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Pharm 845 Exam #3 > Antipsychotics- Dr. Masserano > Flashcards

Antipsychotics- Dr. Masserano Flashcards

1
Q

Positive symptoms

A
  • Delusion
  • Hallucination
  • Thought disorder
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2
Q

Negative symtoms

A
  • Decreased motivation

- Affective flattening

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3
Q

Neurodevelopment Hypothesis of Schizophrenia

A
  • Fetal disturbance (infection, hypoxia)
  • Leads to abnormal neuron migration
  • Excessive pruning/excessive loss of neurons
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4
Q

Progressive nature of the illness

A
  • Indicates that underlying cause is NOT static
  • Increased glutamate
  • Excitotoxicity = excited to death
  • Over stimulation leads to brain damage
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5
Q

Dopamine Hypothesis of Schizophrenia

A
  • Increased dopa synthesis
  • Increased dopa release
  • Decrease in dopa breakdown
  • Inhibition of reuptake
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6
Q

Chlorpromazine

A
  • Has a low affinity for D2 receptors

- So a higher dose is needed in order to control schizophrenia

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7
Q

Treatment options for schizophrenia

A
  • First generation antipsychotics (FGA)
  • Second generation antipsychotics (SGA)
  • All are dopamine D2 receptor antagonists
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8
Q

Examples of FGAs

A
  • Chlorpromazine (Thorazine)

- Haloperidol (Haldol)

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9
Q

Which type(s) of symptoms do FGA control?

A
  • Extrapyramidal symptoms
  • Hyperprolactinemia
  • Neuroleptic malignant syndrome
  • Anticholinergic
  • Antihistamine
  • Adrenergic antagonist
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10
Q

About Chlorpromazine (Thorazine)

A
  • Developed as a pre anesthetic medication
  • Found to be effective in psychosis
  • Helped to release schizophrenics
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11
Q

About Adasuve (Loxapine)

A
  • Inhaler
  • Approved for treatment of acute agitation in patients with bipolar disorder or schizophrenia
  • 10min onset
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12
Q

Chlorpromazine antiemetic effect

A

-D2 receptor antagonist

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13
Q

Scopolamine antiemetic effect

A

-ACh receptor antagonist

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14
Q

Hydroxyzine and promethazine antiemetic effect

A

-Histamine receptor antagonist

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15
Q

Ondansetron (Zofran) and Granisetron (Kytril) antiemetic effect

A

-5HT3 antagonist

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16
Q

Possible effects of FGAs

A
  • Antiemetic
  • Intractable hickups
  • Sedative effects
  • Antipsychotic effects
17
Q

Toxicities/side effects of FGAs

A
  • Decreased seizure threshold
  • Postural hypotension
  • Anticholinergic effects
  • Potentiate CNS depressants
  • Hyperprolactinemia
  • Neuroleptic Malignant Syndrome
  • Torsades de pointe
  • Extrapyramidal syndromes
18
Q

Serotonin (5-HT) receptor function

A

-Helps with negatve symptoms in schizophrenia
-5HT1A: postsynaptic neurons
agonist
-5HT2a: Presynaptic neurons
Antagonist

19
Q

What symptom(s) do SGA treat

A

-Both positive and negative symptoms

20
Q

Possible side effects of SGAs

A
  • Weight gain
  • Diabetes mellitus
  • Cholesterol levels
21
Q

Which atypical antipsychotic leads to the most weight gain and increases cholesterol levels

A

-Olanzapine

22
Q

Black box warnings of Clozapine (Clozaril)

A
  • Agranulocytosis
  • Seizures
  • Myocarditis
  • Other cardio/vascular effects
  • Increased mortality in elderly patients with dementia
23
Q

Side effects of most atypical antipsychotics

A
  • QT prolongation
  • Increased mortality in elderly patients with dementia
  • Suicide warning in young adults
24
Q

Which SGAs have a high incidence of weight gain

A
  • Olanzapine

- Clozapine

25
Q

Which SGAs have a moderate incidence of weight gain

A
  • Quetiapine
  • Risperidone
  • Iloperidone
26
Q

Which SGAs have a low/ no incidence of weight gain

A
  • Aripiprazole
  • Paliperidone
  • Ziprasidone
  • Lurasidone
27
Q

Brexpiprazole (Rexulti)

A
  • Partial agonist of 5HT1A
  • Partial agonist of D2
  • Antagonist of 5HT2A/B
28
Q

Approved therapies for Brexpiprazole (Rexulti)

A
  • Major depressive disorder (add on)

- Treatment of schizophrenia

29
Q

Black box warnings with Brexpiprazole (Rexulti)

A
  • Increased mortality in elderly with dementia

- Increased suicidal thoughts in young adults

30
Q

Cariprazine (Vraylar)

A
  • Partial agonist of D2
  • Partial agonist of 5HT1A
  • Antagonist of 5HT2A receptor
  • Partial D2 antagonist
31
Q

Approved therapies for Cariprazine (Vraylar)

A
  • Schizophrenia

- Acute treatment of manic or mixed episodes associated with bipolar disorder

32
Q

Black box warning with Cariprazine (Vraylar)

A

-Increased mortality in elderly patients with dementia related psychosis

33
Q

SGA or FGA?

A
  • Positive symptoms (BOTH)
  • Weight gain (SGA)
  • Negative symptoms (SGA)
  • Movement disorders (FGA)
  • Hyperprolactinemia (FGA)
34
Q

Antipsychotic drugs in pregnancy

A
  • NOT contraindicated

- Do NOT abruptly stop antipsychotic medications

35
Q

Quetiapine (Seroquel) Abuse

A
  • Not a controlled substance
  • Prescribed off label for insomnia
  • Sedation (H1 antagonist)

Pharm 845 Exam #3 (7 decks)

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