Gibbs Antipsychotics Flashcards by Keri Courtnage

positive symptoms

delusions
hallucinations
disorganized speech
unusual behavior
psychomotor agitation

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negative symptoms

flat affect
poverty of speech (alogia)
lack of energy
lack of interest
social withdrawal
avolition (inability to follow through with activities)
anhedonia (lack of pleasure)

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cognitive symotoms

attention
memory
executive dysfunction
skill acquisition

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mood symptoms

depression
anxiety
aggression
hostility
hopelessness
suicidality

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occupational and social dysfunction

social isolation
unemployment
poor relationships
poor self care

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schizophrenia definition

a debilitating disease of neuronal connectivity and function in which patients experience and interpret reality abnormally

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schizophrenia epidemiology

no gender, racial differences
strong genetic component

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difference of age onset in males vs females

males 17-27
females 20-37

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schizophrenia cost to society

very high
mostly indirect costs

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initial diagnostic presentation of schizophrenia

positive symptoms

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early onset means ___ prognosis

worse

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women tend to have ___ onset and ___ prognosis

later onset, better prognosis

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life expectancy schizophrenia

may be reduced 20-30 years

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DSM-V diagnostic criteria for schizophrenia

at least two of the following for over a month: delusion, hallucination, disorganized speech, disorganized behavior, negative symptoms
ONE OF THE TWO MUST INCLUDE DELUSION, HALLUCINATION, DISORGANIZED SPEECH
must cause social dysfunction
symptoms for at least 6 months
rule out schizoaffective, mood disorder, substance use

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1 cause of premature death in schizophrenia

suicide

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suicide risk is ___ higher than the general population

50X

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schizophrenia therapeutic phases

acute, stabilization, maintenance

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goals of acute phase

reduce acute symptoms, reduce threat to self or others

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goals of stabilization phase

minimize, prevent symptom relapse
optimize therapeutic dose & minimize side effects

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goals of maintenance phase

improve functioning, QOL
monitor for prodrome and adverse effects
promote medication compliance

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classes of FGAs

phenothiazines, thioxanthenes, butyrophenones

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phenothiazines

chlorpromazine, promazine
trifluopromazine
fluphenazine
perphenazine
thioridazine
mesoridazine

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chlorpromazine dose

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200-900 mg/day
LOW POTENCY

chlorpromazine side effects

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sedation, hypotension due to alpha1 adrenergic blockade
EPS due to dopamine D2 receptor blockade in basal ganglia

thioxanthenes

thiothixene flupentixol

butyrophenones

haloperidol droperidol benperidol

haloperidol dose

5-40 mg/day HIGH POTENCY

haloperidol side effects

significant EPS

all of the FGAs mechanistically act as ___

antagonist at dopamine receptors also bind with varying degrees of potency to 5HT, cholinergic, histamine receptors

antipsychotic binding to __ receptors correlates with clinical potency

dopamine hypothesis

excessive dopaminergic activity underlies schizophrenia

3 key points to know for FGAs

1) efficacy correlates w/ D2 blockade 2) alleviate mainly positive symptoms 3) high risk of EPS and tardive dyskinesia with high dose, long term use

modified dopamine hypothesis

schizophrenia is associated with hyperdopamine function in the subcortical regions of the brain (positive symptoms) and hypodopamine function in the prefrontal cortex (negative symptoms)

serotonin hypothesis

hallucinogens (LSD) are 5HT2a agonists atypical antipsychotics are inverse 5HT2a agonists 5HT2a receptors modulate DA release risperidone/olanzapine (5HT2a blocking activity) have greater efficacy for treating NEGATIVE SYMPTOMS/produce fewer EPS

glutamate hypothesis

NMDAR antagonists (PCP, ketamine) produce sensory hallucinations changes in glutamate receptor binding found in brains of subjects with schizophrenia reduced NMDA receptor binding in med-free patients (chronic overactivation of the receptors)

4 defining features of SGAs

1) block more than one type of receptor 2) greater affinity for serotonin receptors 3) more effective at alleviating negative symptoms than FGAs, improve cognitive function 4) less movement disordersS

SGAs (drug names)

clozapine risperidone olanzapine quetiapine ziprasidone paliperidone asenapine iloperidone

clozapine is associated with

significant risk of neutropenia (loss of neutrophils) which can develop into agranulocytosis (loss of WBCs) requires extensive blood monitoring

third generation agent?

aripiprazole

aripiprazole mechanism

acts as D2 partial agonist (instead of antagonist) stabilizes dopamine hyperactivity and hypoactivity

aripiprazole is an antagonist where ___

DA levels high (limbic regions)

aripiprazole is an agonist where ___

DA levels low (prefrontal cortex)

aripiprazole is also involved in serotonin receptors how

partial agonist 5HT1a antagonist 5HT2a

many side effects of antipsychotics

EPS metabolic cardiac endocrine adrenergic anticholinergic antihistaminergic akathisia neuroleptic malignant syndrome

EPS

parkinsonism, dystonias, tardive dyskinesia

metabolic effects

weight gain, hyperglycemia, dyslipidemia, diabetes

cardiac effects

QT prolongation

endocrine effects

hyperprolactinemia gynecomastia men, amenorrhea women

adrenergic effects

orthostatic hypotension

anticholinergic effects

dry eye, dry mouth, constipation, blurred vision, cognitive impairment

antihistaminergic effects

weight gain, sedation

akathisia

feeling of internal restlessness

neuroleptic malignant syndrome

muscular rigidity, fever, severe EPS, potentially fatal

definition of extrapyramidal side effects

movement disorders caused by D2 receptor blockage in the extrapyramidal motor system referred to as pseudoparkinsonism

tardive dyskinesia definition

severe abnormal movements, typically involve face, neck, tongue

Gibbs Antipsychotics Flashcards

(55 cards)