Antipsychotics & Mood Stabilizers Flashcards Preview

4Qpharm3-test1 > Antipsychotics & Mood Stabilizers > Flashcards

Flashcards in Antipsychotics & Mood Stabilizers Deck (17):
1

Schizophrenia: affects how many ppl, sxs appear when

affects abt 1 in 100 ppl
sxs appear during late adolescents or early adulthood

2

"Positive" sxs of schizophrenia: controlled by, due to, & what are they

controlled fairly well by classical antipsychotic drugs
-due to ↑DOPAMINERGIC ACTIVITY IN THE LIMBIC SYSTEM
-abnormality or exaggeration of normal fxn (incoherent speech, agitation)
-hallucinations (U) auditory, delusions, bizarre behaviot & thought d/os

3

"Negative" sxs of SCZ: controlled by, due to & what are the sxs

sxs respond to new gen. "atypical" antipsychotics
-due to DECREASED DOPAMINERGIC ACTIVITY IN FRONTAL CORTEX
-loss or decrease in fxn (little or no speech, blunted emotions), lack of affect, lack of volition, apathy, lack of pleasure, ASOCIAL not antisocial behavior like the handout says

4

Cognitive impairment in SCZ: controlled by & sxs

these sxs do not respond well to current therapies
sxs: inability to pay attention, distraction may impair memory of recent events, disorganized speech, thought, neologisms, memory loss

5

Dopaminergic hypothesis of SCZ

-DA D2 receptor blocking activity correlates with antipsychotic potency
-PET scanning has shown in ↑ in DA receptors in tx & untx schizoprenics
-SEROTONIN may also be involved as drugs that stimulate 5HT2A receptors (LSD) can cause hallucinations and those that block these receptors (antagonists) are effective txs)

6

Mesolimbic pathway

projects from VTA to LIMBIC SYSTEM

a/w higher mental fxn & emotions

OVER-STIMULATION results in POSITIVE sxs of SCZ

7

Mesocortical pathway

projects from VTA to FRONTAL CORTEX

higher mental fxn & emotions

UNDER-STIMULATION results in NEGATIVE sxs of SCZ

8

Nigrostriatal pathway

projects from substantial nigra to caudate/putamen

primary role: control of posture & voluntary movement

↓ in activity produces sxs of Parkinson's dz & EXTRAPYRAMIDAL SYMPTOMS (PD-symptoms induced by drugs)

9

Tuberoinfundibular pathway

projects from hypothalamus to anterior pituitary

reg. prolactin release, DA inhibits secretion of prolactin

10

Classical Antipsychotics: mechanism of action

block DA D2 receptor

inhibits DA release in mesolimbic pathway=relieves positive sxs of SCZ

potency for blocking DA D2 correlates with efficacy of relieveing POSITIVE sxs of SCZ

but NO EFFECT ON NEG SXS

11

Atypical Antipsychotics: mechanisms of action

block 5HT2A receptors in addition to DA receptors

5-HT receptor blockers ↑ DA release in MESOCORTICAL PATHWAY

so tx both neg & pos

most also block muscarinic, alpha-adrenergic & histamine receptors in the brain & periphery=the basis of many SEs

12

Pharmacological Effects of antipsychotics (as a broad class)

↓ fear, hostility, agitation, hallucinations, delusions
slows psychomotor fxn, may ↓ restlessness & anxiety
↓initiative & interest in environment, as do emotions
↓aggressiveness & disrupted behaviors
ANTIEMETIC activity occurs from blockage of DA receptors in CTZ

13

Antipsychotic SEs

fairly safe, high therapeutic index, unpleasant SEs
sleepiness, restlessness, weight gain, autonomic sxs
EPS, TD, endocrine abnormalities

14

Extrapyramidal Symptoms (EPS): what causes them, what are they

D2 antagonists also block DA receptors in nigrostriatal system (substantia nigra, striatum); these areas imp for motor control->EPS
AKATHISIA: anxiety, restlessness, pacing, constant rocking
DYSTONIA: involuntary muscle spasms, sustained abnormal postures of limbs, trunk, face, tongue
PARKINSONIAN SXS: tremor, rigidity, difficulty initiating movement

15

Which drugs antipsychotics have less tendency to cause EPS? Why?

atypicals, like clozapine and risperdone b/c they have ↓ affinity for D2 receptors; bind instead to 5-HT2A &/or D4 receptors

16

EPS are sometime tx w/what

anticholinergic drugs, to bring striatal cholinergic & dopamine activity into balance
[drugs w/ more anticholinergic activity are less likely to cause EPS, but more likely to cause autonomic activity]

17

Tardive Dyskinesia

uncontrollable movements of the mouth