Antipsychotics and Anxiolytics Flashcards
(19 cards)
What are the four key dopamine pathways in the brain
mesocortical
nesolimbic
nigrostriatal
tuberinfundibular
what are the problems that arise in the mesocortiyal pathway
responsible for -ve symptoms and cognitive disorders
problems when there is too little dopamine
what are the problems that arise in the mesolimbic pathway
responsible for +ve symptoms (e.g. hallucinations, delusions)
problems when there is too much dopamine
what are the problems that arise in the nigrostriatal pathway
responsible for movement regulation
problems when there is dopamine hypoactivity - causes parkinsonian movements (rigidity, bradykinesia, tremors)
what are the problems that arise in the tuberoinfundibular pathway
responsible for inhibiting/regulating prolactin release
blocked dopamine leads to hyperprolactinaemia (gynecomastia, galactorrhea, decreased libido, menstrual dysfunction)
when are antipsychotics used
schizophrenia, schizoaffective disorder, bipolar disorder, psychotic depression, as an augmenting agent for anxiety
what are the two groups of antipsychotics
typicals - work as D2 dopamine receptor antagonists
atypicals - work as serotonin-dopamine 2 antagonists
what are the different groups of typical antipsychotics - give examples and risks
high potency - high affinity (risk of extrapyramidal side effects)
eg fluphenazine
low potency - low affinity (risk of cardiotoxicity, increased anticholinergic effects)
eg chlorpromazine
list the 5 atypical antipsychotics
risperidone olanzapine quetiapine aripiprazole clozapine
which atypical has the least side affects
aripiprazole -
low extrapyramidal side effects
no weight gain
low sedation
which atypical has the most/worst side effects
clozapine - increased risk of seizures, sedation, weight gain, abnormal LFTs, hypertriglyceridemia, hypercholesterolemia, hyperglycemia, nonketotic hyperosmolar coma death
what are common side effects for all atypicals
hypertriglyceridemia, hypercholesterolemia, hyperglycemia, EPS weight gain sedtion
what are antipsychotic adverse effects
TD - tardine dyskinesia (involuntary muscle movements)
NMS - neuroleptic malignant syndrome (severe muscle rigidity, fever, altered mental state, increased WBC)
EPS - extrapyramidal side effects (acute dystonia, parkinsonism, akathisia)
what are agents for EPS
anticholinergics
dopamine facilitators
B-blockers (propranolol)
what can anxiolytics be used for
panic disorder, anxiety, substance related disorders/withdrawl, insomnia/parasomnia
in anxiety disorders often used with SSRIs or SNRIs
what are the two most common anxiolytics
buspirone
benzodiazepines
what are some pros and cons of buspirone
pros
good for augmentation
no sedation
cons
takes two weeks to kick in
won’t work on patients that are used to BZD (no sedation to “take off the edge” like they’re used to)
what are benzodiazepines good for
insomnia, parasomnia, anxiety, CNS depressant withdrawal
what are some side effects of BZD
somnolence cognitive deficit amnesia disinhibition tolerance DEPENDENCE
