission- meaning if theres too much dopamine it uses negative feedback to lower dopamine

What is important to know about D2 blockade acute versus chronic.

Acute injections of D2 antagonists increases dopamine because the presynaptic D2 receptor that helps turn it off prevents the negative feedback from occurring. However, chronic use (>3 weeks) dramatically reduces dopamine neuron activity by depolarization block.

What are the dopamine pathways?

-Mesolimbic Pathway -Mesocortical pathway -Nigrostriatal pathway -Tuberoinfundibular pathway

Blocking activity in the mesolimbic pathway causes what?

Decreases dopamine, decreases positive symptoms.

What does the mesolimbic pathway regulate?

-Emotion and pleasure

Constant long term stimulant abuse that effects the mesolimbic pathways causes what?

Paranoia and psychosis indistinguishable from schizophrenia

Hyperactivity of which pathway underlies positive symptoms of schizophrenia?

Mesolimbic pathway

What does the mesocortical pathway regulate?

cognitive function

Which pathway contributes negative and cognitive symptoms?

Mesocortical

What kind of fluctuation of dopamine in the mesocortical pathway causes negative and cognitive symptoms?

DECREASE in dopamine! Which goes against the current treatment of trying to lower ALL dopamine

Which pathway controls movements?

Nigrostriatal pathway

Parkinson's disease is attributed to?

Loss of nigral dopamine neurons, resulting in tremor, rigidity, and bradykinesia

A _ in dopamine in the _ pathway produces parkinson-like phenotype and Tardive dyskinesias?

A decrease in the nigrostriatal

Which pathway inhibits prolactin release?

Tuberoinfundibular pathway

D2 blockade in the tuberoinfundibular pathway can cause what?

-Galactorrhea (milky discharge) -Amenorrhea (absense of menstruation) -Sexual dysfunction

What is neuroleptic malignant syndrome?

Rare but life threatening Severe form of parkinsonism Leads to increased serum creatine kinase and myglobin MAY persist for weeks following discontinuance of APD

What can reverse neuroleptic malignant syndrome? What is the downside?

Dopamine AGONIST- Bromocriptine and a muscle relaxant Dantrolene.... Induces psychosis

Are antipsychotics abused?

No- not tolerable

What is an example of an atypical neuroleptic?

Clozapine

What are benefits of clozapine- an atypical neuroleptic?

-Doesn't cause parkinsonian symptoms -No dystonia -No Tardvie dyskinesia

Why don't atypical neuroleptic cause severe parkinsonian symptoms like the 1 gen antipsychotics do?

Their ratio of 5HT2A/D2 5-HT inhibits dopamine in the nigrostriatal pathway but NOT the mesolimbic pathway.

Explain the relationship between 5HT2A receptors and D2 receptors.

When 5HT2A receptor receives serotonin signal, it inhibits dopamine vesicle release from the presynpatic neuron. This means no dopamine in the synaptic cleft. In the mesolimbic pathway, the 5-HT2 anatognist binds to the receptor which allows the dopamine to be release; however, the dopamine antagonists are completely binded to the postsynaptic receptors- not allowing the dopamine in the cleft to bind. In the nigrostratial pathway, the 5-HT2 antagonist binds to the receptor on the presynaptic neuron, triggering vesicle release of dopamine... and the dopamine antagonists weakly bind in this area, so overall you have an INCREASE in dopamine which is needed to lower parkinsonian symptoms.

Blocking D2 causes what side effects?

EPS (extrapyramidal symptoms) and prolactin elevation

Blocking 5-HT2A causes what?

Anti-EPS (extrapyramidal symptoms)

5-HT2C causes what?

Satiety blockade

What is another problems associated with antipsychotics?

Weight gain Qt prolongation

What were the results of the CATIE (Clinical antipsychotic trials of intervention effectiveness) experiment?

out of 1500 patients, 74% discontinued the study due to inefficacy and intolerable side effects

In the CATIE experiment, what can you say about olanzapine?

Slightly better than the other drugs, but still associated with weight gain as a side efffect

In the CATIE experiment, what can you say about perphenazine?

Even though it was a first gen antipsychotic it was equally effective and tolerated as second generation drug.