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Pyschiatry > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

What is the mesocortical tract involved in

A

cognition, communication, social activity

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1
Q

extrapyramidal effects include

A

dystonias, parkinsonism, akathisia, Tardive dyskinesia

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2
Q

what are the off label uses of lithium

A

treatment of Schizoaffective disorder and cluster headaches

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3
Q

how long does it take lithium to be absorbed and to peak?

A

complete absorption in 6-8 hours

peak serum levels in 2-4 hours

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4
Q

what are the low potency phenothiazines?

A

thioridazine

mesoridazine

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4
Q

what would you use to treat Tourette’s?

A

haloperidol first

pimozide secondary

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4
Q

is lithium bound or unbound to plasma proteins?

A

unbound to plasma proteins

volume of distribution equal to total body water

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4
Q

this drug causes impaired consciousness, rigidity, hyperactive deep reflexes, and coma at plasma levels about 2-3x

A

lithium

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5
Q

blockade of 5-HT2a in the nigrostriatal pathway results in

A

decreased extrapyramidal symptoms

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5
Q

for initial control of manic symptoms as an alternative to lithium

A

haloperidol or clonazepam (off label)

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6
Q

what is akathisia?

A

a movement disorder characterized by a feeling of innerrestlessness and a compelling need to be in constant motion, as well as by actions such as rocking while standing or sitting, lifting the feet as if marching on the spot, and crossing and uncrossing the legs while sitting

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7
Q

CSF concentration of lithium vs plasma concentration

A

CSF concentration is 40-50% of plasma concentration

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8
Q

this drug can cause fatal agranulocytosis and so it requires monitoring

A

clozapine

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10
Q

what is Tardive dyskinesia

A

a disorder resulting in involuntary, repetitive body movements. In this form of dyskinesia, the involuntary movements are tardive, meaning they have a slow or belated onset

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10
Q

what are the butyrophenone derived typical antipsychotics?

A

haloperidol

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10
Q

pimozide

A

potent neuroleptic

many side effects

approved for the treatment of Tourette’s

commonly used when haloperidol does not

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11
Q

what drug would you use when haloperidol does not work to treat Tourette’s?

A

pimozide

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11
Q

this atypical antipsychotic is a partial D2 agonist and 5-HT2 antagonist. It’s approved as an adjunct in depression

A

aripiprazole

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12
Q

this monovalent cation is one of the few psychotherapeutic drugs that has no behavior effects in “normals”

blocks manic behavior

A

lithium

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13
Q

what drugs would you administer to someone having manic episodes in bipolar disorder?

A

aripiprazole

olanzapine

quetiapine

ziprasidone

risperidone

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15
Q

dopamine blockade in the nigrostriatal pathway results in

A

increased extrapyramidal symptoms

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15
Q

list the atypical antipsychotic agents that we gotta know

A

clozapione

olanzapine

risperidone

quetiapine

aripiprazole

ziprasidone

paliperidone

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16
Q

fatique, muscular weakness, GI symptoms, slurred speech, and ataxia are side effects of wide bipolar drug?

A

lithium

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17
Q

what are the advantages and disadvantages of using high potency typical antipsychotics?

A

PROS: lower dosing, less sedative

CONS: more EPS, less anticholinergic

17
Q

used as first line drug in bipolar disorder, sedating

alternative to lithium

A

valproic acid and divalproex sodium

18
Q

dopamine blockade in the tuberoinfundibular tract results in

A

increased prolactin release

19
Q

what are the high potency phenothiazines?

A

fluphenazine

trifluoperazine

perphenazine

prochlorperazine

20
Q

why are typical antipsychotics useful at treating negative symptoms?

A

negative symptoms are brought on by diminished dopaminergic activity in the mesocortical tract. typical antipsychotics work to block dopamine, so they would, if anything, worsen the symptoms

22
Q

where do typical antipsychotics act and by what mechanism?

A

block dopamine receptors and also block ACh and histamine

they block dopamine hyperactivity in the mesolimbic tract to reduce positive symptoms

23
Q

what effects do ACE inhibitors and angiotension II receptor blockers have on lithium?

A

they can raise Li levels

24
Q

what drugs is haloperidol pharmalogically similar to?

A

the high-potency piperazine derivatives

25
Q

describe the therapeutic window of lithium

A

very narrow window, important to monitor levels

25
Q

how does an increase in sodium excretion affect lithium levels? (ie thiazide diuretics, losses of fluids or electrolytes)

A

increased Na excretion increases Li levels

26
Q

this drug has greater reduction in negative symptoms and less extrapyramidal symptoms than traditional antipsychotics

it’s active metabolite is paliperidone

available as an IM depot

A

risperidone

27
Q

this drug may be useful in preventing recurrences of unipolar depression in some patients

A

lithium

29
Q

What is the mesolimbic tract involved in?

A

Arousal, memory, stimulus processing, locomotor activity, motivation behavior

31
Q

what effects does clozapine have on symptoms?

A

improves positive symptoms even in patients not helped by other drugs

improves negative symptoms

lowers seizure thresholds more than other antipsychotics

31
Q

what antipsychotic is antiemetic?

A

not thioridazine

32
Q

the half life of lithium in adults vs elderly patients

A

young adults = 18-24 hours

elderly patients = 30-36 hours

33
Q

what are the low to medium potency phenothiazines?

A

chlorpromazine

triflupromazine

35
Q

this alternative to lithium acts at sodium channels

CNS side effects such as sedation, confusion, ataxia

A

carbamazepine

37
Q

Diminished dopaminergic activity of the mesocortical tract results in

A

negative psychotic symptoms

38
Q

which antipsychotic lowers seizure thresholds more than any other

A

clozapine

40
Q

mechanism of action for clozapine?

A

blocks D4 and 5-HT2 receptors, little effect on D2

muscarinic antagonist

42
Q

what is opisthotonus and when is it observed?

A

It is a state of severe hyperextension and spasticity in which an individual’s head, neck and spinal column enter into a complete “bridging” or “arching” position

It is seen in acute dystonia, 1 to 5 days after use of antipsychotic drugs

44
Q

what are the thioxanthine derived typical antipsychotics?

A

chlorprothixene

thiothixene

45
Q

how are thioxanthine derived antipsychotics different from phenothiazines?

A

they are non-nitrogen containing analogs of phenothiazines

the pharmacology is similar to phenothiazines

46
Q

these antiseizure agents also act at sodium channels or glutamate receptors can be used to treat bipolar

there are warnings on suicidal ideation

A

lamotrigene

topiramate

48
Q

mechanism of action of olanzapine

A

potent 5-HT2 antagonist

D1 and D2 antagonist, some D4

49
Q

5-HT2 and D2 antagonist. may have 5-HT1a agonist activity (anxiolytic?). No weight gain

A

ziprasidone

51
Q

mechanism of action of risperidone

A

combined D2 and 5-HT2 antagonist

52
Q

what antipsychotics augment depression?

A

aripiprazole

olanzapine

quetiapine

53
Q

what are the advantages of using low potency typical antipsychotics?

A

CONS: higher doses, sedative

PROS: no EPS, pronounced anticholinergic actions

54
Q

this drug is structurally related to clozapine but has a shorter half-life

it’s approved for augmentation in depression

there are some reports of abuse

A

quetiapine

55
Q

high potency = ____ cardiovascular effects and ____ sedation

A

lower, lower

56
Q

the tremor caused by lithium can be treated with what?

A

beta-blockers

57
Q

Dopamine hyperactivity of the mesolimbic tract results in

A

positive psychotic symptoms

58
Q

what drug would you give to treat Schizoaffective disorder?

A

paliperidone

59
Q

pros and cons of olanzapine

A

PROS: no agranulocytosis, less seizure incidence than clozapine

CON: weight gain and diabetes, abuse

Pyschiatry (4 decks)

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