Block 2: Antipsychotic Drugs

Front 1

Can you name all the drugs to remember for this lecture? :)
2 old antipsychotics
4 atypical antipsychotics
DA system stabilizer
2 anticholinergic
antihistamine w/ anticholinergic

Back 1

old antipsychotics: chlorpromazine, haloperidol

newer atypical antipsychotics: risperidone, clozapine, olanzapine, quetiapine

Domanine system stabilizer: aripiprazole

anticholinergic:
benztropine,trihexphenidyl

antihistamine w/ anticholinergic: diphenhydramine

Front 2

Hypothesis of Schizophrenia

Back 2

DA excess- DA receptor blockers make better/agonists make worse

Front 3

Neuroleptic syndrome

Back 3

lack of initiative and disinterest caused by antipsychotic drugs

Front 4

Antipsychotic admin

Back 4

oral or im

Front 5

Time of action

Back 5

Full effect of anti-psychs several hours to weeks after admin

Front 6

Generalized side effects

Back 6

Mostly due to blockade of cholinergic and alpha adrenergic receptors in addition to DA receptor block (not associated with benefits)

Front 7

Which side effect is not reversible?

Back 7

Tardive dyskinesia

Front 8

What are the non-neurological side effects?

Back 8

Orthostatic hypotension, altered sexual fxn, increased prolactin, wt. gain, sedation, seizures, anticholinergic effects, phototoxicity, blood dyscrasias

Front 9

Characterize orthostatic hypotension

Back 9

Due to alpha adrenergic block, prevents NE from constricting arterioles
*can cause reflex tachycardia

Front 10

Characterize altered sexual fxn
name two drugs that play a role

Back 10

decreased sex drive
Thioridazine (thI'-er-rid'-ez-zine') & chlorpromazine (chlor-prO'-me-zine') may prevent ejaculation

Front 11

Characterize increased prolactin

Back 11

Caused by block of DA receptors on PL secreting cells, loss of inhibitory signal. Women-glactorrhea/amenorrhea Men- gynecomastia (man boobs)

Front 12

Characterize weight gain

Back 12

May be severe enough to cause DM type 2

Front 13

Characterize seizures

Back 13

All antipsychs lower seizure threshold

Front 14

Characterize anticholinergic effects

Back 14

nasal congestion, dry mouth, blurred near vision, constipation, and urinary retention

Front 15

Characterize phototoxicity

Back 15

Extreme sensitivity, more suceptible to burns

Front 16

Characterize blood dyscrasias

Back 16

leukopenia, usually within first two months of treatment

Front 17

Neurological side effects or Extrapyramidal (involuntary motor activity)

Back 17

Parkinsonism syndrome, dystonias, akathisias, tardive dyskinesia

Front 18

How many treated patients get neuro side effects?

Back 18

1/3

Front 19

Characterize Parkinsonism syndrome

Back 19

Caused by blockade of DA receptors, symptoms identical to that of idiopathing Parkinson's

Front 20

One more time for kicks...symptoms of Parkinson's

Back 20

akinesia, rigidity, alteration of posture, tremor, mask like face, shuffling gait, loss of associative movement, hypersalivation

Front 21

Control of anti-psych induced parkinson's

Back 21

Co-admin of an anticholinergic drug (benztropine or trihexphenidyl)

Front 22

Characterize dystonias

Back 22

Uncoordinated, bizarre, jerking or spastic movements of the neck, face, eyes, tongue, torso, arms, or legs.

Front 23

Control of dystonias

Back 23

I.V. or I.M. benztropine or an antihistamine w/anti-chol properties: diphenhydramine

Front 24

Characterize akathisias

Back 24

discomforting feeling of restlessness and agitation/patients unable to sit still

Front 25

Control of akathisias

Back 25

benztropine

Front 26

Characterize Tardive Dyskinesia

Back 26

Irreversible! Coordinated rhythmic, abnormal, involuntary sucking, chewing, licking, and pursing movements of the tongue and mouth

Front 27

When will tardive appear?

Back 27

Months or years after treatment

Front 28

New atypical antipsychs

Back 28

Risperidone, Clozapine, Olanzapine

Front 29

Properties of new anti-psychs

Back 29

As effective of positive symptoms as haloperidol, more effective at relieving negatives.
Block D2 and 5HT2 receptors
Cause more severe weight gain

Front 30

Risperidone vs. Haloperidol
(causes __, high doses cause __)

Back 30

Causes some elevation of prolactin, high dose cause extrapyrimidal effects

Front 31

Clozapine vs. Haloperidol
(no__ and ___, may cause ___)

Back 31

No prolactin elevation, no Tardive
Can cause agranulocytosis (possibly fatal), WBC count every week

Front 32

D4 receptor

Back 32

Expressed in the mesolimbic system not the striatum. Binds clozapine 10X more than other DA receptors

Front 33

Olanzapine vs. Haloperidol
(no __ or __)

Back 33

Binds to the same receptors as clozapine including 5HT2 and D4
No Tardive or hematologic abnormalities

Front 34

Quetiapine vs. Haloperidol

Back 34

Greater affinity for 5HT2 than for D2. Antagonizes H1, alpha 1 and 2 receptors.

Front 35

Dopamine system stabilizer drug

Back 35

Aripiprazole (ah-re-pip'-ra-zole), partial DA agonist and some serotonin receptors

Front 36

Cholorpromazine

Back 36

Antagonist at D2, DA, alpha-adrenergic, cholinergic receptors

Front 37

Effect of Cholorpromazine and Haloperidol

Back 37

Ameliorates the positive symptoms of schizophrenia

Front 38

What are the symptoms of schizophrenia?

Back 38

thought disorder, flat affect, autism, hallucinations, and delusions

Front 39

Haloperidol

Back 39

D2 receptor antagonist

Front 40

Side effects of cholorpromazine and haloperidol

Back 40

orthostatic hypotension, hyperprolactinemia, wt gain, sedation (Chlor>Halo), antichol effects, blood dyscrasias, parkinosims, dystonias, akathisias, tardive

Front 41

Risperidone

Back 41

Blocks D2 and 5HT2 receptors

Front 42

Effect of risperidone

Back 42

effective for both +/- symptoms

Front 43

Side effects of risperidone

Back 43

hyperprolactinemia and extrapyrimidal effects at high doses

Front 44

Clozapine

Back 44

Blocks D4 receptors>>D2 and 5HT2 receptors

Front 45

Effect of clozapine

Back 45

best drug for relieving symptoms

Front 46

Side effects of Clozapine

Back 46

very mild extrapyramidal effects but AGRANULOCYTOSIS

Front 47

Olanzapine

Back 47

Blocks D2 and D4 receptors equally and 5HT2

Front 48

Effect of olanzapine

Back 48

Both +/- symptoms

Front 49

Side effects of olanzapine

Back 49

Some extrapyramidal, some prolactin elevation

Front 50

Quetiapine

Back 50

Blocks 5HT2 > D2, also blocks H1

Front 51

Effect of Quetiapine

Back 51

Both +/- symptoms

Front 52

Side effects of Quetiapine

Back 52

Some elevated prolactin, some extrapyramidal

Front 53

Aripiprazole

Back 53

Partial DA agonist and some 5HT receptor agonist

Front 54

Effect of aripiprazole

Back 54

As good as atypical anti-psychs

Front 55

Side effects of aripirazole

Back 55

?? We don't know

Front 56

Smile

Back 56

:)

Front 57

Lauren's middle name?

Back 57

Ann

Front 58

Discovery of Chlorpromazine

Back 58

Delay and Deniker 1952

Front 59

Antipsychs are also called

Back 59

Neuroleptics

Front 60

The atomic number of Carbon

Back 60

6