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134 Cards in this Set
- Front
- Back
What are the positive symptoms of schizophrenia? (4)
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disordered thinking
hallucinations delusions uncontrolled behavior |
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What are the negative symptoms of schizophrenia? (3)
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emotional blunting
social withdrawal lack of motivation |
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What characteristic distinguishes paranoid schizophrenia from typical schizophrenia?
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auditory hallucinations
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What genetic factor/predisposition is involved in schizophrenia?
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Neuregulin 1 (identified by gene mapping)
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What does Neuregulin 1 do?
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Regulates NMDA receptors (glutamate)
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True or False - In schizophrenia, there is excessive dopamine signaling
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True
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True or False - In regards to schizophrenia, among older drugs efficacy equals potency at the D2 receptors
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False - Among older drugs, efficacy does NOT equal potency at D2 receptors
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True or False - The schizophrenic brain is devoid of dopamine receptors
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False - High dopamine receptors in the schizophrenic brain
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True or False - There is increased glutamate signaling in schizophrenia
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False - There is reduced glutamate signaling in schizophrenia
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True or False - NMDA receptor agonists induce "schizophrenia-like" symptoms
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False - NMDA receptor ANTagonists induce "schizophrenia-like" symptoms
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Is serotonin signaling increased or decreased in schizophrenia?
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Increased
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True or False - Newer drugs for schizophrenia block 5HT receptors
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True
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True or False - LSD and mescalin are dopamine agonists
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False - LSD and mescalin are hallucinogenic 5HT (serotonin) agonists
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True or False - 5HT signaling regulates dopamine and glutamate signaling
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True
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Which dopamine receptors are Gs coupled? (increase cAMP)
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D1-like receptors
(D1 and D5) |
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Which dopamine receptors are Gi coupled? (decrease cAMP)
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D2, D3, and D4
(D2 is found presynaptically and postsynaptically) |
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Which dopaminergic pathway is involved in mental function, behavior, and mood?
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Mesolimbic-mesocortical pathway
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Which dopaminergic pathway starts in the substantia nigra and innervates the limbic center and cortex?
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Mesolimbic-mesocortical pathway
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Which dopaminergic pathway involves the substantia nigra innervating the caudate putamen (voluntary movement)
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Nigrostriatal pathway
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Which dopaminergic pathway involves the periventricular innervating the hypothalamus and pituitary?
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Tuberoinfundibular system
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The tuberoinfundibular system (dopaminergic pathway) inhibits secretion of what hormone?
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Prolactin
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Which dopaminergic pathway is involved in eating behavior?
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Medullary-periventricular pathway
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Which dopaminergic pathway is involved in motivational behavior?
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Incertohypothalamic pathway
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Which dopaminergic pathway involves vomiting?
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Chemoreceptor trigger zone
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The efficacy of antipsychotics (mental) with regards to dopamine involves D2 blocking what system?
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Mesolimbic system
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The Parkinsonism side effects from antipsychotics involves D2 blocking which dopaminergic pathway?
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Nigrostriatal pathway
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Hyperprolactemia caused by antipsychotics involves D2 blocking what gland?
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Pituitary
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True or False - Newer, effective antipsychotics are not potent D2R antagonists
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True
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What other receptors could be involved in psychosis? (5)
(not including dopamine) |
glutamate*, GABA, acetylcholine, norepinephrine, and serotonin* receptors
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What are the three (3) drug classes for older antipsychotics?
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phenothiazines, thiaxanthenes, butyrophenones
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The phenothiazine antipsychotic drug class includes what three (3) subtypes?
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aliphatic, piperidine, piperazine
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In what class is chlorpromazine?
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Phenothiazine (aliphatic)
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In what class is thioridazine?
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Phenothiazine (piperidine)
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In what class is fluphenazine?
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Phenothiazine (piperazine)
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In what class is trifluoroperazine?
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Phenothiazine (piperazine)
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Which older antipsychotic drug subclasses are low potency?
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aliphatic and piperidine subclasses
(phenothiazines) |
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In what class is thiothixene?
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Thioxanthene
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In what class is haloperidol?
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Butyrophenone
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Which older antipsychotic drug classes/subclasses are high potency?
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piperazine (phenothiazine), thioxanthene, butyrophenone
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Which six (6) drugs are "new"/atypical antipsychotics?
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clozapine, olanzapine, quietapine, risperidone, ziprasidone, aripiprazole
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What receptors does haloperidol antagonize?
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D2 >> alpha1
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Which drugs are NOT 5HT2 antagonists? (2)
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haloperidol, molindone
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True or False - All antipsychotics block alpha1 receptors
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True
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True or False - All antipsychotics block muscarinic receptors
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False - Most block H1, M receptors
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True or False - All antipsychotics block H1 receptors
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False - Most block H1, M receptors
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Which drugs are partial agonists at 5HT1A? (2)
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aripiprazole, ziprasidone
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Which drug is a partial agonist at D2 receptors?
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aripiprazole
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Which antipsychotic is used for D2 antagonist toxicity (has no D2 antagonism)?
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clozapine (no D2 antagonist activity)
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True or False - In antipsychotics, efficacy does NOT correlate with a particular receptor
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True
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True or False - In antipsychotics, toxicity does NOT correlate with receptor activity?
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False
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Which receptor antagonism is responsible for extrapyramidal and endocrine effects?
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D2 blockers
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Which receptor antagonism is responsible for cardiovascular effects?
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alpha1 blockers
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Which receptor antagonism is responsible for a toxic-confusional state?
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antimuscarinics
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Which receptor antagonism is responsible for weight gain?
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H1 antagonism and 5HT blockade
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True or False - Antipsychotics can cause sedation, restlessness, restless legs, and impair psychomotor performance
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True
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True or False - Antipsychotics increase the seizure threshold
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False - Antipsychotics lower seizure threshold (slowing, synchronization of EEG)
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What are some endocrine effects caused by antipsychotics in women? (3 of 4)
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amenorrhea, galactorrhea (lactation), false pregnancy, increase in libido
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What are some endocrine effects caused by antipsychotics in men? (2)
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decreased libido, gynecomastea
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Which drugs have a less pronounced effect of hyperprolactinemia? (3)
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olanzapine, quietapine, aripiprazole
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Antagonism of alpha1 receptors by antipsychotics can result in what cardiovascular effects? (3)
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orthostatic hypotension (chlorpromazine)
high resting pulse abnormal ECG (prolonged QT; thioridazine, ziprasidone) |
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True or False - The primary indication for most antipsychotics is schizophrenia
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True
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Which antipsychotics are used for Tourette's? (2)
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Monlindone (primary indication)
also haloperidol |
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True or False - Efficacy is basically the same on average for antipsychotic drug choice
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True
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True or False - newer drugs are less expensive and are available in injectable formulations
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False - older drugs are less expensive and are available in injectable formulations
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OLD TEST QUESTION
Which antipsychotics are available in injectable formulations? (2) |
fluphenazine, haloperidol
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Newer drugs are more effective in (positive/negative) symptoms
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Negative
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Older, low potency antipsychotics are generally worse with side effects of what receptors?
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alpha1, M
(cardiotoxic, autonomic, sedative side effects) |
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Older, high potency antipsychotics are generally worse with side effects of what receptors?
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D2
(motor control, hyperprolactinemia) |
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Compared to haloperidol, which newer antipsychotics may be better overall?
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clozapine, olanzapine, risperidone
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Which newer antipsychotics are widely used due to low side effect profile compared to clozapine?
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olanzapine, quietapine, risperidone
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Which antipsychotic is typically used last?
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clozapine
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What causes tardive dyskinesia?
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D2 antagonism (and the compensatory response)
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OLD TEST QUESTION
What are two (2) severe side effects caused by clozapine? |
agranulocytosis, seizures
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What can you combine antipsychotics with for combined depression and psychosis?
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TCAs or SSRIs
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What can you combine antipsychotics with for anxiety and insomnia with psychosis?
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Sedatives
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Which antipsychotic can be used as an anti-emetic?
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prochlorperazine
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Dopamine receptors in which part of the brain are inhibited to give anti-emetic effects of antipsychotics?
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Medulla
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True or False - Antipsychotics have anti-itch effects?
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True - H1 antagonists
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True or False - Antipsychotics can be used as pre-operative sedatives?
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True
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Motor control is a balance between what two (2) neurotransmitters?
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dopamine and muscarinics
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Akinesia (loss of movement) comes from blocking what receptors?
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D2 blockade
(responds to anti-Parkinson's drugs) |
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Extrapyramidal effects come from blocking what receptors?
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D2 receptors
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True or False - D2 receptor blockade causes uncontrollable restlessness (akathisia)
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True
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True or False - D2 receptor blockade has not been implicated in acute dystonic reactions
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False - causes muscle spasms, twisting, abnormal posture
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What drug treats adverse effects caused by D2 receptor blockade?
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Amantadine - potentiates dopamine signaling
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Tardive dyskinesia is caused by a relative (dopamine/cholinergic) deficiency
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Cholinergic
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What part of the brain is responsible for abnormal movements mediated by imbalances in cholinergics and dopamine levels?
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Caudate and putamen
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Orthostatic hypotension and impaired ejaculation are caused by blockade of what receptor?
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alpha1
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True or False - Antipsychotics can cause weight gain, hyperglycemia, or hyperprolactinemia
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True
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What kinds of ocular complications can antipsychotics cause? (2)
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corneal/lens deposits
retinal deposits |
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What effect do antipsychotics have on an EKG?
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prolong QT interval
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True or False - Antipsychotics do not have any risk during pregnancy
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False - possibly teratogenic
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Severe Parkinsonism caused by antipsychotics is called what?
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Neuroleptic malignant syndrome (potentially fatal)
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What are two (2) symptoms of neuroleptic malignant syndrome?
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muscle rigidity
impaired sweating (fever) |
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True or False - Antipsychotics have longer clinical duration of action than plasma half-life
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True
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True or False - Antipsychotics do not undergo first-pass metabolism
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False - significant first-pass metabolism
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True or False - Antipsychotics do not cross the BBB
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False - they are lipid soluble and enter the CNS
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What accounts for the long plasma half-life of antipsychotics?
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plasma protein binding
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True or False - Most antipsychotic overdoses are fatal
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False
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Which antipsychotics can have fatal overdoses? (2)
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mesoridazine, thioridazine
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What effects are a result of mesoridazine/thioridazine overdose?
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ventricular arrhythmias, cardiac conduction block, sudden death
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What two neurotransmitters are increased in psychosis?
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dopamine, serotonin
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What two neurotransmitters are increased in bipolar disorder?
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dopamine, norepinephrine
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What is the less severe version of bipolar disorder 1 and 2?
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Cyclothymia
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How many chromosomes is bipolar disorder linked to?
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3
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True or False - Lithium only treats the manic phase of bipolar disorder
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False - Lithium treats both mania and depression
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Which electrolyte MIGHT lithium mimic?
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Na (sodium)
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What neurotransmitters MIGHT lithium enhance the release of? (4)
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serotonin, norepinephrine, dopamine, acetylcholine
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What is the main hypothesis of the lithium mechanism?
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Inhibit phosphodiesterases that recycle inositol phosphates and diminish signaling over time (inositol phosphates are involved in neuronal function)
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What molecule that regulates neuroprotection is inhibited by lithium?
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GSK3
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What is the substrate for the inositol phosphate cycle that lithium depletes?
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PIP2
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True or False - Lithium has a rapid onset of action
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False
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Which antidepressants may precipitate mania when given with lithium in bipolar disorder? (2)
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TCAs, bupropion
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True or False - Antidepressants can be co-administered with lithium during the depressive phase of bipolar disorder
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True
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True or False - Lithium may induce nausea and tremor
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True
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True or False - Lithium is contraindicated in patients with standard depression
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False - Lithium addition significantly improves the effects of TCAs and SSRIs in non-responsive patients
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True or False - Lithium is also indicated in schizophrenia
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False - lithium alone is not effective (add to antipsychotics)
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Which drug classes reduce clearance of lithium?
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diuretics, NSAIDs
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Lithium (increases/decreases) extrapyramidal effects of antipsychotics
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increases
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Clearance of lithium (increases/deceases) during pregnancy and (rises/drops) after delivery
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increases during pregnancy
drops after delivery |
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True or False - Lithium can be transferred through breastmilk
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True
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What side effects are associated with lithium in breastmilk? (3)
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lethargy, cyanosis, poor reflexes
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What effect does lithium have on the thyroid?
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thyroid enlargement, hypothyroidism (rare)
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What effect can lithium have on the kidneys?
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lithium-induced nephrogenic diabetes insipidus
(causes polydipsia and polyuria) |
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True or False - Long-term lithium therapy does not increase the risk for chronic interstitial nephritis
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False - long-term therapy may lead to chronic interstitial nephritis
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True or False - Lithium can cause edema
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True (sodium retention)
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Lithium (increases/decreases) leukocyte count
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increases (can be used in patients with low leukocyte count)
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What is the mechanism of action for valproic acid?
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sodium channel blocker (anti-convulsant)
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OLD TEST QUESTION
Which is more effective in long-term therapy for bipolar disorder? (lithium or valproic acid) |
lithium
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What is the mechanism of action of carbamazepine?
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sodium channel blocker (anti-convulsant)
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True or False - Valproic acid is effective in non-responsive patients
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True
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What is the mechanism of action of lamotrigine?
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sodium channel blocker (anti-convulsant)
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What advantage does lamotrigine have over other alternatives to lithium for bipolar disorder?
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prevents depressive phase following mania
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What other three drugs can be used as an alternative to lithium?
(not valproic acid, carbamazepine, or lamotrigine) |
olanzapine, aripiprazole, clonazepam
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