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49 Cards in this Set

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According to the DA hypothesis of schizophrenia, symptoms arise due to an excess or lack of DA in the CNS
Excess
None
What characterizes the positive symptoms of schizophrenia
Hallucinations
Delusions
Thought disorders
None
What characterizes the negative symptoms of schizophrenia
Flat affect
Amotivation
Social withdrawal
Speech disorders
None
What is the mechanism of action of “typical” antipsychotic agents
Inhibition of D2 receptors in the mesolimbic system of the brain
What is the mechanism of action of “atypical” antipsychotic agents
Inhibition of 5-HT2 receptors (D2 receptors are still involved to some extent)
Give examples of typical antipsychotics
Chlorpromazine
Haloperidol
Thioridazine
Fluphenazine
Pimozide
None
Give examples of atypical antipsychotics
Clozapine
Risperidone
Olanzapine
Ziprasidone
Quetiapine

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