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Antipsychotics Flashcards

1
Q

The hyperactive, positive symptoms of psychosis are due to what?

A

Increased Dopamine in the Mesolimbic Region

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2
Q

The hypoactive, negative symptoms of psychosis are due to what?

A

Decreased Dopamine in the Mesocortical Region

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3
Q

Negative and Cognitive Symptoms are due to which brain area?

A

DFPFC

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4
Q

Negative and Affective Symptoms are due to which brain area?

A

VMPFC

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5
Q

Which area of the brain is responsible for the prolactin related side effect of antipsychotics?

A

Tuberoinfundibular Region

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6
Q

What are the drug abuse/withdrawal causes of Psychosis?

A
  1. Hallucinogens
  2. Amphetamines
  3. Cocaine
  4. Alcohol Withdrawal
  5. Sedative Withdrawal
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7
Q

What are the toxic causes of Psychosis?

A
  1. Heavy Metals
  2. Digitalis
  3. L-Dopa
  4. Pollutants
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8
Q

What are the metabolic causes of Psychosis?

A
  1. Hypoglycemia
  2. Porphyria
  3. Cushing’s syndrome
  4. Abnormal Calcium or Thyroid Levels
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9
Q

What are the nutritional causes of Psychosis?

A
  1. Thiamine Deficiency
  2. Niacin Deficiency
  3. Vitamin B12 Deficiency
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10
Q

What are some neurological causes of Psychosis?

A
  1. Stroke
  2. Tumor
  3. Alzheimer’s
  4. Pick’s Disease
  5. Hypoxic Encephalopathy
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11
Q

What are the two Types of Psychosis?

A
  1. Affective Disorders or Manic Depressive Disorders

2. Schizophrenia

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12
Q

How are Affective Disorders or Manic/Depressive Disorders treated?

A

With antidepressants or mood stabilizers

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13
Q

Which drug class is better to treat Positive Symptoms of Schizophrenia?

A

Typical Antipsychotics (Neuroleptics)

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14
Q

Which drug class is better to treat Negative Symptoms of Schizophrenia?

A

Atypical Antipsychotics (Second Generation)

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15
Q

List 6 common Positive Symptoms

A
  1. Agitation
  2. Delusions
  3. Disorganized Speech
  4. Disorganized Thinking
  5. Hallucinations
  6. Insomnia
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16
Q

List 6 common Negative Symptoms

A
  1. Apathy
  2. Flat affect
  3. Lack of motivation
  4. Lack of pleasure
  5. Poverty of Speech
  6. Social Isolation
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17
Q

What are the three classes of Atypical Antipsychotics?

A
  1. Azepines
  2. Benzisoxazole
  3. Benzisothiazolylpiperzine
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18
Q

Name the 6 Atypical Antipsychotic Drugs

A
  1. Clozapine
  2. Olanzapine
  3. Quetiapine
  4. Risperidone
  5. Arpiprazole
  6. Ziprasidone
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19
Q

What are the 5 classes of Typical Antipsychotics

A
  1. Phenothiazines
  2. Thioxanthenes
  3. Butyrophenones
  4. Azepines
  5. Dihydroindolone
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20
Q

What are the 12 Typical Antipsychotic Drugs?

A
  1. ChlorpromaZINE
  2. FluphenaZINE
  3. ThioridaZINE
  4. TrifluoperaZINE
  5. MesoridaZINE
  6. PerphenaZINE
  7. ThioTHIXENE
  8. ChlorproTHIXENE
  9. HALOPERIDOL
  10. SPIPERONE
  11. LOXAPINE
  12. MOLINDONE
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21
Q

What is the MOA of Atypical Antipsychotics?

A

Competitive Blockade of Serotonin Receptors (and less so Dopamine)

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22
Q

What is the MOA of Typical Antipsychotics?

A

Competitive blockade of Dopamine Receptors (and less so Serotonin)

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23
Q

Which two features result in Atypicals having fewer Parkinson like side effects?

A
  1. Higher affinity for Serotonin Receptors

2. Specific to Mesolimbic over Nigro-Striatal

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24
Q

Adverse Effects of Antipsychotics are due to blockade of which receptors?

A
  1. Alpha 1 Adrenergic
  2. Histamine
  3. Muscarinic
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25
Which diseases may be treated by Antipsychotic drugs?
1. Psychosis 2. Tourette's 3. Huntington's 4. Hiccough 5. Nausea 6. Motion Sickness
26
What is excreted from the kidneys after use of antipsychotics?
Glucuronide Conjugates
27
How long before positive symptoms go away?
1-3 weeks
28
Which symptoms go away within days of antipsychotic treatment?
1. Agitation/Hostility 2. Aggression 3. Anxiety 4. Abnormal Sleep/Eat patterns
29
Within 1-2 weeks which symptoms should improve with antipsychotic treatment?
1. Improved Socialization 2. Improved Self Care habits 3. Improved Mood 4. Decrease abnormal movements
30
Which symptoms take 3-6 weeks to improve after treatment with antipsychotics?
1. Thought Disorder 2. Delusions/Hallucinations 3. Conversation
31
In Dopaminergic neurons, what is the presynaptic change with antipsychotics?
initial- Activates Neurons (increased DA, cAMP and decreased K currents) long term- inactivated
32
In Dopaminergic Neurons, what is the postsynaptic change with antipsychotics?
Initial- receptor blockade | Long Term- Receptor Supersensitivty
33
Which diseases are treated by Haloperidol?
1. Tourette's | 2. Huntington's Disease
34
Which drug decreases the threshold for seizures and is therefore contraindicated?
Chlorpromazine
35
Which drug is used for intractable hiccough?
Chlorpromazine
36
Which drug causes deposits around the lens and cornea?
Chlorpromazine
37
Which drug causes deposits around the Retina?
Thioridazine
38
Which antipsychotics cannot be used as anti-emetics?
Aripiprazole and thioridazine
39
How do antipsychotics cause anti-emetic effect?
Blocking D2 receptors in the Chemical Trigger Zone
40
A low dose of antipsychotics may be used for what purpose?
Anti-emetic
41
Which drug can be used to treat drug-induced nausea (like chemo)?
Prochlorperazine
42
What is Droperidol used for?
Neuroleptanesthesia
43
What are the main side effects due to blockage of D2 Receptors
1. Extrapyramidal Effects 2. Tardive Dyskinesia 3. Neuroleptic Malignant Syndrome 4. Prolactin Effects
44
What are extrapyramidal side effects caused by D2 blockage?
1. Akathisia (restlessness) 2. Pseudoparkinsonism 3. Dystonias, grimacing and torticollis
45
Which drugs cause worse extrapyramidal side effects?
1. Haloperidol 2. Fluphenazine 3. Thiothizene
46
Which drugs cause fewer extrapyramidal side effects?
1. Ones with strong Anticholinergic Effects (Thioridazine and Chlorpromazine) 2. Atypicals
47
What is the treatment for extrapyramidal effects?
1. Stop Drug | 2. Anticholinergic (Trihexyphemidyl, Benztropine, Procyclidine and Biperidin)
48
What is Tardive Dyskinesia?
Abnormal facial/oral muscles that occur years after treatment (due to super sensitivity to DA caused by long term receptor blockade)
49
Which drugs are more/less likely to cause Tardive Dyskinesia?
1. All (especially Typicals) | 2. Lower in Clozapine
50
Can Tardive Dyskinesia be treated?
Not in the advanced state. May become worse upon withdrawal because D2 receptors have been up-regulated
51
What is Neuroleptic Malignant Syndrome?
Potentially fatal condition of muscle rigidity, fever, altered consciousness, autonomic dysfunction (tachy, diaphoresis, tachpnea, incontinence)
52
Which drugs are more likely to cause Neuroleptic Malignant Syndrome?
Typicals
53
What is the treatment for Neuroleptic Malignant Syndrome?
1. STOP Antipsychotic Immediately 2. Give Bromocriptine (D2 Agonist) and Dantrolene 3. Cool patient
54
Which drugs are more likely to cause prolactin side effects?
The Phenothiazines (Chlorpromazine, Fluphenazine, Thioridazine, Trifluoperazine, Mesoridazine, and Perphenazine)
55
What are the side effects due to blockage of Cholinergic (M) receptors?
1. Dry Mouth 2. Blurred Vision 3. Urinary Retention 4. Constipation 5. Confusion
56
Which drugs cause worse Antimuscarinic effects?
1. Thioridazine 2. Chlorpromazine 3. Olanzapine * 4. Clozapine (but it increases salivation)
57
What are the side effects due to blockage of A1 and A2 Adrenergic Receptors?
1. Orthostatic Hypotension --> Syncope | 2. inhibition of ejaculation
58
Which drugs result in more severe anti-adrenergic side effects?
1. Chlorpromazine | 2. Mesoridazine
59
Sedation is due to blockage of which receptors?
Histamine
60
Which drugs result in worse sedation (due to Histamine blockade)?
1. Chlorpromazine 2. Olanzapine 3. Quetiapine 4. Clozapine
61
What is a contraindication for anti-psychotics?
Pregnancy
62
Which drug --> leukopenia and agranulocytosis?
Clozapine
63
Long term antipsychotics --> Perioral Tremor (Rabbit Syndrome); which is the treatment?
1. Antiparkinson's drugs | 2. Anticholinergics
64
Which drug --> Abnormal T Waves and possible Ventricular Arrhythmias?
Thioridazine
65
Which drug --> QT Prolongation?
Ziprasidone
66
Atypical Antipsychotics (and to a lesser extent Typicals) may result in what after long term use?
Metabolic Syndrome (Type II DM, HTN, Hyperlipidemia)
67
Which drugs result in drastic increases in weight, lipids and glucose?
1. Clozapine 2. Olanzapine 3. Chlorpromazine
68
Which drug decreases weight, lipids and glucose?
Molindone

Neuro/Psych Exam (12 decks)

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