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49 Cards in this Set
- Front
- Back
- 3rd side (hint)
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According to the DA hypothesis of schizophrenia, symptoms arise due to an excess or lack of DA in the CNS
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Excess
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None
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What characterizes the positive symptoms of schizophrenia
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Hallucinations
Delusions Thought disorders |
None
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What characterizes the negative symptoms of schizophrenia
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Flat affect
Amotivation Social withdrawal Speech disorders |
None
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What is the mechanism of action of “typical” antipsychotic agents
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Inhibition of D2 receptors in the mesolimbic system of the brain
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What is the mechanism of action of “atypical” antipsychotic agents
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Inhibition of 5-HT2 receptors (D2 receptors are still involved to some extent)
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Give examples of typical antipsychotics
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Chlorpromazine
Haloperidol Thioridazine Fluphenazine Pimozide |
None
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Give examples of atypical antipsychotics
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Clozapine
Risperidone Olanzapine Ziprasidone Quetiapine Aripiprazole |
None
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Of the typical antipsychotics, which are considered “low potency” in that effective doses are in the 100s of milligrams
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Chlorpromazine
Thioridazine |
None
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Of the typical antipsychotics, which are considered “high potency” in that effective doses are in the 10s to 50s of milligrams
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Haloperidol
Fluphenazine |
None
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Which of the typical antipsychotics are considered phenothiazines
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Chlorpromazine
Fluphenazine Thioridazine |
None
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Which typical antipsychotic is considered a butyrophenone
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Haloperidol
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Give an example of a butyrophenone that is commonly used as an antiemetic and is added to fentanyl and nitrous oxide to produce neuroleptic anesthesia
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Droperidol
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None
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Name two typical antipsychotics commonly used in the treatment of Tourette syndrome
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Haloperidol
Pinozide |
None
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What are the extrapyramidal symptoms (EPS)
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Parkinsonian-like symptoms (dystonia, rigidity, tremor, and bradykinesia)
Akathisia Tardive dyskinesia (TD) |
None
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What is akathisia
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Motor restlessness
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None
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What is tardive dyskinesia (TD)
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Inappropriate movements of the tongue, neck, trunk, and limbs (associated with long-term use of DA antagonists)
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What is the mechanism of anti-psychotic-induced TD
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Long-term DA receptor inhibition leads to an upregulation and supersensitivity of DA receptors thereby leading to DA overstimulation, especially when the antipsychotic has been discontinued
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Which antipsychotics are more likely to cause EPS
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High potency typical antipsychotics secondary to weak anticholinergic activity (haloperidol and fluphenazine)
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Which typical antipsychotics cause the least amount of EPS
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Chlorpromazine
Thioridazine |
None
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Why do chlorpromazine and thioridazine have a low EPS potential
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High anticholinergic activity
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None
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What medications are used to treat anti-psychotic-induced EPS
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Benztropine
Amantadine Diphenhydramine (due to its anticholinergic action) |
None
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How do antipsychotics cause parkinsonian-like symptoms
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Inhibition of DA receptors in the nigrostriatal pathway
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How do antipsychotics prevent emesis
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Inhibition of DA receptors in the CTZ
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Where is the CTZ located
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Medulla
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How do antipsychotics cause orthostatic hypotension
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Inhibition of α-adrenergic receptors in the vasculature
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How do antipsychotics cause prolactinemia
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Inhibtion of DA receptors in the anterior pituitary
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Which two antipsychotics possess the highest antimuscarinic activity
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Chlorpromazine
Thioridazine |
None
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Characterize the antimuscarinic activity of chlorpromazine and thioridazine
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Xerostomia
Blurred vision Confusion Constipation Urinary retention |
None
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What is xerostomia
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Dry mouth
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Which antipsychotic agents are more effective at treating negative symptoms
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Atypical antipsychotics
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Which phenothiazine medication is commonly used as an antiemetic and rarely as an antipsychotic
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Prochlorperazine
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Which phenothiazine antipsychotic is also used to treat intractable hiccups
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Chlorpromazine
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Which phenothiazine antipsychotic may cause priapism, agranulocytosis, blue-gray discoloration of the skin, and lower seizure threshold
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Thioridazine
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Which two typical antipsychotics can be formulated as depot intramuscular injections that may last up to 3 weeks
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Haloperidol
Fluphenazine |
None
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Which atypical antipsychotic is usually reserved as a third-line agent to treat schizophrenic patients refractory to traditional therapy
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Clozapine
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What is the major dose-limiting side effect of clozapine
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Agranulocytosis
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How are patients receiving clozapine therapy monitored
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WBCs obtained at baseline and weekly for the first 6 months of therapy, every other week for the second 6 months, and monthly thereafter
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What adverse effect is more common with clozapine, agranulocytosis or seizures
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Seizures (occur in 10% of patients, whereas agranulocytosis occurs in 1 to 2% of patients)
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Why is gynecomastia a common adverse effect of risperidone
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Risperidone-induced prolactinemia (only atypical antipsychotic that increases prolactin levels significantly)
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What is a potential life-threatening adverse effect of antipsychotic medications
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Neuroleptic malignant syndrome (NMS)
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What characterizes NMS
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Cardiovascular instability
Hyperthermia Altered mental status Rigidity |
None
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What is the treatment for NMS
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Dantrolene + Bromocriptine (DA agonist)
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In addition to blocking 5-HT2 receptors, which DA receptor subtype does clozapine strongly antagonize
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D4 receptor subtype
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What are the additional adverse effects of olanzapine
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Weight gain
Hyperglycemia Sialorrhea |
None
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What are the additional adverse effects of ziprasidone
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QTc prolongation; Priapism
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None
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What are the additional adverse effects of quetiapine
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Hypercholesterolemia
Hypertriglyceridemia Hepatotoxicity Weight gain |
None
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What is the mechanism of action of aripiprazole
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Antagonist at 5-HT2a receptors; Partial agonist at D2 and 5-HT1a receptors
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What are the additional adverse effects of aripiprazole
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Weight gain
Hepatotoxicity Rash Sialorrhea |
None
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Which antipsychotic has the highest incidence of sialorrhea
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Clozapine (31 to 48%)
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