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49 Cards in this Set

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What are Anti-psychotics?
1. Major Tranquilizers

2. Neuroleptics

3. Antischizophrenics
What are the Positive Symptoms of Schizophrenia?
1. Hallucinations
2. Delusions = unshakable belief in something untrue
3. Disorganized thought (loose associations)
4. Disorganized or Catatonic behavior
What are the Negative symptoms of Schizophrenia?
1. Flat or inappropriate affect = severe reduction in emotional expressiveness

2. Social isolation or Withdrawal
What is the pathogenesis of Schizophrenia?
Unknown but:
-neurodevelopmental
-50% heritability
Explain the Dopamine Hypothesis in the pathogenesis of Schizophrenia
Positive symptoms arise from hyperactivity of one or more of the CNS dopamine systems
-Mesolimbic = links the ventral tegmentum in the midbrain to the nucleus accumbens in the limbic system
-Mesocortical = connects the ventral tegmentum to the cortex, particularly the frontal lobes
What mechanism of action do all Antipsychotics share?
antagonistic of the D2 dopamine receptor

**Serotonin receptors &/or novel D2-like receptors may be involved
What contributes to the side effect profile of the Antipsychotics?
they interact with a variety of other receptors (alpha, ACh, histamine, etc)
What is the initial effect of Antipsychotics?

What is the effect is normal persons?

In Schizophrenics?
Initial = sedation & decreased agitation

Normal persons = Dysphoria, disinterest, blunted affect

Schizophrenics = Positive symptoms improve over weeks to months of treatment
-Negative symptoms are less affected
What effect do Antipsychotics have by blocking Dopamine receptors in the Chemoreceptor Trigger Zone?
Antiemetic
-but not useful in motion sickness
Describe the evolution of the Extrapyramidal effects (EPS) of Antipsychotics
1-5 days = Dystonia = sustained contraction of muscles leading to twisting distorted postures

5-60 days = Akathisia = unpleasant subjective sensation of "inner" restlessness that manifests itself with an inability to sit still or remain motionless

5-30 days = Parkinsonian Symptoms = tremor, rigidity, bradykinesia
-due to blockage of Striatal Dopamine receptors
What can the Parkinsonian symptoms of antipsychotics be treated with?
Anticholinergics
-Trihexyphenydyl
-Benztropine
What endocrine side effects may antipsychotics cause?
Increased Prolactin release -> Gynecomastia or Amenorrhea
What Antihistaminergic effects may antipsychotics possess?
Sedation
What anti-Alpha adrenergic side effects do Antipsychotics possess?
Orthostatic Hypotension

Sexual dysfunction
What anticholinergic side effects do antipsychotics possess?
Dry mouth, etc
What anti-muscarinic effects do antipsychotics possess?
Delerium or agitation
What cardiovascular side effects may antipsychotics possess?
Prolonged Q-T interval
What ocular side effects may Antipsychotics possess? Which one in particular?
Blurred Vision or Retinitis Pigmentosa

Thioridazine
the antipsychotic drug side effect "Neuroleptic Malignant Syndrome" can be treated with what?
Dantrolene = dopamine agonist
What are the long term side effects of Antipsychotics?
Tardive dyskinesia = stereotyped abnormal movement & facial disfigurement
-frequently irreversible

Perioral tremor = rabbit syndrome

Blood Dyscrasias = agranulocytosis can occur with Clozapine & some Phenothiazines
What drugs do the antipsychotics potentiate (enhance the effect of)?
CNS depressants
What drugs do antipsychotics block the action of?

What drugs do antipsychotics modify the effects of ?
Dopamine agonists

Cardiovascular drugs
What is there an increased risk of when using Meperidine?
seizures
List the "Typical" Phenothiazine antipsychotics
Chlorpromazine

Thioridazine

Fluphenazine
List the "typical" other antipsychotics
Haloperidol

Thiothixene
List the "atypical" antipsychotics
Clozapine
Risperidone
Olanzepine
Quetiapine
Ziprasidone
Aripiprazole

"CROZAQ"
List the 6 properties of Clozapine
1. blocks 5-HT2 > D2
2. no EPS or Tardive dyskinesia
3. improves Negative Symptoms
4. can cause Agranulocytosis
5. proved efficacious in pts not satisfactorily treated with other drugs
6. approved only for treatment-resistent patients who must receive regular blood tests

"Pine Tree w/ Clothes" has NO Granulocytes & like to inhibit Serotonin
Newer atypical antipsychotic that blocks 5-HT2 & D2 receptors equally; has less EPS side effects, but they occur at higher doses
Risperidone
What 4 atypical antipsychotics have very low EPS symptoms?
Olanzepine

Quetiapine

Ziprasidone

Aripiprazole

"QOZA" have low EPS
Atypical antipsychotic that has low EPS symptoms & blocks 5-HT2 receptors > D2 receptors
Olanzepine
Atypical antipsychotic that has very low EPS effects; blocks 5-HT2 = D2; low potency
Quetiapine
Atypical antipsychotic that is a D2 & 5-HT(1A) partial agonist; 5-HT(2A) antagonist
Aripiprazole
Antipsychotics are used in the management of agitation & psychotic symptoms of these conditions other than Schizophrenia
Acute mania

Dementia

Alcoholic hallucinosis
Why should antipsychotics NOT be used in the management of alcohol or barbiturate WITHDRAWAL?
because of increased risk of seizures
What antipsychotics are used to treat Dopamine agonist-induced psychotic symptoms
Clozapine

Quetiapine

Olanzapine
What is Haloperidol used to treat other Schizophrenia?
Tourrette's Syndrome

Huntington's disease
What antipsychotic is used to treat pruritis?
Chlorpromazine
What antipsychotics are used to treat nausea & vomiting?
Phenothiazines
-Chlorpromazine
-Thioridazine
-Fluphenazine
What antipsychotic is used to treat intractable hiccups?
Chlorpromazine
What antipsychotics are used to treat Bipolar Disorder?
Olanzepine

Quetiapine
Chlorpromazine
What Antipsychotic?
Fluphenazine
What antipsychotic?
Thiothixene
What antipsychotic?
Haloperidol
What Antipsychotic?
Clozapine
What antipsychotic?
Risperidone
What antipsychotic?
Olanzepine
What antipsychotic?
Quetiapine
What antipsychotic?
Ziprasidone
What antipsychotic?