Flashcards in Pyschosis Drugs Deck (53):
How can Schizophrenia be diagnosed?
At least one Core Symptom + Another Core/Negative Symptom
- Delusions / Hallucinations
- Disorganized Speech
- Blunted Affect / Lack of Spontaneity
- Poor Abstraction
- Social Withdraw
What is the current theory on etiology of Schizophrenia?
- Hyperactivity of Dopamine Neruons or Receptors in the limbic areas
What is the Mesolimbic dopamine tract responsible for?
- Arousal, Stimulus Processing, Locomotor Activity
if too much Dopamine = Positive Symptoms
What is the Mesocortical Tract responsible for and how does it become dysfunctional in schizophrenia?
Cognition, Communication, Social Activity
- Diminished Dopamine = Negative Symptom (Withdraw)
How would a Dopamine Antagonist affect the Nigrostriatal Pathway?
Increased Extrapyramidal Symptoms
What tract in the brain is responsible for Prolactin release when inhibited by a dopamine Antagonist?
What is it important to block the D2-like Receptors in the CNS when treating Psychotic symptoms?
Inhibiting D2-receptors prevents the down regulation of cAMP in the post synaptic neuron. Ideally regulating more normal functionality of the pathways.
What is the theory on how D2-Antagonists function in the cleft?
They initially block the D2-Receptors on the Post-Synaptic neuron and then the presynaptic releases more Dopamine to try and overcome the inhibition, but manages to desensatize the post-synaptic neuron with less receptors allowing the drug to block a higher percentage working better.
What is a quality of Neuroleptics that can help decrease negative symptoms caused by D2-Antagonists?
- Blocking of 5HT2 Receptors (Atypical Drugs)
What kind of drugs have both D2-Like Antagonism and 5HT2 Antagonism (higher potency)?
Apart of the Antagonism of D2-like receptors, why do Typical Anti-Psychotics cause more side effects?
- Not Selective to only D2-receptors can affect others like Histamine, Alpha-Receptors, and Serotonin
What is a quality of schizophrenics that is important for public health?
They use the health care system significantly most than the average person cost millions of dollars a year to care for them. Since they do not work are supported by disability and tax payers.
What drug can cause significant Parkinsonian Side effects?
What is the main difference between Typical and Atypical Psychotics when treating Schizophrenia?
Atypicals Block 5HT2 Receptors
- Helping control negative symptoms
What are the most common side effects of psychotic drugs of either type?
- Extrapyramidal Effects
- Anticholinergic Effects (lower potency drugs)
What should you watch for 2 week after a patient started taking a new psychotic drug?
- Expressionless Faces
- Shuffling Gait
**Can be treated with Anti-cholinergics or lowered dose of medications
What is the most common side effect caused by chronic use of psychotic drugs that can develop at any time from months to years?
- Can be permanent after long usage
What is it called when the patient is compulsive restless movement with anxiety and agitation, when might it occur?
- Usually 5-60 days after beginning an anti-pyschotic drug
When might you see first notice Acute Dystonia in a patient being treated for schizophrenia?
Immediately after starting the drug 1-5 days
What is the best method to prevent the patient from developing Tardive Dyskinesia?
Drug Holidays -- stopping the drug for a period of time, then resuming a short time later
What type/drugs cause Weight Gain - Diabetes most commonly?
If a patient this is taking Haloperidol regularly and suddenly develops hyperthermia, Parkinsonian symptoms, and goes into a coma. What might have happened?
Neuroleptic Malignant Syndrome
- Hypodopaminergic -- Not enough Dopamine
What drug can cause cardiac side effects when used in patients?
What kind of patient should not receive Phenothiazines?
Patients with a past history of seizures, since they lower the seizure threshold
If a patient is taking an Antipsychotic drug that caused pronouced Anti-cholinergic side effects and sedation, what might he be on?
(Low Potency Phenothiazines)
What are the general trends in drug potency and side effect profile of antipsychotics?
The lower the potency the more anticholinergic effects, higher the potency the more extrapyramidal symptoms.
What are the medium potency Phenothiazines with some extrapyramidal actions and anticholinergic side effects.
Thioridazine -- cardiac side effects
What is another use of the high potency Antipsychotic drug Prochlorperazine?
Trifluoperazine and Fluphenazine are both in what category of drugs to treat psychotic symptoms?
High Potency Phenothiazines
- More Extrapyramidal Reactions
- Less Anticholinergic
What are extrapyramidal effects that can be a side effect of psychotic drugs?
- Tardive Dyskinesia
How are Chlorprothixene and Thiothixene different from Chlorpromazine and Thioridazine?
They are equivalents in potency just different derivative
What is Haloperidol typically used for?
High Potency Antipsychotic
What is the drug typically used to treat Tourette's syndrome?
How are Atypical drugs better than typical antipsychotic drugs?
Lower Incidence of Extrapyramidal Symptoms
Lower Incidence of Tardive Dyskinesia
- Still controlled the positive symptoms well
What needs to be constantly monitored with a patient on Clozapine?
Constant Blood work -- Agranulocytosis
- Lowers Seizure threshold more than others, no epilepsy patients.
What Atypical drugs primarily effects the D4 receptor (+ 5-HT2 antagonist)?
What drug is a potent 5-HT2 antagonist and D1/2 Antagonism that causes weight gain and DM?
How does Olanzapine different from Clozapine?
Olanzapine -- Potent 5HT2 inhibitor, more extrapyramidal symptoms, but does not change seizure threshold
What Atypical Antipsychotic drug with 5HT2 and D2 Antagonism can be given as IM injection once every few weeks?
Why is Risperidone commonly chosen over Atypical antipsychotics?
- Greater reduction of negative symptoms and less extrapyramidal symptoms than other antipsychotics
- No effect on seizure activity
- IM dosage -- higher compliance
What Atypical is best used for elderly and why?
-- shorter half life than most of the other atypicals
What Atypical antipsychotics are approved for depression augmentation?
What Atypical antipsychotic has 5HT2 and D2 Antagonism with 5HT1a agonism without causing the patient weight gain?
What are the most common use for anti-psychotics?
- Acute Psychotic Episodes
- Chronic Schizophrenia
- Manic Episodes / Bipolar
What are the typical symptoms when a patient is undergoing a manic episode?
- Inflated Self-esteem / grandiosity
- Decreased need for sleep
- Racing Thoughts
- Very easily distracted
- Increased goal directed behavior
- Excessive behavior in pleasurable activites, even if dire consequences
What is the drug of choice for management of bipolar-manic episodes?
How does Lithium work to manage manic episodes?
-- Prevent conversion of IP2 --> IP1 in the DAG messenging system, preventing the secondary messengers and effects of stimulation of the neuron
- Depletes PIP2
What should be closely watched and prevented when a patient is on Lithium?
-- Make sure the patient is not on any Thiazide Diuretics, ARBs or ACE inhibiton, since it will increase the Lithium levels in serum
-- Sodium Levels are inversely related to Lithium Levels
the more being excreted the higher lithium raises.
What is most concerning when a patient is regularly taking Lithium?
That they do not take more than prescribed, since there is a narrow therapeutic window and serious toxicity is very easy to reach for a few extra doses.
A patient comes into the ED when friends noticed she was having difficulty walking and her speech was slurred, but they know she had not been drinking. They believe the patient has some kind of psychiatric disorder, but not sure what it is. Upon exam the patient has limited consciousness and is hyperreflexive, what might be going on?
What drug should be used when the patient is resistant to drug therapy for major depressive disorder?
What should be used for Manic episodes and bipolar disorders, if the patient cannot take Lithium due to medications for HTN.
--All of these have risk for pregnant women and spina bifida