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PHAR 557 > Psychosis - Concepts > Flashcards

Psychosis - Concepts Flashcards

1
Q

Define schizophrenia

A

Mental disorder characterized by disorganized, bizarre thoughts, hallucinations, delusions, inappropriate affect/emotions, and impaired social fn’ing

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2
Q

Define psychosis

A

Impairment of an ind’s REALITY > marked by delusions, hallucinations, incoherent speech, and agitated behaviour (pt is NOT aware)

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3
Q

Define hallucination

A

sensing something w/ 1 or more senses that isn’t actually there (e.g. hearing voices)

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4
Q

Define delusion

A

beliefs that’re irrational and not based on reality

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5
Q

Pathophys of schizophrenia?

A
  1. DA dysregulation = key factor
  2. Serotonin dysregulation
  3. Glutamate and GABA also involved
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6
Q

4 sx clusters of schizophrenia:

A
  1. positive sx’s
  2. negative sx’s
  3. cog sx’s
  4. mood sx’s
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7
Q

Drugs known to cause psychosis (KNOW FOR EXAM) - 9 of them:

A
  1. amphetamine use and withdrawal
  2. cocaine use and withdrawal
  3. bupropion (lowers threshold)
  4. caffeine
  5. cannabis
  6. chloroquine
  7. efavirenz
  8. ketamine
  9. steroids
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8
Q

Main MOA of antipsychotics

A

Blocking DA receptors

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9
Q

T or F: Antipsychotics only block DA receptors

A

F

They block DA, 5HT, muscarinic, alpha1 and alpha2, and H1 receptors too!

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10
Q

How do the 5HT-2a and 5HT-2c blockade effects of antipsychotics help w/ schizophrenia?

A

Improves negative sx’s

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11
Q

How do the DA blockade effects of antipsychotics help w/ schizophrenia?

A

Improves positive sx’s

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12
Q

Differentiate between the effects of 1st, 2nd, and 3rd gen antipsychotics:

A

1st gen: DA receptor blocker
2nd gen: DA and 5-HT receptor blocker
3rd gen: DA receptor partial agonist

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13
Q

T or F: Each antipsychotic is unique, hence their efficacies differ considerably from one another.

A

F

Although they do have unique profiles, their efficacies are similar (except clozapine)

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14
Q

What’s clozapine used for wrt schizophrenia?

A

Tx-refractive schizophrenia (GOLD STANDARD)

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15
Q

In schizophrenic pts, 5HT blockade does what?

A

Helps w/ neg sx’s

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16
Q

In schizophrenic pts, muscarinic blockade can result in what?

A

Causes antichol AEs

17
Q

In schizophrenic pts, alpha-1 blockade can result in what?

A

BP issues

18
Q

In schizophrenic pts, alpha-2 blockade can result in what?

A

sexual dysfn

19
Q

In schizophrenic pts, DA blockade helps w/ what?

A

helps w/ positive sx’s

20
Q

What is risperidone

A

2nd gen antipsychotic

21
Q

MOA of risperidone

A

Antagonist of DA, serotonin, and alpha-adrenergic receptors

22
Q

Why does risperidone have the most extrapyramidal sx’s out of all the 2nd generation antipsychotics?

A

Due to it having the highest affinity to DA receptors

23
Q

This 2nd gen antipsychotic behaves the most as a 1st gen one.

A

Risperidone

it has a v. high DA receptor affinity

24
Q

T or F: Risperidone has NO antichol adverse effects.

A

T

It has 0 affinity for muscarinic receptors

25
Q

Dosing for risperidone (oral):

A

Initial: 1-2mg/day (OD or BID)

Gradually increase to 4-6mg/d

26
Q

Dosing for risperidone (injectable)

A

IM injection: 25-50mg IM q2 wks (overlap w/ po risperidone for 3 weeks)

27
Q

Sig. AE of risperidone?

A

Increased prolactin and sexual dysfn

28
Q

What is aripiprazole referred to as?

A

A dopamine system stabilizer

29
Q

How does aripiprazole work?

A

According to the “Goldilocks Principle”

If DA production is high, it acts as an antagonist

If DA production is low, it acts as an agonist

30
Q

What kinds of sx’s occur if DA production is high?

A

positive sx’s

31
Q

What kinds of sx’s occur if DA production is low?

A

negative sx’s

32
Q

Aripiprazole dosing (inc. max daily dose)

A

10-15mg po once daily (max = 30mg/day)

33
Q

Major AE of aripiprazole

A

Akathisia (inner restlessness, in ability to stay still)

34
Q

What is the advantage of using long-acting injectable antipsychotics (LAIAs)?

A

They improve adherence (given q2-4 wks)

PHAR 557 (36 decks)

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