Psych Test 1-Schizo

Front 1

Schizophrenia definition.

Back 1

thought disorder dz characterized by episodes

Front 2

5 episodes of schizophrenia.

Back 2

1. bizarre and disorganized thoughts
2. distorted perceptions of reality
3. hallucinations (experience)
4. delusions (belief)
5. altered emotions

Front 3

What is the most common type of hallucination?

Back 3

hearing voices

Front 4

What are the 2 types of delusions?

Back 4

1. paranoid - conspiracy theory
2. grandeur - celebrity or famous person

Front 5

Schizo exhibit ___ and ___ affect.

Back 5

blunted or flat

Front 6

Positive symptoms

Back 6

delusions, hallucinations, inappropriate behavior or effect

Front 7

Positive symptoms are most improved by what gen of antipsychotic?

Back 7

1st gen - D2 antagonist

Front 8

Negative symptoms

Back 8

loss of emotions, inability to carry on a logical conversation (alogia), loss of sociability and ability to derive pleasure, lack of drive (avolition)

Front 9

Which gen of antipsychotic work for negative symptoms?

Back 9

2nd gen - 5HT2A >>D2

Front 10

Cognitive symptoms

Back 10

problems in attention, learning, memory, and executive functions.
disorganized thoughts

Front 11

What are the 4 types of schizophrenia?

Back 11

paranoid
disorganized
catatonic
undifferentiated

Front 12

Age of onset for schizophrenia

Back 12

late teens and early 20's

Front 13

Most deterioration of schizophrenia occurs in the first ___ years.

Back 13

5

Front 14

Explain the stages in life from which neurodevelopmental model was hypothesized?

Back 14

-unknown in utero or early developmental disturbances
-Early life insult --> altered distribution of neurons
-Late adolescence --> defective pruning --> abnormal connectivity
-late adol or early adult --> glu hypothesis --> excessive pruning --> genes controlling NMDA receptors

Front 15

When do neurological abnormalities exist in schizophrenia? (neurodevelopmental model)

Back 15

before onset of acute psychotic symptoms

Front 16

If both parents have schizo, what is the % that the child will have it?

Back 16

40%

Front 17

What is the % of risk for schizo in the general pop.?

Back 17

1%

Front 18

Dopamine hypothesis

Back 18

dopamine hyperactivity - blockade showed parkinsonism

Front 19

Dopamine reuptake blockers (2)

Back 19

cocaine and amphetamine

Front 20

Dopamine receptor agonists

Back 20

apomorphine

Front 21

What is the correlation of the dissociation constant in schizo?

Back 21

binding to D2 receptors and therapeutic concentration of drug

Front 22

Where is the origin of dopamine?

Back 22

ventral tegmentum of the brain stem (VTA)

Front 23

Mesolimbic have a role in what type of symptoms?

Back 23

positive and disorganized behavior

Front 24

Mesocortical have a role in what type of symptoms?

Back 24

negative: frontal dopaminergic hypofunctionality

Front 25

When are positive effects of antipsychotic seen?

Back 25

3-8 weeks; adaptive response

Front 26

Acute antipsychotic drug effect

Back 26

1. dec in postsynap receptor fxn
2. compensatory inc in DA firing due to blockade
3. net effect = no change in DA recep fxn

Front 27

Chronic antipsychotic drug effect

Back 27

1. continual post- blockade causes pre- to have depolarization blockade
2. cells become less responsive to other cells
3. net effect = presynap adaptation leads to downregulation of DA synapse

Front 28

Which pathway causes increased prolactin and gynecomastia?

Back 28

tuberoinfindibular

Front 29

Which pathway causes EPS and Parkinsonian sx?

Back 29

nigrostriatal

Front 30

What is the serotonin hypothesis?

Back 30

5HT2A agonist like LSD induces hallucination
-deficiency in recep results from inc 5HT activity

Front 31

What is the glutamate hypothesis?

Back 31

NMDA receptor antagonists like PCP and ketamine can induce psychosis
-defects in glu development can lead to schizo

Front 32

What is the relationship btw glu and da system?

Back 32

hypoactivity of glu can lead to hyperactivity of da

-normally, glu inhibits da activity in limbic system

Front 33

Which FGA has the aliphatic side chain?

Back 33

chlorpromazine & thioridazine

Front 34

Which FGA has the piperazine side chain?

Back 34

fluphenazine

Front 35

T/F. Chlorpromazine has higher potency.

Back 35

False - fluphenazine & thiothixene has higher potency

Front 36

Chlorpromazine and fluphenazine are ___ derivatives.

Back 36

phenothiazine

Front 37

Which has higher sedative properties? Chlorpromazine vs. fluphenazine.

Back 37

Chlorpromazine

Front 38

Why do you give chlorpromazine (and thioridazine) in high doses?

Back 38

high 1st pass metab = low bioavailability

Front 39

Thioridazine blocks ___ channels thus leading to what side effects?

Back 39

K; arrhythmias, cardiac death, QT prolongation

Front 40

Which FGA is dosed lower? Why?

Back 40

thiothixene; higher potency

Front 41

Phenothiazines w/ piperazine side chains have reduced ___, ___, and ___ side effects.

Back 41

sedation, anticholinergic, and hypotensive

Front 42

Phenothiazines w/ piperazine side chain drugs

Back 42

fluphenazine, trifluperazine, perphenazine

Front 43

FGA w/ piperazine side chains are metabolized by which P450?

Back 43

2D6

Front 44

FGA w/ piperazine side chains can be administered as ____. Why is this important?

Back 44

decanoates; t1/2 of 14 days; used in chronic therapy

Front 45

Which FGA are butyrophenone derivatives?

Back 45

haloperidol & pimozide

Front 46

Haloperidol has high potency for ___ and ___ side effects but low ___, ___, and ___ side effects.

Back 46

-EPS & prolactin
-sedative, anticholinergic, & hypotensive

Front 47

What is the half life of haloperidol vs. pimozide?

Back 47

H: 12-36 hrs
P: 55 hrs

Front 48

In acute antipsychotic effect, the DA neurotransmission is said to be ___.

Back 48

blunted

Front 49

In chronic antipsychotic effect, the DA neurotransmission is said to be ___.

Back 49

decreased

Front 50

EPS is a result of reduced ___.

Back 50

GABA

Front 51

Hypothalamic ___ inhibits release of ___ from pituitary. What are the side effects?

Back 51

dopaminergic - hypothalamus
prolactin - pituitary
-ammenorrhea & galactorrhea
-male infertility & gynecomastia

Front 52

DA excite the ___ ___ area which results in ___.

Back 52

Area Postrema; emesis
-D2 recep antag has antiemesis effects

Front 53

4 types of EPS sx.

Back 53

1. pseudoparkinsonism
2. dystonia
3. akathesia
4. tardive dyskinesia

Front 54

D2 receptor antag can develop ___ against ___ & ___.

Back 54

tolerance; sedation & hypotension

Front 55

T/F. Classical antipsychotic have a higher threshold for seizures.

Back 55

False - lower (do not combine w/ similar drugs e.g. meperidine)

Front 56

Classical antipsychotic are lipophilic agents that have high ___, ___, and ___ (i.e. readily crosses BBB).

Back 56

first pass metab, plasma protein binding, uptake and binding in tissues

Front 57

Classical antipsychotic elimination is usually by metabolism. What type of reactions?

Back 57

hydroxylation & glucuronidation

Front 58

Which P450 enzymes are affected by classical antipsychotics?

Back 58

3A4, 2D6, 1A2

-smokers eliminate more rapidly

Front 59

Which EPS sx is disabling and often irreversible?

Back 59

tardive dyskinesia

Front 60

Receptor occupancy % for antipsychotic effects? EPS effects?

Back 60

A: 65-70
E: >80

Front 61

SGA have no ___ or ___ side effects

Back 61

EPS (&tardive dyskinesia) or hyperprolactinemia

Front 62

Clozapine is effective against which dopamine receptors?

Back 62

D2 & D4

Front 63

What is a side effect that should be monitored w/ clozapine?

Back 63

agranulocytosis

Front 64

Which SGA is also useful for bipolar?

Back 64

olanzapine

Front 65

Olanzapine is similar to clonzapine except it has a lower incidence of what?

Back 65

agranulocytosis

Front 66

Which SGA has 10x affinity to D2 but no affinity for muscarinic recep?

Back 66

Risperidone

Front 67

What is the active metabolite of risperidone?

Back 67

paliperidone

Front 68

What P450 is risperidone metabolized by?

Back 68

2D6 (polymorphism!)

Front 69

Which SGA has high prolactin side effects unlike the others in its class?

Back 69

risperidone

Front 70

Which SGA has less weight gain potential?

Back 70

quetiapine

Front 71

Which SGA has a parenteral formulation available?

Back 71

ziprasidone

Front 72

Which SGAs have QT prolongation side effect?

Back 72

olanzapine, risperidone, ziprasidone, and quetiapine

Front 73

What are the main ADRs of olanz, risper, zipra, quetia?

Back 73

sedation, inc appetite, wt gain, metabolic syndrome, QT prolongation

Front 74

Aripiprazole is a partial agonist for ___ and ___ receptors; full antagonist for ___ receptor. Half life?

Back 74

D2, 5HT1A; 5HT2A
-75 hrs

Front 75

In schizo, what part of the brain have normal DA levels?

Back 75

striatum & pituitary

Front 76

What do D2 partial antag/agonist do in areas of the brain w/ D2 overstimulation vs. those that are normal?

Back 76

OS: block overstimulation and stimulate same receptors (partial 40% vs. 100%)
N: block effects of DA and stimulate same receptors (40%)

Goal: reduce dopaminergic activity, not shut down

Front 77

Half life of quetiapine, ziprasidone, and aripiprazole?

Back 77

Q & Z: 5-10
A: 75-94 hrs

Front 78

Which SGA comes in a SL tablet for schizo & bipolar for adults?

Back 78

asenapine (Saphris)

Front 79

Which drug has increased risk w/ elderly patients?

Back 79

asenapine --> inc risk of death