Katzung 29 Antipsychotics And Lithium

Front 1

What are the major chemical subgroups of the older antipsychotics?

Back 1

phenothiazines (chlorpromazine, thioridazine, fluphenazine)
thiozanthenes (thiothizene)
butyrophenones (haloperidol)

Front 2

What are newer "second-generation" antipsychotic drugs?

Back 2

Heterocyclic structure including clozapine, loxapine, olanzapine, risperidone, quetiapine, ziprasidone, and aripiprazole

Front 3

Which antipsychotic drugs have parenteral forms that are used for rapid initiation and depot therapy?

Back 3

fluphenazine and haloperidol

Front 4

What are the 3 main reasons excess dopamine is thought to cause schizophrenia?

Back 4

1. Many antipsy drugs block D2
2. dopamine agonist drug exacerbate schizophrenia
3. increased dopamine receptors in schizophrenia patient

Front 5

Which receptor do the older antipsychotic drugs work on? What is the negative side effect?

Back 5

1. D2 repector
2. blocking can cause extrapyramidal dysfunction due to D2 found at caudate putamen, nucleus accumbens, cerebral cortex, and hypothalamus

Front 6

Which receptors does Clozapine act on?

Back 6

D4 and 5-HT2 receptor-blocking action

Front 7

Which receptors does atypical drugs (Olanzapine, quetiapine, and risperidone) act on?

Back 7

5-HT2A mainly and some D2

Front 8

Which receptors does Ziprasidone act on?

Back 8

ANTAGONIST at D2, 5-HT2A and 5-HT1D,
AGONIST 5-HT1A

Front 9

Which receptors does Aripiprazole act on?

Back 9

partial agonist at D2 and 5-HT1A receptor,
strong ANTAGONIST 5-HT2A

Front 10

With the exception of _____, all antipsychotic drugs block H1 receptor to some degree.

Back 10

HALOPERIDOL

Front 11

Which dopaminergic tract regulates mentation and mood?

Back 11

mesocortical-mesolimbic

Front 12

Which dopaminergic tract regulates extrapyramidal function?

Back 12

nigrostriatal pathway

Front 13

Which dopaminergic tract regulates control of prolactin release?

Back 13

tuberoinfundibular pathways

Front 14

Which dopaminergic tract regulates emesis?

Back 14

chemoreceptor trigger zone

Front 15

______ dopamine receptor blockade presumably underlies antipsychotic effects

Back 15

mesocortical-mesolimbic

Front 16

What are the positive symptoms of schizophrenia?

Back 16

hyperactivity, bizarre ideation, hallucinations, and delusions

Front 17

____ is effective in some schizophrenic patients resistant to treatment with other anytipsychotics drugs?

Back 17

Clozapine

Front 18

Newer atypical drugs are reported to improve some of the negative symptoms of schizophrenia, including ___, ___, and ___

Back 18

emotional blunting, social withdrawal and lack of motivation

Front 19

Which two antipsychotic drugs are used for maintence of bipolar disorder?

Back 19

olanzapine and aripiprazole

Front 20

____ is used mainly for Tourette's syndrome and rarely used in schizophrenia

Back 20

Molindone

Front 21

With the exception of ___, most phenothizines have antiemetic actions

Back 21

thioridazine

Front 22

Which phenothiazine is solely used for antiemetic actions?

Back 22

prochlorperazine

Front 23

____ blockade, most often present in short side-chain phenothiazines, provide the basis for their use as antipruritics and sedatives and contribute to antiemetic effects?

Back 23

H1 receptor blockade

Front 24

Extrapyramidal side effects most common with which antipsychotics?

Back 24

haloperidol and piperazine side-chain phenothiazines (fluphenazine and trifluoperazine)

Front 25

Neurologic dysfunctions akathisia and dystonias from antipsychotics can be treated with what 2 agents?

Back 25

diphenhydamine or muscarinic blocking agents

Front 26

What antipsychotic toxicity could be IRREVERSIBLE?

Back 26

Tardive dyskinesias - choreaoathetoid movements of the muscles of the lips and buccal cavity

Front 27

Treating extrapyramidal effects with antimuscarinic drugs may cause what side effect?

Back 27

INCREASE tardive dyskinesia

Front 28

How does increasing the neuroleptic dosage affect tardive dyskinesias?

Back 28

TEMPORARILY decrease suggesting tardive dyskinesia may be caused by dopamine receptor sensitization

Front 29

Which antipsychotic drug has the STRONGEST autonomic effect? WEAKEST?

Back 29

Strongest- Thioridazine
Weakest- Haloperidol

Front 30

___ and most the atypical drugs have intermediate autonomic effects?

Back 30

Clozapine

Front 31

Which two antipsychotics drugs do NOT have atropine side effects?

Back 31

ziprasidone and aripiprazole

Front 32

Which antipsychotics have the most atropine (dry mouth, constipation, urinary retention, and visual problems) side effects?

Back 32

Thiordiazine and phenothiazines with aliphatic side chains (chlorpromazine)

Front 33

Which antipsychotics are known to cause postural hypotension caused by A-blockade

Back 33

older antipsychotics such especially phenothiazines

Front 34

Which antipsychotics can cause orthostatic hypotension?

Back 34

atypical drugs

Front 35

Failure to ejaculate is common in men treated with ___

Back 35

phenothiazines

Front 36

What are the main endrocrine and metabolic side effects of antipsychotics?

Back 36

hyperprolactinemia, gynecomastia, the amenorrhea-galactorrhea syndrome and infertility

Front 37

Which antipsychotic has prominent elevated prolactin side effect?

Back 37

Resperidone

Front 38

Significant weight gain and hyperglycemia due to a diabetogenic action occur with several of the atypical agents, especially ___ and _____

Back 38

clozapine and olanzapine

Front 39

Which two antipsychotic drugs has little or no tendency to cause hyperglycemia, hyperprolactinemia, or weight gain?

Back 39

Aripiprazole and ziprasidone

Front 40

Drugs used to treat malignant hyperthermic syndrome of antipsychotic drugs?

Back 40

dantrolene, diazepam, and dopamine agonist

Front 41

What is the most sedating antipsychotic drug?

Back 41

phenothiazines especially CHLORPROMAZINE

Front 42

Which two of the older antipsychotics are least sedating?

Back 42

fluphenazine and haloperidol

Front 43

Which newer antipsychotic is least sedating?

Back 43

aripiprazole

Front 44

Visual impairment caused by retinal deposits has occurred with ___, at high does, this drug may also cause severe conduction defects in the heart resulting in fatal ventricular arrhythmias

Back 44

thioridazine

Front 45

Most atypicals, especially ___, prolong QT interval of the ECG; the underlying myocardial effect may lead to cardiac arrhythias (torsades)

Back 45

Ziprasidone

Front 46

____ causes small but important (1-2%) incidence of agranulocytosis and at high doses has caused seizures

Back 46

Clozapine

Front 47

Most neuroleptics lower the convulsive threshold and may cause seizures which are treated with ___ and ___

Back 47

diazepan or phenytoin

Front 48

Target therapeutic plasma concentration for Lithium is ___

Back 48

0.8-1.2 mEq/L and for maintenance 0.4-0.7 mEq/L

Front 49

What drugs can cause a increase of Lithium in the blood to toxic levels?

Back 49

Thiazides, NSAIDS, ACEIs, loop diuretics and also Dehydration

Front 50

___ and ___ increase the renal clearance of lithium

Back 50

Caffeine and theophylline

Front 51

MoA of Lithium

Back 51

inhibits inositol monophosphatase, rate limiting enzyme for generation of IP3 and DAG in 2nd messenger amine neurotransmission

Front 52

____ continues to be the standard treatment of bipolar disorder

Back 52

Lithium carbonate

Front 53

Acute mania can be treated with what 3 drugs?

Back 53

Lithium, valproic acid and olanzapine

Front 54

What drugs are required for the initiation of bipolar treatment?

Back 54

Antipsychotics and/or benzodiazepines due to slow onset of lithium and valproic acid

Front 55

Other then lithium, what drugs can be used in the maintenance of bipolar disorder?

Back 55

Aripiprazole and olanzapine, as well as anticonvulsants carbamazepine and lamotrigine

Front 56

Adverse neurologic effects of lithium include ___, ___, __ and ____. ___ enlargement may also occur

Back 56

tremor, sedation, ataxia and aphasia. Thyroid

Front 57

____ kidney problem occurs commonly at therapeutic lithium levels

Back 57

Reversible nephrogenic diabetes insipidus

Front 58

What skin problems can occur with lithium therapy?

Back 58

Edema and acneiform skin eruptions

Front 59

What side effect is ALWAYS present with lithium therapy?

Back 59

Leukocytosis

Front 60

The use of Lithium during pregnancy is thought to increase the incidence of ____

Back 60

congenital cardiac anomalies (Ebstein's anomaly)

Front 61

Can nursing mothers use Lithium?

Back 61

NO, should even stop 24-48 hours before delivery