Anti-Psychotic & Anti-Manic Drugs Part 1 Flashcards Preview

Psych > Anti-Psychotic & Anti-Manic Drugs Part 1 > Flashcards

Flashcards in Anti-Psychotic & Anti-Manic Drugs Part 1 Deck (24)
Loading flashcards...
1
Q

What are the 4 main symptoms of Psychosis?

A
  • Derangement of personality
  • Loss of contact w/ reality
  • Delusions
  • Hallucinations
2
Q

All disorders in this class (Schizophrenia) share some form of the syndrome psychosis w/ abnormalities in one or more domains.

What are these 4 domains?

A
  • Delusions
  • Hallucinations
  • Disorganized thinking
  • Abnormal motor behavior & negative symptoms
3
Q

What is the criteria for Schizophrenia?

Core positive symptoms?

A
  • Central Criteria: 2 or more symptoms during a 1 mo period
    • At least 1 must be a core positive symptom; no subtypes
  • Core Positive
    • Delusions
    • Hallucinations
    • Disorganized speech
4
Q

What are the other symptoms of Schizophrenia aside from positive? Negative symptoms?

A

Grossly disorganized or catatonic behavior

  • Negative symptoms
    • Blunted affect
    • Lack of spontaneity
    • Poor abstract thinking
    • Poverty of thought
    • Social withdrawal
5
Q

What is the Dopamine Hypothesis?

A

Schizophrenia results from hyperactivity of dopaminergic neurons or their receptors, particularly those w/ terminals in limbic areas of the brain

6
Q

What are the 4 Dopaminergic Pathways?

A
  • Mesolimbic tract
  • Mesocortical tract
  • Nigrostriatal pathway
  • Tuberoinfundibular tract
7
Q

Originates in A10
Arousal, memory, stimulus processing, locomotor activity, motivational behavior
Dopamine hyperactivity = positive symptoms

Which tract?

A

Mesolimbic tract

8
Q

Originates in A10
Cognition, communication, social activity
Diminished dopaminergic activity = negative symptoms

Which tract?

A

Mesocortical tract

9
Q

Originates in A9
Dopamine blockade = increased EPS
Blockade of 5-HT2a = decreased EPS, Parkinsonism

Which tract?

A

Nigrostriatal Pathway

10
Q

Dopamine blockade = increased prolactin release

**Which tract? **

A

Tuberinfundibular tract

11
Q

Dopamine Synapse

What are the pre-synaptic receptors? post-synaptic?

Which receptors are D1-like?

Which receptors are D2-like?

A
  • Pre-synaptic: D2/D3R
  • Post-synaptic: D2R, D1R
  • D1-like: D1, D5
      • AC, increased cAMP
  • D2-like: D2, D3, D4
    • – AC, decreased cAMP
12
Q

The better a drug can effectively _____ the dopamine receptor, the better it acts as an anti-psychotic.

A

block

13
Q

Anti-schizophrenic effects take time because….

A

the neuron senses less dopamine & wants to compensate to an extent

14
Q

What is the mechanism of Atypical Antipsychotic drugs?

A
  • Most of the newer drugs have an additional neurochemical effect in addition to DA receptor blockade
  • Block 5-HT2 receptors in the forebrain (often w/ greater potency than for DA receptors)
15
Q

What are the pharmacokinetics of Atypical Antipsychotics?

A
  • Oral absorption (variable)
  • Lipid soluble (absorbed in the brain better/faster)
  • Protein binding (longer t1/2 – medicate less often)
  • Large volumes of distribution
  • Complex metabolism
16
Q

What are the 3 main actions of Antipsychotic Drugs?

A
  • Decrease in psychotic behavior
  • Sedation
  • Extrapyramidal effects
17
Q

Atypical drugs, in addition to treating _______ symptoms, may be more effective in treating ________ symptoms

A

positive

negative

18
Q

What are the 4 main extrapyramidal effects of Antipsychotics?

A
  • Dystonias
  • Parkinsonism (early rxns – more w/ typicals)
  • Akathisia
  • Tardive dyskinesia (late rxn – may be less frequent w/ atypicals)
19
Q

What are some other side effects of Antipsychotics? (7)

A
  • Anticholinergic
    • Dry mouth, blurred vision, urinary retention
  • Orthostatic hypotension
    • Blockage of alpha receptors on blood vessels
  • Neuroendocrine effects
    • Result of dopamine receptor blockade
    • Galactorrhea, gynecomastia
  • Allergic & idiosyncratic effects
    • Liver, blood, cutaneous
  • Cardiac effects
    • Thioridazine is the worst (limited daily dose)
  • Decreased seizure threshold (phenothiazines)
  • Weight gain
    • Diabetes related events more common w/ atypicals (olanzapine, risperidone, clozapine, quetiapine)
20
Q

What is the difference btwn early & late reactions of Antipsychotic drugs?

A
21
Q

Neuroleptic Malignant Syndrome

Definition

Symptoms

Treatment

A
  • Potentially lethal hypodopaminergic side effect of antipsychotic drugs
  • Symptoms
    • Hyperthermia
    • Parkinson-like symptoms (muscular rigidity & tremor)
    • Mutism
    • Possible death
  • Treatment
    • Cooling & hydration
    • Bromocriptine
    • Dantrolene (skeletal muscle relaxation; blocks Ca2+ channels)
22
Q

What are the advantages of atypical antipsychotics over typical? (6)

A
  • Lower incidence of extrapyramidal symptoms (better compliance)
  • Possible lower incidence of tardive dyskinesia (TD)
  • Improve negative symptoms
  • Improve positive symptoms in many anti-psychotic-resistant or refractory patients
  • Less impact on cognitive functioning
  • More cost effective ?
23
Q

What are the uses for antipsychotic drugs? (7)

A
  • Acute psychotic episodes
  • Chronic Schizophrenia
  • Manic episodes, bipolar disorder
    • Aripiprazole, olanzapine, quetiapine, Ziprasidone, risperidone, Asenapine, Lurasidone
  • Schizoaffective disorder – Paliperidone
  • Augmentation in depression – aripiprazole, olanzapine, quetiapine
  • Tourette’s syndrome – haloperidol, pimozide
  • Anti-emesis – NOT Thioridazine
24
Q

What are the criteria for Bipolar Disorder? (DSM IV)

A
  • Inflated self-esteem/grandiosity
  • Decreased need for sleep
  • Talkativeness
  • Flight of ideas/racing thoughts
  • Distractibility
  • Increased goal-directed activity/psychomotor agitation
  • Excessive involvement in pleasurable activities w/ potential for adverse consequences