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Flashcards in Antipsychotics Deck (37)
1

Schizophrenia

thought disorder characterized by divorcement from reality

2

Positive symptoms of Schizophrenia

Psychotic detentions- hallucination, delusion, paranoid, grandeur
Disorganized dimension- speech and behavior

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Negative Sx of schizophrenia

5 A's
Avolition
Ahendonia
Asocial
Alogia
Affect blunted

4

Progression of Schizophrenia

fluctuates between acute episodes and remission.
After initial episode pts will never regain their baseline function

5

Goal of treating schizophrenia

Prevent exacerbations
Pts will be on meds for life- this and the side effects make compliance very difficult

6

What pathways are involved in Schizophrenia

Da pathways
Nigrostriatal
Mesocorticol
Mesolimbic
Tuberoinfundibular

7

Nigrostriatal effects of shizophrenia

Da blockade
movement disorders- this is where extrapyramidal effects occur

8

Mesolimbic effects of schizophrenia

Da hyperactivity results in the positive symptoms

9

Mesocortical effects of shizophrenia

Da hypoactivity
causes negative symptoms

10

Tuberoinfundibular effects of schizophrenia

Da blockage decreases blockage of prolactin so more prolactin is released resutling in
ammenorhea and galactorrhea

11

What pathway is targeted by typical antipsychotics

D2 receptors, antagonists
Work on positive symptoms

12

How are typical antipscychotics broken down

High potency vs low potency based on affinity for D2 receptors

13

What is the effect of this difference in affinity for D2 receptors

Extrapyramidal systems or not
high affinity= more EPS
low affinity= less EPS, but more AE at other receptor types

14

what are the other receptor types targeted by typical antipsychotics

M, H1, alpha adrenergic

15

High potency APs

potent at D2 receptors but less potent at other receptors, thus inc risk of EPS
ex: Haloperidol

16

Low potency APs

higher potency at other receptors- antimuscarinic activity, anti histamine activity, anti alpha adrenergic activity.
Dec incidence of EPS
ex: Chlorpromazine

17

What are the 5 main Da related AE of typical APs

Dystonia
Pseudoparkinsonism
Akathesia
Tardive dyskinesia
Neuroleptic Malignant syndrome

18

Describe D2 blockage and Dystonia

protlonged painful muscle spasm- torticolus, Oculogyric Crisis
Tx with IV anticholinergics to restore Da/ Ach balance (Ach is anti kinetic, Da is prokinetic)

19

Describe D2 blockage and pseudoparkinsonism

Resembles idiopathic PD, but has bilateral and faster onset
no real tx, but may develop tolerance to this

20

Akasthesia

restless and inability to sit still or stay calm
tx betablockers or benzos

21

Tardive dyskinesia

involuntary muscle movements normally oral or with the jaw
this is caused by an up-regulation of D2 receptors in the nigrostriatal pathway
this may be untreatable and irreversible
tx: lowe dosage switch to an atypical

22

Neuroleptic malignant syndrom

muscle tension causes excess heat and disruption of the normal thermoregulatory proceses
Signs: lead pipe rigidity, fever over 38 C, myoglobinuria, altered consciousness
potentially fatal
tx: discontinue current meds, supportive, antiparkinsonian meds (Da agonist Bromocriptime)
only atypical antipsychotics should be used after this (not even risperidone)

23

Antimuscarinic AE of Aps

constipation
dry mouth
urinary retention
but also reduces EPC by acting on the Ach/Da imbalance by reducing Ach so there is more Da

24

Anti alpha 1 AE of AP

orthostatic Hypotension

25

Anti Histaminic AE of AP

weight gain
drowsiness

26

endocrine AE of APs

Hyperprolactinemia- by blocking Da- inc Prolactin
Women: galactorrhea and amehorhrea
Men: Gynecomastia and galactorrhea
both have sexual dysfunction
tx by switching to atypicap APs

27

Atypical APs

work on positive Sx by blocking Da
improves negative Sx by blocking 5HT2A in the mesocortical pathway which inc dopamine release.
Move Da blockage to between 60 and 80% rather than 100% with the typicals (causes EPS, TD, and endrocine AE)

28

What do atypical APs do in the mesocortical pathway

inc DA in frontal areas thus reversing hyporontality, alleviating negative Sx

29

What do atypical APs due for endocrine AEs

decrease prolactin release thus block the prolactin related AE

30

Atypical APs- names

Clozapine
Risperidone
Olanzapine
Quetiapine
Ziprasidone
Apriprazole

31

Risperidone

only atypical that causes EPS Sx b/c has most DA blockage (exceeds the 80%)

32

Clozapine

prototype- most effective for pos Sx, neg Sx, and suicide prevention
causes fatal AE: agranulocytosis, seizure, and weight gain
measure WBC and do not use if WBC <3000

33

when is clozapine used

Clozapine is only used if pts have failed 2 atypical APs

34

Atypical AEs

weight gain
hyperglycemia
lipid abnormalities

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Order of metabolic AE

Clozapine= olanzapine>risperidone> quetiapine>Ziprasidone and aripiprazole
mirrors efficacy

36

What should be monitored at baseline and as pts take atypical APs

obesity and CV risks

37

quetiapine

lowest D2 binding
DOC for psychosis with PD