Antipsychs

Question 1

3 categories of schizophrenia

Answer 1

Positive symptoms – hallucinations, delusions, disorganized speech, disorganized or agitated behavior

Negative symptoms – apathy, lack of drive/motivation, inability to speak

Cognitive deficits – deficits in working memory, social cognition, problem solving

Question 2

Antipsychotic drugs are most effective in treating _____

Answer 2

positive symptoms

Question 3

Dopamine Hypothesis of psychosis: Psychosis is due to _____

Answer 3

excess of dopamine neuronal activity in the mesolimbic- mesocortical pathways

Question 4

Certain drugs that enhance dopamine activity (e.g. amphetamines, cocaine) can _____.

Answer 4

produce psychotic effects

Question 5

Antipsychs are classified into _____ and ____

Answer 5

“Typical” or “First Generation” and “Atypical” or “Second Generation”

Question 6

The atypical antipsychotic drugs have ____ than the typical antipsychotic drugs

Answer 6

Fewer side effects

Question 7

Side Effects of antipsychs

Answer 7

Movement disorders (blocks D2 in basal ganglia)

Sedation (blocks h1 and/or muscarinic)

orthostatic hypotension (alpha1 adrenergic antagonist)

hyperprolactinemia (blockade of dopamine inhibition of prolactin release)

Metabolic Syndrome (weigth gain stimulates appetite, diabetes, dyslipidemias)

Anticholinergic

cardiovascular (prolonged QTc - Torsades)

Sexual dysfunction

Question 8

Movement Side Effects of Antipsychs

Answer 8

Parkinson-like sx (extrapyramidal side effects. Need lower dose)

Neuroleptic malignant Syndrome (like severe Parkinsonism)

Tardive Dyskinesia (sensitivity of D2 after prolonged blockade. can be irreversible)

Question 9

Typical Antipsychs MOA:

All produce some degree of ___, ___, and ____

Answer 9

dopamine D2 receptor antagonist

sedation, extrapyramidal side effects and orthostatic hypotension

Question 10

Low Potency Typical Antipsychs

Side Effects:

Answer 10

sedation, orthostatic hypotension, anticholinergic effects (dry mouth & constipation) and weight gain

Question 11

Chlorpromazine (Thorazine)

Answer 11

Low Potency Typical Antipsych

D2 Antagonist

Very sedative (H1), orthostatic Hypotension (alpha1 adrenergic), and weight gain, extrapyramidal effects

Question 12

High Potency Typical Antipsychs

Side Effects

Answer 12

High risk for movement disorders, especially Parkinson-like disorders.

Question 13

Haloperidol (Haldol)

Answer 13

High potency Typical

most commonly used typical antipsychotic agent.

Significant extrapyramidal side effects.

Mild sedation and orthostatic hypotension and weight gain

Question 14

Fluphenazine

Answer 14

High Potency Typical

significant extrapyramidal side effects

lower orthostatic hypotension, weight gain, lower sedative effects

Question 15

Atypical Antipsychotic Drugs MOA:

Answer 15

Weak antagonism of D2 receptors and antagonizing 5-HT2 receptors (serotonin)

Question 16

Atypical Antipsychotic Drugs Side Effects

Answer 16

weight gain, dyslipidemia and have risk for diabetes.

Most of these drugs do not have the significant extrapyramidal side effects of the typical antipsychotic drugs. This is thought to be due to the combination of D2 and 5-HT2 antagonism.

Question 17

Clozapine

Answer 17

The first atypical antidepressant

5-HT2 antagonist, D4 receptor antagonist, weak D2 antagonist.

Effective in refractory schizophrenia.

Side effects: significant weight gain and hyperlipidemia and hyperglycemia, seizures, agranulocytosis

Question 18

Risperidone (Risperdol)

Answer 18

Atypical Antipsych

5-HT and D2 Antagonist

Tx bipolar disorder and as adjunct for PTSD

Elevates prolactin, small increase in weight and lipids

Question 19

Olanzapine (Zyprexa)

Answer 19

5-HT2 antagonist, weak D2 antagonist

also H1 antagonist, alpha1 antagonist, and D4 and D1 antagonist.

It is effective for negative as well as positive symptoms.

Side effects: weight gain, increased lipids, hyperglycemia and DM. Decreased seizure threshold and slight sedation.

Question 20

Quetiapine (Seroquel)

Answer 20

D2 and 5-HT2 receptor antagonist.

Also alpha1, M1,3 and H1 receptor antagonist.

Very low risk of extrapyramidal effects

Also approved for bipolar disorder

Side effects: prolonged QTc interval, intermediate weight gain

Question 21

Aripiprazole (Abilify)

Answer 21

5-HT2 antagonist, D2 partial agonist.

Also antagonist for D4, alpha1, H1 and D1 receptors.

Side effects: small increase in weight and lipids

Question 22

Bipolar Disorder and Mood Stabilizers

Idea is that if you prevent ___, you prevent the ____ as well

Answer 22

manic phase

Depressive phase

Question 23

Lithium

Answer 23

Mood Stabilizer

Used to treat manic phase of BPD - acute phase f mania and prevent recurrences

Question 24

Lithium MOA

Answer 24

Alters metabolism of second messengers. Blocks phosphoinositide metabolism

Question 25

Lithium PK

Answer 25

Slow onset - 5-7 days low therapeutic index (Monitor regularly!) eliminated through kidneys (renal dosing)

Question 26

Lithium Side effects

Answer 26

fine hand tremor weight gain polydipsia, polyuria decreased thyroid function

Question 27

Lithium toxicity and OD

Answer 27

narrow window vomiting, profuse diarrhea, coarse tremor, ataxia, coma and convulsions and is dependent on serum concentrations. Severe toxic symptoms include mental confusion, hyperreflexia, gross tremor, dysarthria, seizures, and cranial nerve and focal neurological signs, progressing to coma and death.

Question 28

Lithium and renal elimination issues

Answer 28

dehydration (increases level) Increased sodium intake (lower levels) Decreased Sodium Intake (increases level) Diuretics and ACE inhibitors

Question 29

Several ____drugs have been shown to be effective in treating mania

Answer 29

anti-seizure

Question 30

Stimulants Their primary use is for ___ and ____

Answer 30

narcolepsy and ADHD

Question 31

amphetamines and derivatives cause...

Answer 31

elation, euphoria, concentration, mood, self confidence

Question 32

High doses of amphetamine will produce ______ which are probably due to the release of _____.

Answer 32

alterations in perception and psychotic effects serotonin

Question 33

Amphetamines also increase _____ and a reflex ____. At high doses arrhythmias may occur.

Answer 33

diastolic and systolic blood pressure bradycardia

Question 34

Amphetamines MOA

Answer 34

stimulating the release of NE, dopamine and serotonin from presynaptic nerve terminals inhibit the uptake of neurotransmitter into the synaptic vesicles reverse the monoamine transporters responsible for the reuptake of the catecholamines and serotonin.

Question 35

Amphetamine have a ____ and are schedule _____

Answer 35

abuse potential C-II

Question 36

Amphetamine: dextroamphetamine, 3:1 (Adderall)

Answer 36

onset 20-60 minutes up to 6 hr. duration of action, half-life – 10 hr. Releases catecholamines and 5-HT. Abuse potential and increased bp and HR. narcolepsy and ADHD.

Question 37

Methylphenidate (Ritalin®, Methylin®)

Answer 37

Amphetamine-like drug with mild CNS stimulant activity. ADHD and narcolepsy. Releases catecholamines and 5-HT Side effects: Abuse potential. Increased bp and HR. When used for ADHD include insomnia, abdominal pain, weight loss and suppression of growth in children. Onset of action 30-60 minutes and duration of action of 5 hr.

Question 38

Modafinil (Provigil®)

Answer 38

Differs from amphetamine-like compounds. It inhibits NET and DAT and increases synaptic concentrations of NE, DA and 5-HT. Side effects include mild increases in BP and heart rate. Used for treatment of narcolepsy

Question 39

Antiseizure meds used to treat mania:

Answer 39

Carbamazapine Valproic Acid Lamotrigine all are sodium channel modulators