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53 Cards in this Set
- Front
- Back
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What is the most common hallucination in schizophrenia?
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Auditory
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What is the basis of the dopaminergic hypothesis of paranoid schizophrenia?
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DA mimicking drugs such as amphetamine, cocaine, and bromocriptine can produce symptoms of paranoid schizophrenia and it can be blocked using AP agents.
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What is the very general MOA of AP in the forebrain?
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DA (D2) receptor antagonist
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What is the predominant catcholamine found in the brain? (DA, NE, E?)
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DA
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What are the three classes of DA neurons?
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Ultra-Short, Intermediate, and Long
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Where are ultra-short DA neurons found?
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In the olfactory bulb
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Where are intermediate DA neurons found?
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Ventral hypothalamus, pitutary
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Where are long projection DA neurons found?
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Substantia nigra, ventral tementum
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What explains the different pharmalogical profiles of the different classes of AP drugs?
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Differential distribution of DA receptor subtypes
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Where are D3 and D4 receptors primarily found? Significance of these receptors?
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The Limbic system...responsible for the most important role in the AP actions of the drugs
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Where are D2 receptors primarily found? What is the significance of D2 receptors?
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Striatum, SNpc, and pituitary. They are responsible for the side effects, particulary parkinsonism.
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What is Neuroleptic syndrome?
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A decrease in spontaneous movements and complex behavior with preservation of reflexes
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What are the acute side effects of high potency 1st generation APs?
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Acute extrapyramidal SEs
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What are the side effects of low potency 1st generation APs?
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Sedation, Hypotention, and autonomic SEs
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What are the side effects of 2nd generation APs?
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Limited extrapyrimidal SEs, WEIGHT GAIN.
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How quickly does tolerance build to the AP effects of the 2nd generation APs?
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It doesn't
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What kind of AP would you use in someone with a cognitive disorder (delirium, dementia)?
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High Potency 1st generation or 2nd generation
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Haloperidol: Class?
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High Potency 1st generation AP
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Fluphenazine: Class?
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High Potency 1st gen
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Chlorpromazine: Class?
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Low Potency 1st Gen
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Thioridazine: Class?
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Low Potency 1st Gen
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Clozapine: Class?
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2nd Generation AP
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Risperidone: Class?
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2nd Generation AP
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Why do you think there are fewer extrapyrimidal SEs with the 2nd generations?
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They have a higher affinity for D3 and D4 receptors and a lower for D2
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Quetiapine: Class?
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2nd Generation AP
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Olanzapine: Class?
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2nd Generation AP
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Risperidone: MOA? Higher affinity for which receptors?
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Binds 5-HT1>D2, also H1, a1, M1. Selective for limbic sites because of D3 localization
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Clozapine: MOA? Higher affinity for which receptors?
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Binds 5-HT1>D2, D3,4>D2, also H1, a1, M1. Selective for limbic sites because of D3 localization
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Quentiapine: MOA? Higher affinity for which receptors?
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5-HT2>D2; also H1, a1, a2
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Olanzapine: MOA? Higher affinity for which receptors?
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D1, 2, and 4; 5-HT2, 3; H1, a1, M1
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What is an undesirable SE of 2nd generation APs in teens and young adults (esp. girls) that interfere with compliance?
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Weight Gain and hyperglycemia
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Which 2nd generation AP would you give in someone concerned with weight gain?
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Quetiapine
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Ziprasidone: Class?
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2nd Generation AP
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Ziprasidone: MOA?
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Potent 5-HT2A antagonist, with higher affinity for 5-HT2 receptors than D2 receptors. Also affinity for 5-HT1A, 1D, 2C.
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Antagonistic action against which receptor may limit the EPS associated with DA receptor blockade and diminish the negative symptoms in schizophrenia. Which drug(s) accomplishes this?
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5-HT2A, Ziprasidone
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What property of Ziprasidone makes it ideal for elderly pts with cognitive disabilities?
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Weak anticholinergic activitiy...low potential for impairing cognitive abilities.
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Arpipiprazole: Class?
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Atypical AP
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Aripiprazole: MOA?
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partial agonist of D2 and 5-HT1A.
Antagonist of 5-HT2A |
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What drug is approved for Tx of acute manic and mixed episodes associated with bipolar disorder?
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Ariripiprazole
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Name as many extrapyramidal SEs as you can (there are 6)
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Dystonias
Akathisia Iatrogenic Parkinsonism Neuroleptic Malignant syndrome Perioral tremor Tarditive dyskinesia |
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What are dystonias? Does tolerance develop?
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Maintenance of an abnormal posture. You can sometimes "sculpt" these people. Yes
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What is akathisia? Does tolerance develop?
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Subjective feeling of restlessness. No
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What is Iatrogenic Parkinsonism? Does tolerance develop?
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Duh. May not develop
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What drugs would you NOT use in the treatment of iatrogenic parkinsonism due to AP Rx?
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Levodopa and bromocriptine, as they worsen the psychotic symptoms
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What is Neuroleptic Malignant syndrome?
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Very severe form of parkinsonism with catatonia, tremor, autonomic instability, stupor, elevated creatine, elevated myoglobin. High mortality.
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What should be used to Tx Neuroleptic Malignant syndrome?
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Dantrolene or bromocriptine
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What is Tardive Dyskinesia?
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Repetitive, painless, involuntary, quick, choreiform movements of the face, eyelids, mouth, tongue, extremities, or trunk.
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What can be used to tx tardive dyskinesia?
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Reserpine
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He flew through "other SEs" in class, so I didn't cover them here
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OK
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Which AP drug exhibits the most antimuscarinic SEs? The least?
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chlorpromazine. Haloperidol
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What is the order for potency of APs for producing antiadrenergic side effects?
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Same as anitmusc.: chlorpromazine>risperidone>
haloperidol |
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Which AP drugs are the most potent antihistaminergic?
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Clozapine>chlorpromazine
>>haloperidol=risperidone |
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Which class of AP drugs causes Jaundice/
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Low potency 1st gen
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