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76 Cards in this Set
- Front
- Back
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What types of symptoms do you find in schizophrenia?
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Positive and negative
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What are the positive symptoms in schizophrenia?
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Delusions
hallucinations disorganized speech catatonic behavior |
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What are the negative symptoms in schizophrenia?
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Flattened affect
alogia avolition don't initiate behaviors |
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What is schizophrenia?
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A disorder in which though processes diverge from reality. May manifest d/o of perception, thinking, speech, emotion or physical activity.
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What is the drugs used to treat psychotic (schizophrenia)?
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Antipsychotics:
Phenothiazines Butryphenones Atypicals |
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What are the signs and symptoms of a neurotic disorder?
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Anxiety, dissatisfaction, feelins of inferiority and frustration, apathy or agitation and hostility
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What are the drugs used for treatment of neurotic d/o's?
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Anxiolytics: Benzodiazepines, Buspirone, SSRI
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What are the signs and symptoms of the depressive affective d/o?
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Disturbances of mood (low self-esteem and guilt), loss of feeling, low level of motivation
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What is the treatment for depression?
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SSRI's, TCA
Monoamine oxidase inhibitors: atypical antidepressants |
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What are the signs and symptoms of the manic affective d/o?
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Hyperactivity, ease of enjoyment, unrealistic optimism with acting out, aggressiveness
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What is the treatment for mania?
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Lithium, valproate, carbamezepine, antipsychotics
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What are biological theories?
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Theories which postulate neurochemcial defect as the basis of mental d/o.
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What is the biogenic amine hypothesis?
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Innappropriate amounts of amine neurotransmitters (NE, dopamine, serotonin) in CNS leads to inappropriate behavior.
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What is the biogenic amine hypothesis based on?
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Drug effects
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What do antidepressants do to receptors?
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It increases levels of NE, 5HT (serotonin)
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What is depression caused by?
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Too little NE, 5HT
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What happens if dopamine is increased and unregulated?
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Causes pychosis
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What does antipsychotics do to the receptors?
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Blocks dopamine receptors
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What are the "typical" agents used to treat psychoses?
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Chlorpromazine (Thorazine)
Thioridazine (Mellaril) Fluphenazine (Permitil, Prolixin) Thiothixen (Navane) Haloperidol (Haldol) |
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What are the "atypical" agents used to treat psychoses?
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Loxapine (Loxitane)
Clozapine (Clozaril) Risperidone (Risperdal) Olanzapine (Zyprexa) Quetapine (Seroquel) Ziprasidone (Geodon) Aripiperazole (Abilify) |
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What does it mean if it is "atypical"?
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Their mechanism of action is not typical (or binding to receptor) and it will produce different side effects from the typical drugs.
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What is the advantages and disadvantages of chlorpromazine?
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Adv.-Generic and inexpensive
Disadv.-many adverse effects, esecially autonomic |
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What is the adv/disad of Thioridazine?
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Adv. slight EPS, generic
Disadv.-800 mg/d limit; no parenteral form, cardiotoxic |
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What is the adv./diadv. of Fluphenazine?
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Adv.-Depot form also avialable
Disadv.-Increases tardive dyskinesia |
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What is the adv/disad of Thiothixen?
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Parenteral form also available; decreased tardive dyskenesia
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What is the adv/disad of Halperidol?
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Adv.-Parental form also available;generic
Disadv-Severe EPS |
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What is the adv/disad of Loxapine?
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Adv.-no weight gain
Disadv.-Uncertain |
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What is the adv/disad of Clozapine?
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Adv.-May benefit treatment-resistant patients; little EPS toxicity
Disadv.-May cause agranulocytosis; wt gain, hyperglycemia, diabetes, dyslipidemia |
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What is the adv/disad of Risperidone?
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Adv.-broad efficacy; little or no EPS dysfunction at low doses
Disadv.-may cause EPS or hypotension with higher doses; wt gain, hyerglycemia, diabetes, dyslipidemaia |
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What is the adv/disad of Olanzapine?
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Adv.-effective against neg. as well as pos. symptoms; little or no EPS
Disadv.-wt gain, hyperglycemia, diabetes, dyslipidemai, cataracts (?) |
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What is the adv/disad of Queitapine (Seroquel)?
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Adv.-little or no EPS
Disadv.-Wt gain, hyperglycemia, diabetes, dyslipidemia, cataracts? |
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What is the adv/disad of Ziprasidone?
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Adv.-less et gain than other atyipicals
Disadv.-Prolongs QT interval, but no arrhythmias reported yet, somnolence, some EPS |
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What is the adv/disad of Aripiperazole?
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Adv.-little or no EPS, less wt gain, or QT changes
Disadv-Akathesia, insomnia, anxiety; cautin in patient siwth epilepsy or Alz. |
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What are the receptor interactions of antipsychotic drugs?
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All block D2 but the importance of this in relation to other receptor actions varies from drug to drug. Many receptors are involved.
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What is the receptor binding profile of Chlorpromazine?
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A1 = 5HT2 > D2 > D1
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What is the receptor binding profile of haloperidol?
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D2 > D1 = D4 > A1 > 5 HT2
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What is the receptor binding profile of Clozapine?
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D4 = A1 > 5HT2 > D2 = D1
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What is the difference between atypicals and typicals in regards to potency and receptors?
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Atypicals tend to be less potent at D2 receptors and much more potent at 5 HT2 and D4 receptors
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What is Aripiprazole?
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partial agonist at D2 and 5HT1a, claimed to be a new generation of antipsychotics
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What happens if you block the D2 receptors in a schizophrenic patient?
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Allevites positive symptoms (tension, hostility, hyperactivity, combativeness, hallucinations, delusions, insomnia, and anorexia)
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What happens if you block D4 nd 5HT2 receptors in a schizophrenic patient?
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Alleviate the negative symptoms (apathy, withdrawal, unresponsivesness)
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What are the 2 dopamine pathways that are important in relieving psychotic symptoms?
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Mesolimbic
Mesocorticol |
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Which 2 pathways contribute to the side effects of antipsychotics?
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Nigrostriatal
Tuberoinfundibular |
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What are the neurological side effects of antipyschotic agents?
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Acute dystonia
Akathisia Parkinsonism |
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What are some of the important side offects of antipsychotics?
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Neurological
Neurological Malignant Syndrome Late onset (can't treat) CNS Effects |
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What are the features of acute dystonia?
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Spasm of muscles of tongue, face, neck, back; may mimic seizures; not hysteria
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How do you treat acute dystonia?
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Antiparkinsonian agents are diagnostic and curative
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What are the features of akathisia?
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Motor restlessness; not anxiety or agiatation
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What is the treatment of akathisia?
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Antiparkinsonian agents, diphenhydramine, benzodiapines, or propranolol
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What are the features of the side effect Parkinsonism?
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Bradykinesia, rigidity, variable tremor, mask facies, shuffling gait
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What are the features of neurologic malignant syndrome (NMS)?
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Catatonia, stupor, fever, unstable BP, myoglobinemia: can be fatal
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Treatment of NMS?
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Stop antipsychotic immmediately: dantrolene or bromcriptinemay help; antiparkinsonian agents NOT effective
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What is late onset side effects?
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Perioral tremor "rabbit syndrome" and Tardive dyskinesia
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How do you treat perioral tremor?
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Antiparkinsonian agents sometimes help
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What are the features of tardive dyskinesia?
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Oral-facial dyskinesia; widespread choreoathetosis or dystonia
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Treatment of tardive dyskinesia?
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Prevention is crucial; clozapinen or olanzapine may help
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What areas of the CNS are affected with side effects from antipsychotics?
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Basal ganglia
Hypothalamus Medullary chemoreceptor trigger zone (CTZ) |
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What do you see from the basal ganglia SE?
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Parkinson-like extrapyramidal effects which is caused by blocking D2
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What do you see from hypothalamus?
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Increased prolactin secretion; temperature regulation (usually cold)
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What do you see from the CTZ?
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antiemetic action; DMV-increased eating from vagus nerve stimulation; weight gain
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Do you see weight gain with typicals or atypicals?
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Atypicals
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What effects do you see in the autonomic nervous system from antipsychotics?
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Peripheral cholinergic block, alpha adrenergic block
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What changes do you see in endocrine system?
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Alterations in secretion of many hormones
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What effects do you see in the CVS?
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Direct depressant effect on the heart, direct vasodilation plus indirect effects due to ANS effects --> decreased BP
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How are antipsychotics metabolized?
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Liver--oxidation and glucruonide conjugation; some active metabolites formed
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How are antipsychotics eliminated?
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Reneal excretion
T 1/2 is 10-20 hours and biological effects last 24 hours or more |
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How is antipsychotics absorbed?
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Absorption after oral administraion tends to be erratic and unpredictable
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What are the most serious adverse reactions to antipsychotic drugs?
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EPS and orthostatic hypotension
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What are the early onset adverse reactions?
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Parkinson syndrome
Akathisia Acute dystonic reactions |
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What are the late onset adverse reactions?
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Tardive dyskinesia
Perioral tremor |
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Why do you see orthostatic hypotension in antipsychotic agents?
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Peripheral alpha blockade
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What blood disorders are adverse reactions?
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Leukopenia
Agranulocytosis (particualry clozapine) |
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What is Neuroleptic Malignant Syndrome (NMS)?
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severe muscular hypertonicity, akinesia, dysarthria, fever and cardiovascular changes
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What are some other adverse effects of antipsychotic agents?
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Cholestatic jaundice
Rashes and photosensitivity Seizures Cataracts?--examine eyes every 6 months |
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What are some other autonomic side effects of antipsychotics?
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Sedation, nasal stuffiness, dry mouth, constipation, palpitation, skin reactions, arrhythmias (ziprasidone, thioridazine), weight gain, diabetes (atypicals), a risk of stroke in patients with dementia (risperidone and olanzapine)
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What are the therapeutic uses of antipsychotic drugs?
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Psychoses
All agents improve positive symptoms Atypicals will improve negative symptoms NV Hiccough Other neuropsychiatric diseases (Tourette's-Haloperidol or pimozide) and agitation associated with Alzheimer's Disease |
