Neuro 2 - Carrier - Anti-Psychotics

Front 1

Whats the most common form of psychosis?

Back 1

Schizophrenia = neurodevelopmental disorder

Front 2

What are the positive signs of schizophrenia?

Back 2

Delusions, Hallucinations, Reality Distortions (grandiosity, bellicosity, thought disorders, bizarre and or agitated behavior)

Front 3

What are the negative signs of Schizophrenia?

Back 3

Flat affect, Emotional and/or Social Withdrawal

Front 4

What are the neural pathways involved in Schizophrenia?

Back 4

Glutamate, Serotonin, Dopamine

Front 5

Which pathway is responsible for the negative symptoms seen in Schizophrenia?

Back 5

Mesocortical (its inhibited in Schizophrenics)

Front 6

Which pathway is responsible for the positive symptoms seen in Schizophrenia?

Back 6

Mesolimbic pathway

Front 7

Which pathway is responsible for the Adverse effects like Parkinson's seen in Schizophrenic pts?

Back 7

Nigrostriatal pathway

Front 8

Define the Dopamine Hypothesis

Back 8

Based on the fact that many anti-psychotic drugs block post-synaptic D2 receptors

Drugs that inc. Dopamine signaling aggravate schizophrenia

Front 9

What are the cons of the Dopamine Hypothesis?

Back 9

Dec cortical or hippocampal dopaminergic activity - underlying cognitive and negative symptoms in Schizophrenia

Dec. Dopaminergic innervation in medial temporal cortex, dorsolateral prefrontal cortex, and hippocampus

Role of atypicals in Tx

Front 10

Anti-psychotics block what?

Back 10

Dopamine Activity

Front 11

The meso-limbic and meso-cortical doapmine systems are related to what features of schizophrenia?

Back 11

the behavior aspect of it

Meso-cortical = negative symptoms

Meso-limbic = positive symptoms

Front 12

T/F: Typical anti-psychotics require 60% occupancy of striatal D2 receptors

Back 12

TRUE

Front 13

T/F: Atypical Anti-psychotics require occupancy of 30-50% D2 receptors. (WHY?)

Back 13

TRUE

The reason this works is that there is a high concurrence of 5-HT receptors that are also occupied

Front 14

MOA Anti-psychotics?

Back 14

Competitive blockade of Dopamine receptors and serotonin receptors

Front 15

Blocking dopamine receptors can cause what side effect, even at clinical doses?

Back 15

Extrapyramidal side effects

Front 16

Absorption and Distribution of Anti-psychotics?

Back 16

Absorption - readily

Distribution = Lipid soluble. Have large Vd (get sequestered) Longer DOA than is estimated by plasma half life - prolonged occupancy at D2 receptors

Front 17

Whats the metabolism of Anti-psychotics?

Back 17

Oxidation-Demethylation rxns

Front 18

Excretion of anti-psychotics?

Back 18

can be prolonged depending on drug


Ex = long-acting formulations may block D2 receptors 3-6 months after last injection

Front 19

What are the Anti-psychotics effects on EEG?

Back 19

Slows pattern of EEG frequency = inc. synchrony

Hypersynchrony is focal or unilateral leading to wrong Dx interpretation

Front 20

T/F: Some anti-psychotics lower seizure threshold and induce EEG patterns typical of seizure disorders

Back 20

TRUE

Front 21

CV effects of PHENOTHIAZINES anti-psychotics (= typical anti-psychotic)?

Back 21

Orthostatic hypotension and tachy
Dec. MAP, peripheral resistance and stoke volume, inc HR

Front 22

CV effects of Thioridazine (=a typical anti-psychotic)

Back 22

Prolonged QT interval
Abnormal ST segments and T waves

Front 23

CV effects of Haloperidol (=A typical anti-psychotic)?

Back 23

Inc. risk Torsades des Pointes

Inc. QT interval

Front 24

What are the CV effects of ATYPICAL anti-psychotics?

Back 24

Inc. QT interval

Possible inc. in arrhythmias: Ziprasidone, Quetiapine

Front 25

What are the ENDOCRINE effects of anti-psychotics, namely TYPICALS, Paliperidone and Risperidone?

Back 25

Inc. Prolactin

Front 26

What are the anti-psychotics that can be used as anti-emetics? How do they do this?

Back 26

Prochlorperazine and Benzquinamide

Due to: Dopamine receptor blockade (centrally = chemoreceptor trigger zone in medulla, peripherally = receptors in the stomach)

Front 27

Anti-psychotics can be used to treat Pruritis, as a pre-op sedative, or for Neuroleptanesthesia thanks to what actions?

Back 27

They block the H1-receptor

Front 28

What anti-psychotic can be used as a pre-op sedative?

Back 28

Promethazine

Front 29

What anti-psychotics can be used as Neuroleptanesthesia?

Back 29

Droperidol and Fentanyl

Front 30

What are the psychiatric indications for anti-psychotics?

Back 30

Schizophrenia, Drug-induced psychosis, psychosis involved with manic phase of bipolar disorder, schizoaffective disorders, Tourette's syndrome, Alzheimer's

Front 31

T/F: Both Typicals and Atypicals will work for the positive symptoms of schizophrenia

Back 31

TRUE

Front 32

What drug class among Atypicals and Typicals can only treat the negative symptoms?

Back 32

Atypical Drugs

Front 33

Which have few adverse drug reactions such as tardive dyskinesia, Extrapyramidal symptoms, and minimal inc. in prolactin?

Back 33

Atypicals

Front 34

Whats the best guide when choosing an Atypical or Typical anti-psychotic?

Back 34

Patient's past response

Front 35

For typicals, how do we choose the drug to use?

Back 35

High potency is preferred over low potency:

Haloperidol > Chlorpromazine> Thiordiazine

Front 36

Which Atypical anti-psychotic is used more b/c of its minimal SE's

Back 36

Risperidone

Front 37

Which anti-psychotic is indicated to reduce the risk of suicide in schizophrenia or as a last resort med?

Back 37

Clozapine

Front 38

What drug combo do we use to treat concomittant depression with a psychotic disorder?

Back 38

Anti-psychotic PLUS Tricyclic anti-depressant OR SSRI

Front 39

What drug combo do we use to treat concomittant mania with a psychotic disorder?

Back 39

anti-psychotic PLUS Lithium or Valproic Acid

Front 40

What are the adverse SE's on the CNS by Typicals?

Back 40

Usually Neurologic

Front 41

What are the Exprapyramidal SE's seen with anti-psychotics?

Back 41

Tremor, slurred speech, akathisia, dystonia, anxiety, distress, paranoia, brady

Parkinson's symptoms

Front 42

A pt is on a Typical anti-psychotic (OR Risperidone = atypical) and starts to show signs of involuntary, repetitive body movements. Should you be concerned?

Back 42

yes, they are showing signs of tardive dyskinesia and early recognition is important b/c it can't be reversed in the later stages

Front 43

A pt is on a Typical anti-psychotic (OR Risperidone = atypical) and starts to show signs of involuntary, repetitive body movements. What drug do you switch them too?

Back 43

Pt showing signs of tardive dyskinesia

Switch to Quetiapine or Clozapine (ie switch to a newer atypical)

Remove all drugs with anti-cholinergic properties

Treat with Diazepam to enhance GABA activity

Front 44

A pt is on an anti-psychotic drug and starts to experience new onset seizures. What drug is causing them?

Back 44

Clozapine

Front 45

Older typical agents can cause what?

Back 45

Behavioral problems ie Pseudodepression and toxic-confused states

Front 46

What SE's can anti-psychotics have on the Autonomic Nervous System?

Back 46

Anti-muscarinic = urinary retention, constipation, dry mouth

Front 47

A pt is experiencing Orthostatic Hypotension and impaired ejaculation. What drugs are responsible?

Back 47

Chlorpromazine or Mesoridazine

Front 48

A pt experiences deposits in their cornea and lens in the left eye and deposits in the retina in their right eye. What is causing these?

Back 48

Cornea and Lens deposits = Chlorpromazine

Retina deposits = Thioridazine (resembles retinitis pigmentosa)

Front 49

A pt states their vision has become "brown". What drug is causing this?

Back 49

Browning of vision = deposits in retina = Thioridazine is causing this

Front 50

A pt experiences weight gain while on their anti-psychotic. What drugs are responsible? How to we manage?

Back 50

Clozapine and olanzapine

Monitor carbs (hyperglycemia), Hyperlipidemia management (every 3-6 months do fasting blood sugar and lipids)

Front 51

What are some of the Endocrine SE's of anti-psychotics?

Back 51

Women = Amenorrhea-galactorrhea
False-positive pregnancy test
Inc. libido

Men = dec. Libido
Gynecomastia

Front 52

A pt is on Clozapine. What do we need to monitor, esp between weeks 6-18?

Back 52

blood count b/c Agranulocytosis (low WBCs) is a SE that develops rapidly between weeks 6-18

Front 53

A pt on anti-psychotic develops a fever, autonomic instability with altered BP and pulse, muscle rigidity, and extrapyramidal signs. What do we do to treat?

Back 53

They are having Neuroleptic Malignant Syndrome.

Tx = Anti-parkinson's drugs, muscle relaxants, or DANTROLENE (<--- KNOW)

Front 54

Treatment for Neuroleptic Malignant Syndrome. ?

Back 54

Dantrolene or Anti-parkinson's drugs, muscle relaxants

Front 55

Cardiac effects of Thioridizine?

Back 55

T wave abnormalities
OD --> Torsades, cardiac conduction block, sudden death

Front 56

Cardiac effects of Ziprasidone?

Back 56

GREATEST risk of QT prolongation = don't combine with other agents that inc. QT interval

Front 57

Cardiac effects of Clozapine?

Back 57

Assoc. with myocarditis

Front 58

Can we use anti-psychotics in pregnancy?

Back 58

yes, potential teratogenic risk small