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38 Cards in this Set

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What is the major theory behind the Dopamine Hypothesis of schizophrenia?
Excess of dopaminergic neurotransmission
Dopamine DEPLETING agensts (reserpine) does what?
Improve psychotic phase
Dopamine receptor blockers (antagonists) do what?
Improve psychosis symptoms
Dopamine agonists (L-Dopa, cocaine) do what?
Induce psychotic symptoms
All typical antipsychotic drugs are what kind of drugs? What do they especially affect?
Dopamine receptor antagonists.

D2 dopamine receptors
What side effects can be seen by blocking dopamine receptors in the basal ganglia?
Extrapyramidal side effects
What is the site of action (systems) for antipsychotic effects of neuroleptic drugs?
Mesolimbic/mesocortical system
Antipsychotics increase what hormone?
Prolactin
Blocking dopamine receptors in the Chemoreceptor Trigger Zone (CTZ) does what?
Protection against nausea and emesis. (anti-emetic action)
Antipsychotic effects on the kidney do what? via what?
Diuretic action

via blocking antidiuretic hormone
What is the superior combo of drugs in treating a particular symptom complex?
No such thing as a superior drug or combo.

However, atypical antipsychotics (e.g.- clozapine) is preferred in order to decrease extrapyramidal side effects
The right antipsychotic drugs to use is dependent on what? x2
Which side effects to avoid.

MD experience
Potent neuroleptics:

- Decrease what effects?
- Increase what effects?
Autonomic effects

Extrapyramidal effects
Why is it hard to OD on antipsychotics?
High therapeutic index
Muscarinic receptor blockade causes what symptoms? x4
Constipation
Urinary retention
Dry mouth
Loss of accomodation
Alpha-adrenergic blockade causes what symptoms? x3
Orthostatic hypOtention

Impotence
Failure to ejaculate
Dopamine receptor blockade in the basal ganglia leads to what symptoms? x3
Parkinsonian syndrome

Akathisia

Dytonia
Dopamine receptor supersensitivity causes what?
Tardive Dyskinesia
Toxic-confusional state is caused by what physiological mechanism induced by antipsychotics?
Blockade of muscarinic receptors
Hyperprolacteremia is caused by what mechanism where?

What are the results? x4
Dopamine receptor blockade in the endocrine system (hypothalamus/pituitary)

Amenorrhea
Galactorrhea
Infertility
Impotence
Therapeutic doses of antipsychotics can cause which of the following:

a.) hyperthermia
b.) hypothermia
c.) both
d.) none of the above
c.) both hyperthermia and hypothermia
Tolerance develops typically to what physiological blockade?
Antimuscarinic
What are the four extrapyramidal syndromes that appear concomitantly with antipsychotic adminitration?
1. Acute dystonia
2. Parkinsonian syndrome
3. Neuroleptic Malignant syndrome.
4. Akathisia
What are the two extrapyramidal syndromes that appear following prolonged treatment with antipsychotics?
1. Tardive Dyskinesia
2. Withdrawal-Emergent syndrome
Acute dystonia can be somewhat resolved with what?
Anticholinergic antiparkinsonian agents
Parkinsonian syndrome can be somewhat resolved with what?
Anticholinergic antiparkinsonian agents.
Describe neuroleptic malignant syndrome. x4
Stupor
Catatonia
Autonomic instability
Myoglobinemia
T/F - Neuroleptic malignant syndrome can be resolved with antiparkinsonian agents.
False
What is the treatment for neuroleptic malignant syndrome? x3
Immediate attention due to high mortality rate

Cessation of neuroleptics
Supportive care
Dantrolene
Akathisia can be resolved by what? x3
1. Reduce neuroleptics
2. Antianxiety drugs
3. Propanolol
What is the treatment for Tardive Dyskinesia?
No adequate therapy.

Best approach is preventative
Clozapine is an example of what?
Atypical antipsychotic
Clozapine is associated with an increased incidence of what? x2
Agranulocytosis

Seizures
Describe Tardive Dyskinesia.
1. Lip sucking/smacking
2. Lateral jaw movements
3. Darting of tongue
4. Choreiform movements
5. Dystonic athetoid movements
T/F - Tardive Dyskinesia is nocturnal.
False. Symptoms disappear during sleep
With Tardive Dyskinesia:

- effect by using increased neuroleptics
- effect by using antiparkinsonian agents
Will mask symptoms (DON'T USE)

Worsen symptoms (DON'T USE)
Withdrawal Emergent Dyskinesias can be resolved how? How long will resolve take?
Anticholinergic antiparkinson's agents.

Rapid resolve
What is the best way to treat all Extrapyramidal side effects.
Prevention