Antipsychotics

Question 1

What is psychosis?

Answer 1

A variety of mental disorders with multiple causes and manifestations

Question 2

Severe psychiatric disorders are characterized by what?

Answer 2

Delusion and hallucinations

Question 3

Positive or negative symptom of schizophrenia: delusions/hallucinations

Answer 3

Positive

Question 4

Positive or negative symptom of schizophrenia: agitation

Answer 4

Positive

Question 5

Positive or negative symptom of schizophrenia: emotional apathy

Answer 5

Negative

Question 6

Positive or negative symptom of schizophrenia: paranoia

Answer 6

Positive

Question 7

Positive or negative symptom of schizophrenia: socially withdrawn

Answer 7

Negative

Question 8

Positive or negative symptom of schizophrenia: Intrusion of thoughts

Answer 8

Positive

Question 9

Positive or negative symptom of schizophrenia: inattentiveness

Answer 9

Negative

Question 10

Positive or negative symptom of schizophrenia: aberrant thinking

Answer 10

Positive

Question 11

Schizophrenia is what type of disorder?

Answer 11

Neurodevelopmental

Question 12

What is the difference between the positive and negative symptoms of schizophrenia?

Answer 12

Positive is a manifestation of abnormal behavior

Negative is absence of normal behavior

Question 13

What is the dopamine hypothesis of schizophrenia?

Answer 13

Hyperactivity of the mesolimbic mesocortical DA system causes psychosis

Question 14

What is the MOA of many of the antipsychotic drugs?

Answer 14

Block D2 receptors

Question 15

What are the postmortem findings of a schizophrenia brain?

Answer 15

DA levels and D2 receptors density are increased

Question 16

Why is the dopamine theory of schizophrenia no perfect?

Answer 16

Cannot explain the cognitive impairment

Question 17

What is the route of innervation from the hippocampus to the cortical regions?

Answer 17

Hippo to VT to cortical regions

Question 18

What is the serotonin hypothesis of schizophrenia? What leads credence to this theory?

Answer 18

Overactivation of 5HT2A receptors

Blocking these work

Question 19

What is the glutamate hypothesis of schizophrenia? What leads credence to this theory?

Answer 19

Hypofunction of NMDA receptors can lead to hyperstimulation of cortical neurons

NMDA inhibitors can exacerbate symptoms

Question 20

What are neuroleptics?

Answer 20

Subtype of antipsychotics that produce extrapyramidal side effects

Question 21

What are the extra pyramidal symptoms?

Answer 21

Parkinsonian-like symptoms

Question 22

What are the typical vs atypical antipsychotics?

Answer 22

Typical = older
Atypical = newer

Question 23

What is the major change with atypical antipsychotics compared to typical?

Answer 23

Less extrapyramidal effects

Question 24

What are the four main therapeutic indications for antipsychotics?

Answer 24

Schizophrenia
Psychotic behaviors
Severe mania
Antiemetic

Question 25

What are the four typical antipsychotics?

Answer 25

Chlorpromazine Thioridazine Fluphenazine Haloperidol

Question 26

What are the 6 atypical antipsychotics?

Answer 26

``` Clozapine Olanzapine Risperidone Aripiprazole Quetiapine Ziprasidone ```

Question 27

What are the two aliphatic drugs?

Answer 27

Chlorpromazine | Promethazine

Question 28

What are the two piperidine drugs?

Answer 28

Thioridazine | Mesoridazine

Question 29

What are the two piperazine drugs?

Answer 29

Prochlorperazine | Fluphenazine

Question 30

What are the two thioxanthenes?

Answer 30

thiothixene

Question 31

What is the relative bioavailability of antipsychotics? Vd?

Answer 31

Low bioavailability | Large Vd

Question 32

Atypical antipsychotics are metabolized how?

Answer 32

CYP450 system in the liver

Question 33

What is the MOA of most typical antipsychotics?

Answer 33

Dopamine (D2) receptor antagonists

Question 34

What are the MOAs of atypical agents?

Answer 34

5HT-2A receptor and D2 receptor antagonists

Question 35

What is the relationship between D2 receptor affinity and potency of antipsychotics

Answer 35

Direct, and very strong fit

Question 36

What are the common side effects of antipsychotics and BP? Why?

Answer 36

Cause orthostatic hypotension by blocking alpha2

Question 37

Why is it important to block both dopamine and 5HT like the atypical antipsychotics do?

Answer 37

Stop the EPS

Question 38

What is the role of the limbic and neocortex system in schizophrenia?

Answer 38

Behavior and psychosis

Question 39

What is the role of the nigrostriatal system in schizophrenia?

Answer 39

Coordination of voluntary movement--blockage leads to EPS

Question 40

What is the role of the tuberoinfundibular zone?

Answer 40

Inhibition of prolactin secretion from the anterior pituitary

Question 41

What is the role of the medullary periventricular area in schizophrenia?

Answer 41

Chemoreceptor zone that is involved in eating behavior

Question 42

What is tardive dyskinesia?

Answer 42

Involuntary movements of the tongue, mouth, face, and head

Question 43

What is episthotinus?

Answer 43

Spasm of the back

Question 44

What is akathisia?

Answer 44

Motor restlessness and anxiety

Question 45

What are the endocrine side effects of antipsychotics?

Answer 45

Hyperprolactinemia | Gynecomastia

Question 46

Why is weight gain associated with antipsychotics? What two antipsychotics are these symptoms associated with?

Answer 46

DA or H1 mechanism Clozapine Olanzapine

Question 47

What are the antihistamine effects with antipsychotics?

Answer 47

Sedation | Weight gain

Question 48

What are the anti-adrenergic effects with antipsychotics?

Answer 48

Postural hypotension Reflex tachy ED

Question 49

What are the DA mediated adverse effects of antipsychotics?

Answer 49

EPS Hyperprolactinemia Neuroleptic malignant syndrome

Question 50

What atypical agent is most strongly associated with EPS? least?

Answer 50

Risperidone = most Clozapine and quetiapine

Question 51

What are the EPS risk factors with antipsychotics?

Answer 51

Rapid dose escalation

Question 52

Who usually gets that tardive dyskinesia with antipsychotics?

Answer 52

Older pts

Question 53

What antipsychotic drugs are strongly associated with weight gain?

Answer 53

``` Clozapine Olanzapine Risperidone Quetiapine Aripiprazole Ziprasidone ```

Question 54

What are the reasons for pts to stop taking antipsychotics? (besides obvious)

Answer 54

Lack of disease insight EPS Sexual side effects

Question 55

Typical or atypical antipsychotic: chlorpormazine

Answer 55

typical

Question 56

Typical or atypical antipsychotic: clozapine

Answer 56

Atypical

Question 57

Typical or atypical antipsychotic: olanzapine

Answer 57

Atypical

Question 58

Typical or atypical antipsychotic: thioridazine

Answer 58

Typical

Question 59

Typical or atypical antipsychotic: fluphenazine

Answer 59

typical

Question 60

Typical or atypical antipsychotic: haloperidol

Answer 60

Typical

Question 61

Typical or atypical antipsychotic: risperidone

Answer 61

Atypical

Question 62

Typical or atypical antipsychotic: aripiprazole?

Answer 62

Atypical

Question 63

Typical or atypical antipsychotic: Quetiapine

Answer 63

Atypical

Question 64

Typical or atypical antipsychotic: Ziprasidone

Answer 64

Atypical

Question 65

What are the three high potency typical antipsychotics?

Answer 65

Trifluoperazine Fluphenazine Haloperidol

Question 66

What are the two low potency typical antipsychotics?

Answer 66

Chlorpromazine | Thioridazine

Question 67

What is the major side effect with clozapine?

Answer 67

Agranulocytosis