Cns Pharm- Antipsychotics

Front 1

According to the DA hypothesis of schizophrenia, symptoms arise due an excess or lack of DA in the CNS?

Back 1

excess

Front 2

What characterizes the positive symptoms of schizophrenia?

Back 2

Hallucinations, delusions, thought disorders

Front 3

What characterizes the negative symptoms of schizophrenia?

Back 3

Speech disorders, flat affect, amotivation, social withdrawal

Front 4

What is the MOA of "typical" antipsychotics meds?

Back 4

Inhibition of D2 receptors in the mesolimbic system of the brain

Front 5

What is the MOA of "atypical" antipsychotics meds?

Back 5

Inhibition of 5HT2 receptors, D2 receptors are still involved to some extent

Front 6

Give examples of typical antipsychotic meds

Back 6

Haloperidolm Chlorpromazine, thioridazine, fluphenazine, pimozide

Front 7

Give examples of atypical antipsychotics

Back 7

Clozapine, risperidone, aripiprazole, olanzapine, ziprasidone, quetiapine

Front 8

Of the typical antipsychotics, which are considered "low potency" in that the effective doses are in the 100s of mgs?

Back 8

Chlorpromazine, thioridazine

Front 9

of the typical antipsychotics, which are considered to be "high potency" in that effective doses are in the 10s-50s of mgs?

Back 9

Haloperidol and fluphenazine

Front 10

Which of the typicals are considered phenothiazines?

Back 10

Fluphenazine, chlorpromazine, thioridazine

Front 11

which typical is considered to be a butyrophenone?

Back 11

Haloperidol

Front 12

Give an example of a butyrophenone that is commonly used as an anti-emetic and is added to fentanyl and NO to produces neuroleptic anesthesiA

Back 12

Droperidol

Front 13

Name to typical antipsychotics commonly used in the treatment of Tourette syndrome

Back 13

haloperidol and pimozide

Front 14

What are the extra-pyramidal symptoms associated with antipsychotic med usage?

Back 14

Parkinsonian-like symptoms: dystonia, rigidity, tremor, and bradykinesia. Also akathesia and tardiv diskinesia (TD)

Front 15

What is TD?

Back 15

Inappropriate movements of the tounge, neck, trunk, and limbs (associated with long term use of DA antagonists ie typical antipsychotics)

Front 16

What is the mechanism of antipsychotic induced TD?

Back 16

Long-term DA receptor inhibition leads to an upregulation and supersensitivity of DA receptors thereby leading to DA overstimulation, especially when the antipsychotic has been discontinued

Front 17

Which antipsychotics are more likely to cause EPS?

Back 17

high potency typical antipsychotics secondary to weak anticholinergic activity (haloperidol and fluphenazine)

Front 18

Which typical antpsychotics cause the LEAST amount of EPS?

Back 18

Thioridazine, and chlorpromazine

Front 19

Why do thioridazine and chlorpromazine have low EPS potential?

Back 19

High anti-cholinergic activity

Front 20

What medications are used to tx the anti-psychotic-induced EPS?

Back 20

Benztropine, amantadine, diphenhydramine (due to its anticholinergic activity)

Front 21

How do antipsychotics cause parkinsonian like symptoms?

Back 21

Inhibition of DA receptors in the nigrostriatal pathway.

Front 22

How do antipsychotics prevent emesis?

Back 22

Inhibition of the DA receptors in the CTZ

Front 23

Where is the CTZ located?

Back 23

Medulla

Front 24

How do antipsychotics cause orthostatic hypotension?

Back 24

Inhibition of alpha-adrenergic receptors in the vasculature

Front 25

How do antipsychotics cause prolactinemia?

Back 25

Inhibition of DA receptors in the anterior pituitary

Front 26

Which two antipsychotics possess the highest antimuscarinic activity?

Back 26

Chlorpromzine and thioridazine

Front 27

Characterize the antimuscarinic activity of chlorpromazine and thioridazine

Back 27

xerostomia, blurred vision, confusion, constipation, urinary retention

Front 28

What is xerostomia?

Back 28

Dry mouth

Front 29

Which antipsychotic agents are more effective at treating negative symptoms?

Back 29

Atypical antipsychotics

Front 30

Which phenothiazine med is more commonly used as an en antiemetic and rarely used as an antipsychotic?

Back 30

Prochlorperazine

Front 31

Which phenothiazine is used also used to tx intractable hiccups?

Back 31

Chlorpromazine

Front 32

Which phenothiazine antipsychotic may cause priapism, angranulocytosis, blue-gray discoloration of the skin, and lower seizure threshold?

Back 32

Thioridazine

Front 33

Which teo typical antipsychotics can be formulated as a depot intramuscular injection that may last up to 3 weeks?

Back 33

Haloperidol Fluphenazine

Front 34

Which typical antipsychotic is usually reserved as a third line agent to treat schizo in patients refractory to traditional therapy?

Back 34

Clozapine

Front 35

What is the major dose limiting side effect of clozapine?

Back 35

Agranulocytosis!

Front 36

How are patients recieving clozapine therapy monitored?

Back 36

WBCs obtained at baseline and then weekly for the first 6mo of therapy, every other week for the 2nd 6mo, and monthly thereafter

Front 37

What adverse effect is more common with clozapine, agranulocytosis or seizures?

Back 37

SEIZURES! they occur in 10% of patients whereas agranulocytosis only occurs in 1-2% of patients

Front 38

Why is gynecomastia a common adverse SE of risperidone?

Back 38

Risperidone-induced prolactinemia, only atypical antipsychotics increase prolactin levels significantly)

Front 39

What is a potential life-threatening adverse effect of antipsychotic medications?

Back 39

Neuroleptic Malignant Syndrome (NMS)

Front 40

What characterizes NMS?

Back 40

Hyperthermia, rigidity, altered mental status, cardiovascular instability.

Front 41

What is the tx for NMS?

Back 41

Dantrolene + Bromocriptine (a DA agonist)

Front 42

In addition to blocking the 5HT2 receptors, which DA receptor subtype does clozapine strongly antagonize?

Back 42

D4 receptor subtype

Front 43

What are the additional adverse effects of olanzapine?

Back 43

Weight gain, hyperglycemia, sialorrhea

Front 44

What are the additional side effects of ziprasidone?

Back 44

QTc prolongation, priapism

Front 45

What are the additional adverse effects of quetiapine?

Back 45

Hypercholesterolemia, hyperTGs, weight gain, hepatotoxicity

Front 46

What is the mechanism of action of aripiprazole?

Back 46

Antagonist at 5HT2a receptors, partial agonist at D2 and 5HT1a receptors

Front 47

What are the adverse effects of aripiprazole?

Back 47

Weight gain, rash, sialorrhea, hepatotoxicity

Front 48

Which antipsychotic medication has the highest incidence of sialorrhea?

Back 48

Clozapine (31-48%)