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Flashcards in Antipsychotics Deck (30)
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1
Q

Four positive symptoms of psychosis

A

Anhedonia, hallucinations, bizarre behaviour, disorganised thoughts/incomprehensible speech

2
Q

Five negative symptoms of psychosis

A

Amotivation, anhedonia, “stuntedness”, poverty of speech, asociality,

3
Q

Why do we suspect a genetic influence on psychosis risk?

A

1st degree relatives: 10% chance

identical twins: 50% chance.

4
Q

The dopamine theory is strengthened by the effectiveness of D2 receptor antagonists. What conversely supports the theory?

A

D2 agonists like apomorphine or amphetamines or levodopa bring symptoms on.

5
Q

You start a young male on a first gen antipsychotic. What do you tell him about his chances of responding vs. trying something else?

A

About 30% of people don’t respond to 1st gen antipsychotics.

6
Q

What do 1st gen antipschotics famously NOT do?

A

Help negative symptoms.

7
Q

What other theories cover aspects of psychosis?

A
Glutamate theory (psychosis = not enough glutamate)
Seratonin hypothesis (psychosis = too much seratonin)
8
Q

What do the 1st gens end in?

That older toy is the dol you do operations on. 1st gen’s are nastier, they’re like a xena of antipsychotics. Lucky I’m typing because my pen ink can get to thick and I can’t pour out my soul.

A
  • azine
  • operidol
  • penthixol
9
Q

What do the first gen drugs end in?

A

azine
operidol
penthixol

10
Q

What are the seven 2nd gen antipsychotics .

Keeps you quite. I’m gonna sulk at the parade. Say “the president” in a French accent.

A

clozapine, aripiprazole, respiradone, olanzapine,

ziprazadone, amisulparide, quetiapine

11
Q

What are the seven second gen antipsychotics

A

clozapine, olanzapine, respiridol, aripiprazole, quetiapine, zipresadone, imasulpiride

12
Q

What makes second gen better? Four things (one’s just a feature)

A

efficacy for resistant patients
efficacy against negative symptoms
fewer extrapyramidal side effects (and prolactin secretion)
different receptor affinity profile

13
Q

Four blockades characteristic of antipsychotics in general (one’s not under a blockade heading though)

A

Alpha
histamine
5HT
antimuscarinic (atropine-like)

14
Q
What are the associated side effects of: 
antimuscarinic
alpha blockade
histamine blockade
seratonin blockade
A

blurred vision, dry mouth, constipation, urinary retention
postural hypertension (peripheral hypotension)
sedation
weight gain

15
Q

Which of the blockade-heading side effects show tolerance after a short while.

A

sedative

hypotension

16
Q

Dopamine inhibits _______ in the _________ system, preventing lactation.

A

prolactin secretion; TUBEROFUNDIBULAR

17
Q

What are the four idiosyncratic reactions to antipsychotics

A

jaundice and blood stuff, antipsychotic malignant syndrome, urticaria

bonus: blood stuff is leukocytopaenia and agranulocytosis

18
Q

what is antipsychotic malignant syndrome?

A

an idiosyncratic side effect of antipsychotics.

Bonus: stiff muscles mixed with hypertension and confusion.

19
Q

ANTIPSYCHOTICS: what are the two brain structures you MUST remember?
Bonus: what’s the lactation one?

A
mesolimbic (antipsychotic effects)
substantia nigra (extrapyramidal effects)

tuberofundibular (lactation)

20
Q

Where are the antipsychotic effects created in the brain?

A

mesolimbic

21
Q

where are the extrapyramidal side effects created in the brain?

A

nigrostriatal pathway

22
Q

What is the significance of the mesolimbic system in antipsychotic therapy?

A

That’s where the antipsychotic dopamine reduction occurs.

23
Q

What is benztropine and why might you give it alongside an antipsychotic?

A

It’s an anticholinergic - helps restore some ACh/DA balance in the striatum and reduce extrapyramidal effects.

24
Q

2nd gen have higher affinities for ACh receptors. What’s the advantage here?

A

Lower extrapyramidal effects.

25
Q

What are the early EPSs antipsychotics? Tell me in order of appearance after dosing:
hours-days
weeks

A

acute dystonias - postural and facial spasms
laryngeal spasm can be life threatening
akithisia - almost restless leg syndrome

26
Q

Which suptype of EPS can be life threatening?

A

laryngeal spasming in acute dystonia

27
Q

What is the long term mega EPS?

When do we expect it to usually occur?

A

TARDIVE DYSKINESIA
Darting limbs and mega mouth/jaw spasms.

Often precipitates on discontinuation.
Because of upregulated D2 receptors and chronic [inhibitory] D1 block.

28
Q

What’s behind the tardive diskinesia?

A

“disuse supersensitivity”

29
Q

Why would more rapidly dissociating drugs have lower EPS?

A

More accommodating of brief surges of DA (e.g. in the striatum).

30
Q

Which 2nd gen is also a partial D2 agonist?

A

Aripiprazole.

Partial agonism in the mesocortical pathway helps prevent negative symptoms and in the striatum it helps prevent EPS.