Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
45 Cards in this Set
- Front
- Back
|
Which NT receptor is the target for antipsychotics?
|
D2 receptor
|
|
|
The dopamine hypothesis:
Which pathway is targeted for positive symtoms of schizophrenia? |
mesolimbic
|
|
|
The dopamine hypothesis:
Which pathway mediates the negative symptoms of schizophrenia? |
mesocortical
|
|
|
The dopamine hypothesis:
Which pathway mediates the extrapyramidal symptoms(EPS)? |
nigrostriatal
|
|
|
The dopamine hypothesis:
Which pathway mediates the inhibition of prolactin release? |
tuberoinfundibular (endocrine)
|
|
|
Which of the following pathways is the principle target of antipsychotic medication?
- mesolimbic - mesocortical - nigrostriatal - tuberoinfundibular |
mesolimbic
|
|
|
T/F: There is a very narrow margin between therpeutic level and those associated with side effects for 1st generation antipsychotics.
|
T. (65%-72% receptor occupation)
|
|
|
These are features of which class of drugs?
- efficacy for treating psychosis. - lower propensity for neurological side effects. - metabolic side effects: eg. weight gain, hyperglycemia, hyperlipidemia. |
atypical antipsychotics
- clozapine - risperidone - olanzapine - quetiapine - ziprasidone - aripiprazone - paliperidone |
|
|
What acconts for atypical psychotics' low propensity for neurological side effects?
|
5HT2A antagonism: increases DA release, overcomes the D2 blockade in mesocortical, nigrostriatal, and tuberoinfundibulat pathways.
|
|
|
Which of the following atypical antipsychotics has the weakest D2 binding affinity?
- clozapine - risperidone - olanzapine - quetiapine - ziprasidone - aripiprazone - paliperidone |
clozapine
|
|
|
T/F: Clozapine does not reduce suicidality and substance abuse in schizophrenics.
|
F.
|
|
|
Name two atypical antipsychotics that dissociate fast from D2 receptors.
|
- clozapine
- quetiapine |
|
|
Name the partial DA agonist which is also called the DA stabilizer.
|
aripiprazole: high affinity and some intrinsic activity.
|
|
|
Why is there a couple-week delay in response to antipsychotics?
|
chronic receptor blockade is needed to lead to intracellular cascade of events which then lead to transcription changes.
|
|
|
T/F: Early intervention reduces long-term severity and chronicity in schizophrenia, slows neurodegenerative changes.
|
T.
|
|
|
T/F: Atypical antipsychotics are only used in schizophrenia.
|
F. It is useful in reducing psychotic symptoms relgradless of underlying cause.
ex: - primary psychotic disorders - demetia - delirium - general medical etiologies - drug intoxication |
|
|
Which atypical antipsychotic is not useful in schizophrenia?
|
pimozide: for tic disorder
|
|
|
Which atypical antipsychotic is FDA-approved for reducing risk of suicidal behavior in schizophrenic/schizoaffective disorder?
|
clozapine
|
|
|
Which atypical antipsychotic is FDA-approved for agitation associated with schizophrenia/bipolar disorder?
|
olanzapine
ziprasidone |
|
|
Which atypical antipsychotic is FDA-approved for bipolar mania?
|
all
|
|
|
Which atypical antipsychotic is FDA-approved for maintenance treatment for bipolar disorder?
|
olanzapine
aripiprazole |
|
|
Which atypical antipsychotic is FDA-approved for augmentation in unipolar and nonpsychotic depression?
|
aripiprazole
|
|
|
Which atypical antipsychotic is FDA-approved for tic disorders?
|
pimozide
|
|
|
What are some general areas of side effects of atypical antipsychotics?
|
major:
- metabolic - CV conduction delay - death(elderly) minor - EPS - tardive syndromes - endocrine - NMS |
|
|
What are some general areas of side effects of 1st generation antipsychotics?
|
major
- EPS - tardive syndromes - endocrine - NMS minor - metabolic |
|
|
What are some acute EPS in response to 1st generation antipsychotics?
|
- dystonia
- parkinsonism - akathisia (most common) |
|
|
What is the most common EPS associated with 1st generation antipsychotics?
|
akathisia
|
|
|
How to treat dystonia associated with taking 1st generation antipsychotics?
|
anticholinergic drugs
|
|
|
Couple days after taking 1st generation antipsychotics, patient A report feeling unable to relax, impulsive feeling. Your observation leads you to think she has hyperactive motor behaviors.
What is the name of this symptom? Which drug can you used to treat it? |
This is akathisia: motor restlessness.
Should switch to betablockers or anticholinergics. |
|
|
Couple days after taking 1st generation antipsychotics, the elderly patient developed muscle regidity, tremor(resting), bradykinesia, and flattened affect.
What is the name of this symptom? Which drug can you used to treat it? |
This is parkinsonism.
Should switch to anticholinergic amantadine. |
|
|
Couple days after taking 1st generation antipsychotics, the 24 y/o patient developed muscle spasms, especially in the back and neck region, some in his eyes.
What is the name of this symptom? Which drug can you used to treat it? |
This is dystonia.
Should treat with anticholinergics. |
|
|
An elderly women has started on 1st generation antipsychotics recently.
What side effects might she experience early? What side effects might she experience a year later? What class drug may prevent the late side effects? |
- early: ETS (dystonia, parkinsonism, akathisia)
- later: tardive syndrome (dyskinesia, akathisia, dystonia) - atypical antipsychotics have low risk of develop tardive syndrome: risperidone, aripiprazole, olanzapine, ziprasidone. |
|
|
Which 4 of the following atypical antipsychotics has low risk of TD side effects?
- clozapine - risperidone - olanzapine - quetiapine - ziprasidone - aripiprazone - paliperidone |
- risperidone
- aripiprazole - olanzapine - ziprasodone |
|
|
How to treat TD related to taking 1st generation antipsychotics?
|
- antioxidant (vit E)
- cholinergic drugs - naltrexone/clonazepam combo - high dose branced chain AA - melatonine - vit B6 - botox |
|
|
A controlled psychotic women comes in complaining about breast swelling and tenderness, sexual inhibitions. What is this symptom called? What is this caused by?
|
This is galactorrhea: caused by hyperprolactinemia related to taking 1st generation antipsychotics.
|
|
|
After taking 1st generation antipsychotics, the patient developed rigidity, hyperpyrexia, dysautonomia, and mental status change. Lab also shows increased CK and WBC.
What is this symptom called? How to treat it? |
This is neuroleptic malignant syndrome (NMS).
Treatment: supportive, dantrolene, bromocriptine, ECT. |
|
|
What are the 4 "black box" warnings of clozapine?
|
- agranulocytosis
- seizures - myocarditis - orthostatic hypotension/respiratory depression (esp if coadminstered with benzo) |
|
|
What would you recommend athletic patient taking antipsychotics?
|
aggressive fluid replacement
shade cooling breaks * to prevent heat-induced syndrome (heat exhaustion, heat stroke) because body's normal heat dissipation mechanism is impaired when taking any kind of antipsychotics. |
|
|
What are some antipsychotic drug interactions?
|
- drugs that alter P450: phenytoin, phenobarbitol induce it.
- antacid: retard absorption |
|
|
T/F: Antipsychotics can readily cross into placental circulation and breat milk.
|
T.
|
|
|
Which drug is used initially for schizophrenia? And what is used subsequently?
|
- atypical antipsychotics initially
- 2nd or 3r atypical |
|
|
Which drug is used to persistant resistance to treatment?
|
clozapine
|
|
|
Which two of the following teach schizophrenic pateints instrumental skills of daily living through formal teaching, role-playing, and supervised social settings?
- psychosocial intervention - family intervention - cognitive rehabilitation - social skills traning - psychosocial rehabilitation |
- social skills traning
- psychosocial rehabilitation |
|
|
What communication types will aggrevate schizophrenic symptoms?
|
highly expressed emotions:
- overt criticism - hostility - emotional overinvolvement |
|
|
What is assertive community treatment (ACT)?
|
multiple visit per day to patient home to build practical skills, teaches patient to negotiate the challenges in the community, etc.
|
