Module 3 - The Antipsychotic Market Flashcards
(42 cards)
What are 2 main side effects of 1st gen antipsychotics?
EPS and Tardive Dyskinesia
What is EPS?
Extrapyramidal symptoms
- spasms, tremors
What is Tardive Dyskinesia?
irregular, jerky movements
What pathway is overactive in schizophrenia?
Mesolimbine (increase da)
How do conventional antipsychotics reduce positive symptoms?
Blocking D2 in the mesolimbic pathway
Can D2 antagonism be selectively delivered to the mesolimbic pathway?
No, it gets delivered to the entire brain. blockade of d2 in other pathways results in undesirable side effects
Is the mesocortical pathway in a person with schizophrenia thought to be already underactive or overactive?
Underactive
What does treatment with a d2 antagonist do in the mesocortical pathway, and what are the side effects associated?
Decrease dopamine to the prefrontal cortex, resulting in worsened negative and cognitive symptoms
What are the 5 EPS symptoms that occur when there is D2 antagonism to the nigrostriatal pathway?
- Tremor
- Rigidity
- Dystonia (movement disorders)
- Akinesia (absence/ loss of control of voluntary muscle control)
- Bradykinesia (slow movements)
How does D2 antagonism lead to tardive dyskinesia?
If the D2-r are chronically blocked, the neurons compensate by producing more D2-r AKA Upregulate
What are 4 symptoms related to Tardive dyskinesia?
- Constant chewing
- Tongue protrusion
- Facial grimacing
- Jerky limb movements
What occurs to prolactin when there is D2 antagonism in the tuberofundibular pathway?
PLT increases
What side effects are associated with Hyperprolactinaemia?
irregular; breast secretion, sx fx, bone demineralisations, periods.
What is the term for too much Prolactin?
Hyperprolactinaemia
How long have atypicals existed?
20 years
What receptor is ALSO antagonised in atypicals?
5-HT2A
What happens when 5-HT2A-r are antagonised?
Disinhibits release of DA. Therefore more is available in the synapse
Name 3 partial D2 agonists.
Ambilify, Rexulti, Reagila
Where are 5-HT2A-r most abundant and what is the effect?
Mesocortical Pathway, net result is improved negative symptoms
What is PANSS and what does it stand for?
Schitzophnrenia rating scale
Positive And Negative Syndrome Scale
What is BPRS and what does it stand for?
Measures major psychotic and non-psychotic symptoms
Brief Psychiatric Rating Scale
What is CGI and what does it stand for?
Measure overall illness severity/ used to measure the effectiveness of treatment.
Clinical Global Impression
What is CGI-S v CGI-I
s= Severity of illness v I= improvement
What is PSP?
Clinician rated assessment
Personal Social Performance
