Antipsychotic Drugs And Lithium

Front 1

Define Schizophrenia

Back 1

Psychosis characterized by clear sensorium but marked thinking disorder, of unknown etiology.

Front 2

State whether each of the following is a positive or negative symptom of schizophrenia:

1. Hallucinations
2. Flat affect
3. Poverty of speech
4. Delusions
5. Bizarre behavior
6. Avolition and apathy
7. Anhedonia
8. Neologisms (word salad)
9. Social withdrawal

Back 2

1. Positive
2. Negative
3. Negative
4. Postive
5. Positive
6. Negative
7. Negative
8. Positive
9. Negative

Front 3

State the two main hypotheses in the study of schizophrenia treatment.

Back 3

The dopamine hypothesis and the serotonin hypothesis.

Front 4

1. In the dopamine hypothesis, what do the schizophrenic symptoms result from?

Back 4

Excess DA activity

This is an old theory, supported by pharmocologic data. All anti-psychotic medications are DA antagonists.

Front 5

T/F
Drugs that increases dopamine synthesis (L-DOPA, amphetamines, apomorphine) aggravate psychotic Sx in schizophrenics

Back 5

True

Front 6

T/F
There is a decrease in DA receptor density in the brains of schizophrenics

Back 6

False. There is an increase in DA receptor density

Front 7

What is the main difference between the older DA antagonists and the newer atypical anti-psychotics?

Back 7

The atypicals also block 5-HT in addition to their anti-DA activity.

Front 8

What is the first line treatment for antipsychotic treatment?

Back 8

Atypical antipsychotics that block both the 5-HT receptors and the D2 receptors

Front 9

Structurally, what drug type are the phenothiazines similar to?

Back 9

They are similar to the TCA's; three ring structure

Front 10

Name the three subfamilies of the phenothiazines and their relative potency.

Back 10

1. Chlorpromazine (low potency)
2. Thioridazine (intermediate potency)
3. Fluphenazine (high potency)

Front 11

T/F
Low potency drugs have a greater sedative effect

T/F
High potency drugs have more adverse EP effects

Back 11

True

True

Front 12

What are the primary receptor types blocked by the phenothiazines?

Back 12

D2 dopamine receptors; 5-HT2 receptors

Also, block H1 histamine receptors, alpha adrenoreceptors, and muscarinic receptors

Front 13

Name the side effect that is associated with blockade of each of the following:

1. Alpha-adrenergic
2. Muscarinic Ach blockade
3. H1 blockade
4. D2 blockade

Other

Back 13

1. Orthostatic hypotension
2. Dry mouth, urinary retention, blurred vision
3. Sedation
4. Motor disturbances; hyperprolactinemia (women may lactate)

Other: decreased seizure threshold, abnormal temperature regulation and moderate weight gain

Front 14

1. Name the extrapyramidal side effects of phenothiazines

2. What are the extrapyramidal side effects due to?

Back 14

1.Pseudoparkinsonism, akithisia, and tardive dyskinesia

2. Antagonism of DA

Front 15

Match each of the following statements with its appropriate phenothiazine extrapyramidal side effect.

1. Motor restlessness with maximal risk at 5-60 days

2. Late complication of phenothiazine treatment

3. Petit-pas gait, bradykinesia, tremor, with maximal rish at 5-30 days

Back 15

1. Akathisia

2. Tardive dyskinesia

3. Pseudoparkinsonism

Front 16

A psychiatric patient presents with severe hyperthermia, muscle rigidity, unstable BP, agitation, and confusion. Medical history is pertinent for recent IM dose of haloperidol. What is the treatment?

Back 16

The patient is experiencing NEUROLEPTIC MALIGNANT SYNDROME, an extrapyramidal side effect of the phenothiazines.

Treatment: Aggressive fever control, dantrolene (to relax muscles), and bromocriptine (DA agonist)

Front 17

What is the effect of phenothiazines on each of the following:

1. Anticholinergics

2. CNS depressants, benzodiazepines

3. Meperidine (opioid)

4. Alpha blockers, nitrates

Back 17

1. Potentiates (increases the effect of the anticholinergics)

2. Potentiates

3. Potentiates

4. Potentiates

Also, potentiates sildenafil causing hypotension

Front 18

Match each of the following phrases with its appropriate non-phenothiazine antipsychotic (Haloperidol, Molindone, or Thiothixene)

1. High potency and high incidence of extrapyramidal side effects.

2. Less potent than phenothiazines with lower incidence of EP side effects.

3. Fewer autonomic effects

Back 18

1. Haloperidol and Molindone

2. Thiothixene

3. Haloperidol

Front 19

Why are the atypical antipsychotics considered "atypical?"

Back 19

They block 5-HT receptors as well as D2

Front 20

What is the mechanism of each of the following drugs?

1. Clozapine

2. Olanzipine

3. Risperidone

4. Quetiapine

5. Ziprasidone

6. Aripiprazole

Back 20

1. Blocks 5-HT2, D2, and alpha receptors

2. Blocks 5-HT2A, 5-HT2C, 5-HT3, 5-HT6, D2, and alpha receptors

3. Blocks 5-HT2 and D2 receptors; also blocks alpha-1,2 and H1 receptors with lower affinity

4. Blocks D1, D2, 5-Ht1A, 5-HT2, and H1 receptors

5. Blocks D2, 5-HT2, and alpha receptors

6. Complex unique mechanism that is thought to involve mixed agonist and antagonist activities at the D2 and 5-HT receptor subtypes

Front 21

What side effects are common to all of the "atypicals?"

Back 21

Somnolence, orthostatic hypotension, hyperglycemia, and obesity

Front 22

Match each of the following effects with its appropriate atypical antipsychotic:

1. Lowers seizure threshold

2. Prolong Q-T interval with possible arrythmias

3. Risk of sudden death

4. Agranulocytosis after 4-16 weeks in 1% of patients

5. Weight gain less than with other atypicals

Back 22

1. Clozapine

2. Risperidone and Ziprasidone

3. Ziprasidone

4. Clozapine

5. Aripiprazole

Front 23

Name which drug is associated with each of the following:

1. Approved for use in mania

2. All chronic schizophrenics at Central State Hospital in Louisville now receive this drug

3. Approved for use in bipolar disease

Back 23

1. Olanzipine

2. Risperidone

3. Aripiprazole

Front 24

T/F

Studies have shown that atypicals are not really more efficacious than phenothiazines

Back 24

True. And they are a heck of a lot (10-20x) more expensive

Front 25

What is lithium used for in treatment of psychotic disorders?

Back 25

-Stabilization of mood swings in manic depression

- Decreases inositol triphosphate

Front 26

What happens when Lithium is taken concurrently with-

1. Thiazide diuretics?

2. NSAIDs?

Back 26

1. Na depletion

2. Increased Li reabsorption

Front 27

Briefly describe the glutamate hypothesis

Back 27

1. Decreased function of the glutamate (NMDA) receptor in the neocortex could lead to sx of schizophrenia

2. Evidence includes: blockade of NMDA by PCP/ketamine induces positive and negative shizophrenia symptoms; SNPs in a subunit are found in the brains of a subset of schizophrenics, which reduce the binding of glu to the receptor.

3. Large doses of glycine with clozapine improve negative symptoms (glycine is a NMDA agonist); a new drug from Lilly is an NMDA superagonist that is very effective in reducing negative symptoms with few side effects.

Front 28

What are the therapeutic indications for antipsychotic drugs?

Back 28

Schizophrenia, bipolar disease with psychotic features, Tourette's syndrome, disturbed behavior in dementia, and anti-emesis