M2.4 Flashcards
(118 cards)
1
Q
- are used primarily to treat SCHIZOPRENIA
- also effective in other psychotic and manic states
A
antipsychotics
2
Q
ANTIPSYCHOTICS are also called
A
NEUROLEPTICS or MAJOR TRANQUILIZERS
3
Q
the use of these medications involves a difficult trade-off between the BENEFIT of alleviating psychotic symptoms and the risk of a wide variety of troubling ADVERSE EFFECTS
A
ANTIPSYHOTICS
4
Q
ANTIPSYCHOTICS are ____ and DO NOT eliminate chronic thought disorders
A
NOT CURATIVE
5
Q
ANTIPSYCHOTICS | CLASSIFICATION
1st gen
A
Classic drugs
azine & haloperidol
6
Q
ANTIPSYCHOTICS | CLASSIFICATION
1st gen:
acts on ____
A
DOPAMINE receptor
DA antagonist
7
Q
ANTIPSYCHOTICS | CLASSIFICATION
2nd gen
A
Newer agents
zapine, done
8
Q
ANTIPSYCHOTICS | CLASSIFICATION
2nd gen:
acts on ____
A
5HT2 receptor (Serotonin)
5HT2 antagonist
9
Q
- mental disorder which involves BREAKDOWN of PERSONALITY
- presence of delusions (false beliefs)
- halluciantions
- grossly disorganized thinking in a clear sensorium
A
PSYCHOSIS
10
Q
PSYCHOSIS
various types of hallucinations
A
auditory
visual
tactile
olfactory
11
Q
PSYCHOSIS
MOST COMMON type of hallucination
A
auditory
12
Q
PSYCHOSIS | TYPES
typical baliw
A
schizophrenia
13
Q
PSYCHOSIS | TYPES
Depression and Mania
A
affective disorders
14
Q
PSYCHOSIS | TYPES
- has other causes
- mental disturbances caused by head injury, alcoholism, or other kinds of organic diseases
A
organic psychosis
15
Q
PSYCHOSIS | TYPES
- a psychotic disorder characterized by DISTORTIONS in thinking, perception, emotions, language, sense of self, and behavior
- symptoms are grouped as positive symptoms and negative symptoms
A
SCHIZOPRENIA
16
Q
PSYCHOSIS | TYPES
the SYMPTOMS of schizophrenia are grouped as ____ and ____
A
positive and negative symptoms
17
Q
PSYCHOSIS | TYPES
SCHIZOPHRENIA:
* USUAL symptoms
* DELUSIONS (often paranoid in nature)
* HALLUCINATIONS, usually in the form of voices, and often exhortatory in their message (paranoia)
* THOUGHT disorder, comprising of wild trains of taught and IRRATIONAL conclusions (leads to irrational actions)
A
POSITIVE SYMPTOMS
18
Q
PSYCHOSIS | TYPES
SCHIZOPHRENIA:
POSITIVE symptoms affect ____
A
MESOCORTICAL SYSTEM
19
Q
PSYCHOSIS | TYPES
SCHIZOPHRENIA:
* ANTISOCIAL symptoms
* WITHDRAWAL from social contacts
* Flattening of emotional responses
A
NEGATIVE SYMPTOMS
20
Q
PSYCHOSIS | TYPES
SCHIZOPHRENIA:
NEGATIVE symptoms affect the ____
A
MESOLIMBIC SYSTEM
21
Q
PSYCHOSIS | TYPES
THEORIES | SCHIZOPHRENIA:
schizophrenic gene can be ____
A
inherited
(HEREDITARY)
22
Q
PSYCHOSIS | TYPES
THEORIES | SCHIZOPHRENIA:
Neurodevelopmental disorder
A
- Cortical atrophy (certain part of the brain is small)
- Maternal virus during pregnancy
23
Q
PSYCHOSIS | TYPES
THEORIES | SCHIZOPHRENIA:
certain chemical causes a defect in “SELECTIVE ATTENTION”
A
NEUROCHEMICAL THEORY
24
Q
PSYCHOSIS | TYPES
THEORIES | SCHIZOPHRENIA:
____ or ____ has been proposed to be the cause of schziophrenia and is used as a basis for pharmacotherapy
A
biochemical imbalances or abnormality in the brain
25
# **PSYCHOSIS | TYPES**
THEORIES | SCHIZOPHRENIA:
**BIOCHEMICAL IMBALANCES**
increased SEROTONIN
increased DOPAMINE
decreased GLUTAMATE
26
# **PSYCHOSIS | SCHIZOPHRENIA**
**Hallucinatory effects** could be associated with **5-HT2A** recpetor and possible **5-HT2C** stimulation
SEROTONIN theory (hypothesis)
27
# **PSYCHOSIS | SCHIZOPHRENIA**
SEROTONIN THEORY:
* modulate the **RELEASE** of **dopamine**, **norepinephrine**, **glutamate**, **GABA**, and **acetylcholine** in the cortex, limbic region, and striatum
5-HT2**A** & 5-HT2**C** receptors
28
# **PSYCHOSIS | SCHIZOPHRENIA**
SEROTONIN THEORY:
* leads to **DEPOLARIZATION** of **GLUTAMATE** neurons (***only in specific region of the brain***) but also **STABILIZATION** of **NMDA** receptors
5-HT2**A** receptor **stimulation**
29
# **PSYCHOSIS | SCHIZOPHRENIA**
SEROTONIN THEORY:
* leads to **INHIBITION** of **CORTICAL** and **LIMBIC dopamine release**
5-HT2**C** receptor **stimulation**
30
# **PSYCHOSIS | SCHIZOPHRENIA**
major action
increase DA, SE
31
# **PSYCHOSIS | SCHIZOPHRENIA**
inhibitory or excitatory
inhibitory effect
32
# **PSYCHOSIS | SCHIZOPHRENIA**
DOPAMINE THEORY:
* many antipsychotic drugs **strongly BLOCK** ____ in thee CNS, especially in the mesolimbic and striatal-frontal system
postsynaptic D2 receptor
33
# **PSYCHOSIS | SCHIZOPHRENIA**
DOPAMINE THEORY:
* drugs that ____ either **AGGRAVATE** schizophrenia psychosis or produce **PSYCHOSIS DE NOVO** in some patients
## Footnote
psychosis de novo - cause psychosis in **healthy** patients
increase dopaminergic activity
34
# **PSYCHOSIS | SCHIZOPHRENIA**
DOPAMINE THEORY:
* **dopamine-receptor density** has been found postmortem to be ____ in the brains of **schizophrenic**
increased
35
# **PSYCHOSIS | SCHIZOPHRENIA**
GLUTAMATE THEORY:
* **hypofunction** of ____ located on GABAergic internuerons, leads to **DIMINISHED INHIBITORY** influences on neuronal function
NMDA receptors
36
# **PSYCHOSIS | SCHIZOPHRENIA**
GLUTAMATE THEORY:
* an ____ of **downstream glutamatergic activity**, which can lead to **HYPERSTIMULATION** of **cortical neruons** through non-NMDA receptors
induce disinhibition
37
# **PSYCHOSIS | TYPES**
* characetrized primarily by **CHANGES OF MOOD** rather than by thought disorder
* **Depression**
* **Mania**
AFFECTIVE DISORDERS
38
# **PSYCHOSIS | AFFECTIVE DISORDERS**
DOWN phase
depression
39
# **PSYCHOSIS | AFFECTIVE DISORDERS**
HYPERACTIVE
mania
40
# **PSYCHOSIS | AFFECTIVE DISORDERS**
TYPES OF DEPRESSIVE SYNDROME
Unipolar
Bipolar
41
# **PSYCHOSIS | AFFECTIVE DISORDERS | TYPES OF DEPRESSIVE SYNDROME**
* **Reactive** depression
* **Endogenous** depression
UNIPOLAR
42
# **PSYCHOSIS | AFFECTIVE DISORDERS | TYPES OF DEPRESSIVE SYNDROME**
UNIPOLAR:
* caused by **external factors** clearly associated with **STRESSFUL LIFE EVENTS**, and accompanied by symptoms of **anxiety** and **agitation**
* characterized by a **PERIOD OF SHOCK** and **DEPRESSION** which is followed by a period of **READJUSTMENT** and resolve that life must go on
REACTIVE depression
43
# **PSYCHOSIS | AFFECTIVE DISORDERS | TYPES OF DEPRESSIVE SYNDROME**
UNIPOLAR:
* **UNRELATED** to **external** stress
* may involve **psychological DISTURBANCES** and **MALADJUSTMENTS** or **BICOHEMICAL DEFECTS** in the brain
ENDOGENOUS depression
44
# **PSYCHOSIS | AFFECTIVE DISORDERS | TYPES OF DEPRESSIVE SYNDROME**
* characterized by **ALTERNATING CYCLES** of **depression** and **mania**
* weeks of depression, then mania
BIPOLAR AFFECTIVE DISORDER
45
# **PSYCHOSIS | AFFECTIVE DISORDERS | TYPES OF DEPRESSIVE SYNDROME**
BIPOLAR:
____ is the **OPPOSITE** of **depression**, with excess **exuberance**, **enthusiasm** and **self-confidence**, accompanied by **impulsive actions**
MANIA
46
# **DRUGS FOR PSYCHOSIS**
ANTIPSYCHOTICS:
**blockers** of ____
DOPAMINE receptors
47
# **DRUGS FOR PSYCHOSIS**
MOST **antipsychotics** are ____ in action, meaning they **block** other receptors such as **alpha adrenergic**, **hsitamine**, and **serotonin** receptors in addition to **dopamine** receptor
NONSELECTIVE
48
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
* MOA: **block D2** receptors
* ADDITONAL EFFECTS: **anti-HAM** (Histamine, Alpha1, Muscarinic)
* USE: for **POSITIVE** symptoms only
1st gen / Classical / Traditional / Typical antipsychotics
49
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
1st gen:
**azine**
phenothiazine
50
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
1st GEN:
**peridol**
Butyrophenones
51
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
1st GEN | PHENOTHIAZINE:
**aliphatic**
promazine
52
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
1st GEN | PHENOTHIAZINE:
**piperazine**
phenazine
53
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
1st GEN | PHENOTHIAZINE:
**piperidine**
ridazine
54
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
1st GEN:
* for **MANIC** phase
BUTRYOPHENONES - "peridol"
55
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
DOC for **PEHNCYCLIDINE overdose** and is clinically used also in **HUNTINGTON'S disease** and **TOURETTE'S syndrome**
HALOPERIDOL
56
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
1st GEN:
**thix**
thioxanthenes
thiothixine
57
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
POTENCY
butyrophenos = piperazines > piperidine . thioxanthenes > aliphatic
58
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
increase HAM affinity
Aliphatic > Thioxanthenes > Piperadine > Piperazine = Butyrophenone
59
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
* MOA: **block 5HT** receptor more than D2 receptor, block **D4**
* USE: for **NEGATIVE** symptoms
* **LESS binding** to **DA** = **LESS EPS**
2nd gen / ATYPICAL antipsychotics
60
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
the ONLY atypical **WITHOUT EPS** effect
## Footnote
EPS - extrapyrimidal syndrome
CLOZAPINE
61
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
**POSITIVE** symptoms
1st gen = 2nd gen
62
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
**NEGATIVE** symptoms
2nd gen > 1st gen
63
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
ATYPICAL:
* **no EPS**
* only antipsychotic that **REDUCE SUICIDE EFFECT**
* causes **seizure**, **agranulocytosis**, **myocarditis**
CLOZAPINE
64
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
ATYPICAL:
**CLOZAPINE** causes
seizures
agranulocytosis
myocarditis
65
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
ATYPICAL:
* **NEWEST**
* **partial** D2 agonist
* **LEAST** sedating
ARIPIPRAZOLE
## Footnote
prazole but not PPI
66
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
ATYPICAL:
* causes **OVERWEIGHT** or **OBESITY**
Olanzapine
67
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
ATYPICAL:
* used for **INTRACTABLE HICCUPS**
Risperidone
68
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
ATYPICAL:
* causes **QT prolongation**
Ziprasidone
69
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
ATYPICAL:
* watch out for **sedation** (**VERY SEDATING**)
QUETIAPINE
70
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
ADVERSE EFFECTS:
**decrease** level of **DA** = **increase Ach**
EPS
71
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
ADVERSE EFFECTS:
**management** for **EPD**
anticholinergics
72
anti**CHOLINERGICS**
Biperiden
Benztropine
Trihexylphenidyl
73
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
ADVERSE EFFECTS:
* **LOW DA** = **HIGH PROLACTIN**
* **galactorrhea**, **amenorrhea**, **infertility**, **decrease libido**
HYPERPROLACTINEMIA
74
a **PROLACTIN INHIBITING** hormone
DA
75
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
ADVERSE EFFECTS:
* rare **life threatening**
* **idiosyncratic**
* **fever**, **muscle rigidity**, **altered mental status**, **unstable vital sign**
MALIGNANT HYPERTHERMIA
76
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
DOC for **MALIGNANT HYPERTHERMIA**
DANTROLENE
77
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
ADVERSE EFFECT:
due to **H1** receptor **blockade**
sedation
78
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
ADVERSE EFFECTS:
due to **alpha1 blocker**
orthostatic hypotension
failure to ejaculate
79
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
ADVERSE EFFECTS:
due to **M** receptor **blockade**
anticholinergic effects
80
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
ADVERSE EFFECT:
by **CLOZAPINE**
seizure
agranulocytes
81
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
ADVERSE EFFECT:
**CARDIAC: Clozapine**
myocarditis
82
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
ADVERSE EFFECT:
**CARDIAC: Thioridazine, Ziprasidone**
QT prolongation
83
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
ADVERSE EFFECTS:
by **THIORIDAZINE**
## Footnote
may cause blindness
RETINAL DEPOSITS
84
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
ADVERSE EFFECTS:
by **CHLORPROMAZIE**
## Footnote
does NOT cause blindness
CORNEAL DEPOSITS
85
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
ADVERSE EFFECT:
common in **2nd gen** antipsychotics except in **Amilsupride**, **Molindone**, **Aripiprazole**
weight gain
86
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
ADVERSE EFFECT:
by **OLANZAPINE**
risk for DM
87
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
PROTOTYPE
CLOZAPINE
88
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
ADVERSE EFFECTS:
* occurs with the **CHRONIC USE** of antipsychotics
* has two main kinds: **Acute Dystonias**, **Tardive Dyskinesia**
EXTRAPYRIMIDAL MOTOR DISTURBANCES
89
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
AE | EPMD:
* are **involuntary** movements (**muscle spasm**, **protruding tounge**, **torticollis**, and often a **PArkinson-type** syndrome)
* **REVERSIBLE**
ACUTE DYSTONIAS
90
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
AE | EPMD:
* consist of **involuntary** movements, often of the**FACE** and the **TOUNGE**, but also of the **TRUNKS** and **LIMBS**
* **IRREVERSIBLE**
TARDIVE DYSKINESIA
91
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
AE | EPM:
incidence of **extrapyrimidal** effects is **LESS** with ____
ATYPICAL
## Footnote
bcs they bind to SE
92
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
ONSET OF ACTION
may not be effective for several weeks
93
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS**
ONSET OF ACTION:
**sedation** and **side effects**
rapidly
94
# **PHARMACOLOGY | NEUROLEPTICS**
AE:
* **Hyperprolactinemia**
* **Endocrine** effects
* **Gynecomastia**
* **Galactorrhea**
* **Sexual dysnfunction**
DOPAMINE-receptore blockade
95
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
AE:
* difficulty **micturition**
* **constipation**
* **blurred vision**
* **dry mouth** (xerostomia)
CHLONIERGIC-receptor blockade
96
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
AE:
* failure to **ejaculate**
* **orthostatic hypotension**
* **light headedness**
ALPHA-ADRENOCEPTOR blockade
97
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
AE:
* **sedation**
HISTAMINE blockade
98
# **DRUGS FOR PSYCHOSIS | NEUROLEPTICS | ATYPICAL**
AE:
* **hypo**thermia
* **hyper**thermia
SEROTONIN blockade
99
# **PHARMACOLOGY | NEUROLEPTICS**
* primarily indicated for **schizophrenia**
* **CATATONIC** forms of schizo
* best managed by **IV benzodiazepines**
* also indicated fro **schizoaffective disorders**
* therapy of **psychotic depression** and **bipolar affective disorder**
PSYCHIATRIC INDICATONS
100
# **PHARMACOLOGY | NEUROLEPTICS**
**MONOtherapy** of **ACUTE BIPOLAR depression**
QUETIAPINE
IURASIDONE
OLANZAPINE (in combination with Fluoxetine)
101
# **PHARMACOLOGY | NEUROLEPTICS**
**adjunct** to antidepressants in the treatment of **UNIPOLAR depression**
Aripiprazole
Quetiapine
Olanzapine
102
# **PHARMACOLOGY | NEUROLEPTICS**
indicated in **HIGHLY AGITATED** and **MANIC** patients
haloperidol
103
# **PHARMACOLOGY | NEUROLEPTICS**
have a specific **antidepressant action**
Sulpiride
104
# **PHARMACOLOGY | NEUROLEPTICS**
tx of **HUNTINGTON'S chorea**
## Footnote
uncontrollable DANCE-like movements
HALOPERIDOL
105
# **PHARMACOLOGY | NEUROLEPTICS**
**NONpsychiatric**:
**NOT** an anti-**emetic**
THIORIDAZINE
106
# **PHARMACOLOGY | NEUROLEPTICS | NONPSYCHIATRIC**
anti-**emetic**
Prochlorperazine
Benzquinamide
107
# **PHARMACOLOGY | NEUROLEPTICS | NONPSYCHIATRIC**
used in combination with **NARCOTIC analgesics** for the tx of **CHRONIC PAIN** with **SEVERE ANXIETY**
Droperidol & Fentanyl citrate
108
# **PHARMACOLOGY | NEUROLEPTICS | NONPSYCHIATRIC**
for relief of **PRURITUS**
Phenothiazines
109
# **PHARMACOLOGY | NEUROLEPTICS | NONPSYCHIATRIC**
as **PREOPERATIVE sedatives**
Promethazine
110
# **CLINICAL EFFICACY OF ANTIPSYCHOTICS**
____ may be needed in controlling symptoms of **ACUTE schizophrenia**
large doses
111
# **CLINICAL EFFICACY OF ANTIPSYCHOTICS**
____ antipsychotic treatment is **often effective** in **PREVENTING RECURRENCE** of **schizophrenic attacks**
LONG-TERM
112
# **CLINICAL EFFICACY OF ANTIPSYCHOTICS**
____ are effective only in **70%** of schizophrenic patients
typical antipsychotics
113
# **CLINICAL EFFICACY OF ANTIPSYCHOTICS**
**30%** are classes as
treatment resistant
114
# **CLINICAL EFFICACY OF ANTIPSYCHOTICS**
**TYPICAL** antipsychotics effectively control the ____ symptoms
POSITIVE
115
# **CLINICAL EFFICACY OF ANTIPSYCHOTICS**
**TYPICAL** antipsychotics are **INEFFECTIVE** in relieving ____ symptoms
NEGATIVEQ
116
# **CLINICAL EFFICACY OF ANTIPSYCHOTICS**
____ overcome theb **SHORTCOMINGS** of **typical** antipsychotics, showing efficacy in **"treatment resistant"** patient and improving negative & positive symptoms
CLOZAPINE
117
# **CLINICAL EFFICACY OF ANTIPSYCHOTICS**
the ONLY ATYPICAL antipsychotic drug indicated to **REDUCE** the **RISK** of **SUICIDE**
CLOZAPINE
118
