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134 Cards in this Set

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