Pharm2 And Antipsychotics

Front 1

Causal agents for following drug toxicity:

gingival hyperplasia

Back 1

phenytoin

Front 2

Causal agents for following drug toxicity:

diabetes insipidus

Back 2

lithium

Front 3

Causal agents for following drug toxicity:

tardive dyskinesia

Back 3

antipsychotics

Front 4

Causal agents for following drug toxicity:

fanconi's syndrome

Back 4

expired tetracyclines

Front 5

Causal agents for following drug toxicity:

gray baby syndrome

Back 5

chloramphenicol

Front 6

Causal agents for following drug toxicity:

extrapyramidal side effects

Back 6

chlorpromazine, thioridazine, haloperidol

Front 7

Causal agents for following drug toxicity:

osteoperosis

Back 7

corticosteroids, heparin

Front 8

Causal agents for following drug toxicity:

coronary vasospasm

Back 8

cocaine

Front 9

positive symptoms of schizophrenia?

Back 9

Delusions
Hallucinations -- auditory
Bizarre behavior – sexual disinhibition

Front 10

NEGATIVE SYMPTOMS - SCHIZOPHRENIA

Back 10

Affective flattening (lack of emotional expression)
Alogia (absence of words)
Anhedonia (inability to derive pleasure from any activity)
Apathy
Withdrawal from the social contact

Front 11

Dopamine hypothesis of schizophrenia :
Schizophrenia results from abnormalities in dopamine neurotransmission in ______ and ________ neuronal pathways.

Back 11

mesolimbic; mesocortical

Front 12

Dopamine hypothesis of schizophrenia :
Increased dopamine neurotransmission in the mesolimbic pathways results in positive symptoms
Dysfunctional ______ pathways account for the negative symptoms

Back 12

mesocortical

Front 13

Typical Anti-psychotics - block the _____ receptors in the mesolimbic pathways - decrease the dopaminergic transmission in the mesolimbic pathways to nucleus accumbens - alleviates positive symptoms

Back 13

D-2

Front 14

Typical Anti-psychotics - block the D-2 receptors in the mesolimbic pathways - decrease the dopaminergic transmission in the mesolimbic pathways to nucleus accumbens - alleviates positive symptoms - more extra-pyramidal features (((parkonism like features---regidity, coarsetremmors…akinesia…and get increased prolacting causing infertility and ______ in male and ______in female…

Back 14

gynacomastia; galctorrhea

Front 15

Typical Anti-psychotics :
Inhibition of _____________ results in extra pyramidal symptoms of anti-psychotics.(((pseudoparkinsonism)))

Back 15

nigrostriatal pathways

Front 16

Typical Anti-psychotics :

Blockade of tuberoinfundibular pathways results in increase _________.

Back 16

prolactin secretion

Front 17

Name the Phenothiazines

Back 17

Chlorpromazine (Thorazine)
Thioridazine (Mellaril)((know its adverse effects--))
Trifluoperazine (Stelazine)
Fluphenazine (Prolixin)(((available for injection also—as depo injection…)))
Perphenazine (Trilafon)
Haloperidol (Haldol) ONEONEOmost commonly used

Front 18

Most commonly used phenothiazine?

Back 18

haloperidol!!!

Front 19

Who am I?

CNS
Motor activity is decreased.
Sleep pattern is set normal.
Emesis is blocked.(((can use as anti emetic)))
Improve cognitive abilities.

Back 19

Chlorpromazine

Front 20

What does Chlorpromazine do in the CVS?

Back 20

Hypotension, QT interval prolongation and ventricular arrhythmia.

Front 21

the following are the effects of what?

D-2 antagonist – alleviation of positive symptoms and presence of extra pyramidal symptoms ((parkinsonism like features…))
Alpha-1 antagonist – hypotension, sexual dysfunction ---failure of ejaculation ---need contraction alpha one of epidedimys….)))reason PRAZOSIN as drug for HTN has lost its role…
H-1 antagonist – increased appetite
Anticholinergic action – urinary retention and dry mouth

Back 21

Chlorpromazine

Front 22

Who am I?

Anti-psychotics are lipophilic, orally effective.
Haloperidol and Fluphenazine are available as i.m injections (depot) at intervals of 2 - 4 weeks.
No true physical dependence and wide safety margin.

Back 22

PHARMACOKINETICS

Front 23

adverse effects of typical anti-psychotics?

Back 23

CNS : Sedation, drowsiness
ANS : Alpha blocker – hypotension
Anticholinergic – dry mouth
Endocrine : Hyperprolactinemia leading to Amenorrhea – Galactorrhea, Infertility,
Gynecomastia
Weight gain : 5HT-2 blocker and H-1

Extra pyramidal disturbances
Acute dystonia – 4 hours
Akinesia - 4 days
Akathisia - 4 weeks
Tardive dyskinesia – 4 months
(Often irreversible, not seen with Clozapine)

Front 24

Features of Neuroleptic malignant syndrome? NMS

Back 24

FEVER

F - Fever
E - Encephalopathy
V - Vitals unstable
E - Elevated enzymes (elevated CPK)
R - Rigidity of muscles

Front 25

Who am I?

-- block the 5-HT 2 and D2 receptors
-- increase the release of dopamine in mesocortical pathways to prefrontal lobe
-- alleviates negative and positive symptoms
-- less extra pyramidal symptoms

Back 25

Atypical Anti - Psychotics

Front 26

Name the atypical anti-psychotics

Back 26

Clozapine (Clozaril)
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Ziprasidone (Geodon)

Front 27

Who am I?

Potent 5 HT2-A blocker
Weak D2/D4 blocker
Reduce both positive and negative symptoms

Limitation is agranulocytosis, weight gain and seizures.
Requires weekly monitoring for 6 months, then biweekly.
Reserved for drug resistant schizophrenia.
Reserved for patients with tardive dyskinesia.

Back 27

Clozapine

Front 28

Who am I?

Antipsychotic with D-2 and 5–HT 2 receptors antagonist .
It is quantitative atypical anti-psychotic ----- dose of < 6 mg /day
Less sedation and agranulocytosis than clozapine.
Hyperprolactinemia even on low dose.

Back 28

Risperidone

Front 29

Who am I?

Block 5-HT2A, D-2, D-4 receptors
Less prolactin elevation than typical anti-psychotics
Low incidence of EPS and TD
Significant weight gain.

Back 29

Olanzapine

Front 30

Who am I?

Greater 5-HT2A blocker than D-2 / alpha-1
Less prolactin elevation
Low incidence of EPS and anti-muscarinic effects.
Cataracts
Requires monitoring early in treatment and every six months

Back 30

Quetiapine

Front 31

who am i?

5-HT2A and D-2 blocker.
5-HT1A agonist
QT interval prolongation

Back 31

Ziprasidone

Front 32

who am i?

This is the first dopamine stabilizer effective for positive and negative symptoms.
Low risk of EPS, weight gain, hyperprolactinemia
Partial agonist
D2 and 5-HT-1A receptors
Antagonist
5-HT2 receptor

Back 32

Aripiprazole (Abilify)

Front 33

uses of antipsychotics?

Back 33

Schizophrenia
Nausea and Vomiting
Tourette’s syndrome – vocal and motor tics --- Pimozide / haloperidol
Bipolar disorder
Neuroleptanalgesia

Front 34

Typical Anti-psychotics are less prescribed because of _______

Back 34

tardive dyskinesia.

Front 35

_______is used along with anti-psychotics in resistant patients.

Back 35

Lithium

Front 36

______ requires WBC monitoring and does not produce tardive dyskinesia

Back 36

Clozapine