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Antipsychotic Drugs Study this set online at: http://www.cram.com/flashcards/935151 What are the functions impaired in

Antipsychotic Drugs

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What are the functions impaired in Psychosis?

What is Schizophrenia?

the functions impaired in Psychosis? What is Schizophrenia? What are POSITIVE Symptoms of Schizophrenia? A dimunition

What are POSITIVE Symptoms of Schizophrenia?

A dimunition or loss of normal functions in Schizophrenia is termed?

A dimunition or loss of normal functions in Schizophrenia is termed?

Mental capacity Affective response Capacity to recognize reality Communication Relating to others

Breakdown of integration between Emotions Thought Actions

Positive symptoms -An EXCESS of normal functions

Delusion Thought disorder Perceptual disturbances Incongruous mood Increased motor function

NEGATIVE Symptoms

Poverty of Speech Loss of emotional responsiveness Reduced motor function Social withdrawal

Antipsychotic Drugs Study this set online at: http://www.cram.com/flashcards/935151 What is the biological basis of the

Antipsychotic Drugs

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What is the biological basis of the Positive symptoms in Schizophrenia?

What evidence supports this Dopaminergic activity in Schiz?

What evidence supports this Dopaminergic activity in Schiz?

Which 2 drugs can cause a Paranoid psychosis indistinguishable from Schiz?

Which receptor does Antipsychotics block?

Overactivity of DOPAMINE neurons in - MESO-LIMBIC Dopamine Pathway

Drugs that Increase Dopaminergic Activity - Increase or Produce Positive psychotic symptoms

Drugs that Decrease Dopaminergic Activity - Decrease or Stop Positive symptoms

Amphetamines and Cocaine If given repeatedly

D2 recptors

Antipsychotic Drugs Study this set online at: http://www.cram.com/flashcards/935151 Mesolimbic NIgrostriatal Mesocortical

Antipsychotic Drugs

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Mesolimbic

NIgrostriatal

Mesocortical

Tuberoinfundibular

Name the 4 well defined Dopamine pathways in the brain

The Mesolimbic Pathway involves

?

It projects from the Brainstem to the Limbic area

Controls BEHAVIOUR

Overactivity of the Mesolimbic pathway produces

?

Delusions

Hallucinations

These symptoms are decreased when the Mesolimbic pathway is shut down by blocking Post synaptic dopamine receptors (hypothesized)

The Nigrostriatal Pathway projects from

?

the Substantia Nigra to the Corpus Striatum

Controls MOVEMENT

Antipsychotic Drugs Study this set online at: http://www.cram.com/flashcards/935151 Blocking the dopamine receptors in the

Antipsychotic Drugs

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Blocking the dopamine receptors in the Nigrostriatal Pathway causes?

How are the side effects of blocking post synaptic dopamine receptors in the Nigrostriatal Pathway caused?

How are the side effects of blocking post synaptic dopamine receptors in the Nigrostriatal Pathway caused?

How is the Mesocortical Pathway involved in Schiz?

How does Classical or Typical antipsychotics affect the Mesocortical Pathway?

How does Classical or Typical antipsychotics affect the Mesocortical Pathway?

Disorders of movement like those in Parkinson's disease

The Nigrostriatal Pathway projects to the Basal Ganglia which forms part of the Extrapyramidal nueronal system of the CNS

Side effects are called EXTRA PYRAMIDAL symptoms - a set of movement disorders

It may be involved in mediating Positive and perharps Negative symptoms

Blockade of dopamine receptors in the pathway They produce Blunting of emotions and various Cognitive side effects

They are not useful for negative symptoms

Antipsychotic Drugs Study this set online at: http://www.cram.com/flashcards/935151 When dopamine receptors are blocked

Antipsychotic Drugs

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When dopamine receptors are blocked They cause Prolactin levels to rise - Galactorrhea

Dopamine released from neurons in this pathway INHIBITS Prolactin secretion

How does blockade of dopamine receptors affect the Tuberoinfundibular pathway?

What are the other names for antipsychotic drugs?

NEUROLEPTIC

drugs

MAJOR

TRANQUILIZERS

List the Classical or Typical antipsychotics.

Chlopromazine

Fluphenazine

Haloperidol

Thioridazine

Thiothixene

Two famous drugs are Chlopromazine and Haloperidol

List the Atypical antipsychotics

Clozapine

Risperidone

Olanzapine

Quetiopine

Ziprasidone

Aripiprazole

Paliperidone

Antipsychotic Drugs Study this set online at: http://www.cram.com/flashcards/935151 What is the efficacy of Classical

Antipsychotic Drugs

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What is the efficacy of Classical antiphych. drugs related to?

The efficacy is closely related to their ability to block D2 receptors in - Mesolimbic pathway

How are the Atypical antiphych. drugs

different to Classical

They have Higher affinities for other receptors particularly 5-HT than D2

They appear to exert part of their action by blocking 5-HT receptors

?

They are MUCH less likely to cause Extrapyramidal symptoms

Clozapine an atypical antiphych. drugs has a high affinity for which receptors?

D1, D4, 5HT2, M, Alpha adrenergic

But it also blocks D2

Risperidone blocks which recptor to a greater extent than

D2?

5HT2

Unlike Clozipine it can cause EPS but this is rare at normal therapeutic doses

Antipsychotic Drugs Study this set online at: http://www.cram.com/flashcards/935151 Most of the Atypicals have High

Antipsychotic Drugs

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Most of the Atypicals have High affinity for which 5-HT receptors?

List the differences of Clozapine from Typical antipsychotic agents.

What is the minimal definition for an Atypical antipsychotic?

What is the minimal definition for an Atypical antipsychotic?

What effect does Classical antipsych. have on the Mesolimbic and Nigrostriatal system?

'5-HT2A'

*Minimal. if any, Extrapyramidal Symptoms (EPS) *Essentially, NO Tardive dyskinesia *Minimal Increases in Prolactin *Negative symptom efficacy *Efficacy in treatment of refractory populations

*Dual antagonism of Serotonin 5-HT2A and Dopamine D2 receptors

*Reduced propensity for EPS

D2 blockade of the Mesolimbic - Relieves the Positive symptoms of Schizophrenia but D2 blockade of the Nigrostriatal system causes Extrapyramidal side effects

Antipsychotic Drugs Study this set online at: http://www.cram.com/flashcards/935151 How does SDAs (serotonin-dopamine

Antipsychotic Drugs

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How does SDAs (serotonin-dopamine antagonists) affect the Mesolimbic and Nigrostriatal system?

How does SDAs (serotonin-dopamine antagonists) affect the Mesolimbic and Nigrostriatal system?

How does the Competitive Antagonism at Pre synaptic 5- HT2 receptors in the Nigrostriatal pathway assist in reducing the EPS effects by SDAs?

Antagonism at Pre synaptic 5- HT2 receptors in the Nigrostriatal pathway assist in reducing the EPS
Antagonism at Pre synaptic 5- HT2 receptors in the Nigrostriatal pathway assist in reducing the EPS

What are the 2 major actions of antipsychotics?

What are the 2 major actions of antipsychotics?
What are the 2 major actions of antipsychotics?

What are the Extra pyramidal effects associated with?

What are the Extra pyramidal effects associated with?

D2 blockade of the Mesolimbic -Relieves the Positive symptoms of Schizophrenia (same as classical) however

They are Competitive Antagonists at Pre synaptic 5HT2 receptors in the Nigrostriatal pathway

5-HT2 receptors function like alpha 2 receptos on presyaptic neurons

They inhibit the release of Dopamine when acted on by Serotonin but SDAs block this inhibition and so Dopamine is released

This decreases the Dopamine blockade and prevents the EPS

*Antipsychotics (as the name suggests) -they reduce halucination and agitation they have a calming effect

*Antiemetics -mediated by blockade of D2 at the chemoreceptor trigger zone (most older antpsychotics hve this effect)

Many also block Muscarinic, alpha 1 adrenergic, and H1 receptors this causes a variety of side effects

High potency of the drug for D2 receptors

The more potent the drug for D2, the more EPS

Antipsychotic Drugs Study this set online at: http://www.cram.com/flashcards/935151 What r the 2 drugs that have

Antipsychotic Drugs

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What r the 2 drugs that have a high affinity for D2 receptors?

What r the 2 drugs that have a high affinity for D2 receptors?
What r the 2 drugs that have a high affinity for D2 receptors?

Which classical antipsych. is low potency at D2 receptors?

Which classical antipsych. is low potency at D2 receptors?
Which classical antipsych. is low potency at D2 receptors? Which 2 classical antipsych. are Stong anticholinergics?

Which 2 classical antipsych. are Stong anticholinergics?

Which 2 classical antipsych. are Stong anticholinergics?

Which 2 antipsych. has no Antiemetic effects?

Which 2 antipsych. has no Antiemetic effects?
Which 2 antipsych. has no Antiemetic effects?

Haloperidol

Fluphenazine

both are Classical antipsychotics with High Potency

Thiorizadine

EPS are less likely to occur

Thiorizadine

Chlopromazine

EPS are less likely to occur because of this

Aripiprazole

Thioridazine

Clopromazine is useful as pharmacological antiemetic

Antipsychotic Drugs Study this set online at: http://www.cram.com/flashcards/935151 How are antipsych. different from

Antipsychotic Drugs

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How are antipsych. different from barbituates?

Antipsych. that have Low Potency at D2 also have what effect on EPS?

Antipsych. that have Low Potency at D2 also have what effect on EPS?

Which drug causes the worse EPS?

Which drug causes the worse EPS?

The Best antipsych. drug?

The Best antipsych. drug?

Antipsych. DO NOT depress intellectual function Motor incoordination is minimal

They have low Extra- pyramidal symptoms

Remember this is the same for High potency at 5HT2

Haloperidol

High potency at D2 -High EPS Low potency at M or 5HT2 No sedation

Clozapine

Medium potency D2 Medium potency M High potency at 5HT2 - NO EPS

Antipsychotic Drugs Study this set online at: http://www.cram.com/flashcards/935151 Which 2 antipsych. drugs cause

Antipsychotic Drugs

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Which 2 antipsych. drugs cause Hypotension? Which receptor acted on by antipsych. drugs causes sedation?

Which 2 antipsych. drugs cause Hypotension?

Which 2 antipsych. drugs cause Hypotension?

Which receptor acted on by antipsych. drugs causes sedation?

Rispiridone has High potency at D2 and at 5HT2. It thus has what effect on EPS?

What is the Most important unwanted AE of antipsych. drugs?

Chlopromazine

Thioridazine

They block alpha 1 receptors

5HT1

Low EPS

Tardive dyskinesia late occuring syndrome of abnormal choreoathetoid movements

Antipsychotic Drugs Study this set online at: http://www.cram.com/flashcards/935151 What is the possible cause of Tardive

Antipsychotic Drugs

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What is the possible cause of Tardive dyskinesia ?

May be due to UP- regulation of Dopamine receptors - due to longterm blockade

Which antipsych. causes Agronulocytosis in 1- 2% of patients?

Clozapine This makes it a 2nd line drug NOT the DOC

What causes Galactorrhea from use of antipsych.?

Blockade of D2 in Pituitary Increase Prolactin secretion

In women- amenorrhea- galactorrhea syndrome and infertility

What are the endocrine effects of antipsych. in men?

Impotence Loss of Libido Infertility

Antipsychotic Drugs Study this set online at: http://www.cram.com/flashcards/935151 Which group of antipsych. is less

Antipsychotic Drugs

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Which group of antipsych. is less likely to produce elevations in Prolactin?

Which group of antipsych. is less likely to produce elevations in Prolactin?

Which group of antipsych. is less likely to produce elevations in Prolactin?
Which 2 Atypicals cause the worse Weight gain?

Which 2 Atypicals cause the worse Weight gain?

Which 2 Atypicals cause the worse Weight gain?
Which 2 Atypicals cause the worse Weight gain?
Which Atypical drug causes the LEAST Weight gain?

Which Atypical drug causes the LEAST Weight gain?

Which Atypical drug causes the LEAST Weight gain?
Blockade of Muscarinic receptors

Blockade of Muscarinic receptors

can cause

?

Atypicals

They cause more Weight gain and incr. in Lipids than some Typical agents

Clozapine

Olanzipine

Consequence of Wt gain: HTN, DM type 2, Hyperlipidemia

ZIPRASID

ONE

Anticholinergic effects but This antimuscarinic effect may be beneficial in relation to EPS

Anticholinergic effects but This antimuscarinic effect may be beneficial in relation to EPS
Antipsychotic Drugs Study this set online at: http://www.cram.com/flashcards/935151 Beside orthostatic Hypotension,

Antipsychotic Drugs

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Beside orthostatic Hypotension, blockade of alpha 1 can

Beside orthostatic

Hypotension, blockade of alpha 1 can

cause

in

men?

What effect does Thioridazine have on the eye?

What effect does Thioridazine have on the eye?

What effect does Thioridazine have on the eye?
What effect does Thioridazine have on the eye?
What effect does Thioridazine have on the eye?

Which drug causes reversible abnormalities in T waves?

Which drug causes reversible abnormalities in T waves?

Which Atypical has the Greatest risk of QT prolongation?

Which Atypical has the Greatest risk of QT prolongation?

Impaired

Ejaculation

Thioridazine cause Retinal deposits

Chlopromazine causes Cornea and Lens deposits

Thiorazidine - at High doses

Ziprasidone

Antipsychotic Drugs Study this set online at: http://www.cram.com/flashcards/935151 What is the Rare but life-threatning

Antipsychotic Drugs

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What is the Rare but life-threatning disorder of antipsych.?

What is the Rare but life-threatning disorder of antipsych.?

What are the symptoms of Neuroleptic Malignant Syndrome?

Apart from Schizophrenia what are the other clinical uses of antipsych.?

What are Non- pyschyatric uses of antipsych.?

What are Non- pyschyatric uses of antipsych.?

Neuroleptic Malignant Syndrome

Occurs in patients who are extremely sensitive to the EPS of antipsych.

Muscle rigidity Fever altered mental status Stupor Unstable BP Myoglobinemia

Bipolar disorder Tourette's syndrome Huntington's disease -paranoid behaviour Alzheimer's Dementia-Control of disturbed behaviour

Nausea, vomiting

Droperidol is used in combo with Fentanyl in Neuroleptic -anesthesia

Antipsychotic Drugs Study this set online at: http://www.cram.com/flashcards/935151 2 antipsych promoted solely as

Antipsychotic Drugs

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2 antipsych promoted solely as antiemetics?

2 antipsych promoted solely as antiemetics?
2 antipsych promoted solely as antiemetics?

Which antipsych is Category B in pregnancy?

Which antipsych is Category B in pregnancy?

Why are Atypicals prefered as DOC?

Clozapine is reserved for refractory patients, why?

Clozapine is reserved for refractory patients, why?
Clozapine is reserved for refractory patients, why?

Prochloperazin

e

Benzquinamide

Only Clopazine

all others are Category C

*Benefit for Negative symptoms and cognition *Diminished risk of Tardive Dyskinesia, EPS *Lesser incr. of prolactin levels

Potential for

Agranulocytosi

s

Antipsychotic Drugs Study this set online at: http://www.cram.com/flashcards/935151 Antipsych may be used to control

Antipsychotic Drugs

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Antipsych may be used to control

Antipsych may be used to control

Agitation or psychosis

Agitation or psychosis

in

?

Jaundice is caused by which drug?

Jaundice is caused by which drug?

Jaundice is caused by which drug?
AE of Parkinsonism can be treated with?

AE of Parkinsonism can be treated with?

AE of Parkinsonism can be treated with?
What are some EPS?

What are some EPS?

Depressed

patients

patients

Chloproma

zine

Conventional antiParkinson's drugs of the Muscarinic type

Never Levadopa

Parkinsonism Akathisia -uncontrollable restlessness acute Dystonic Reactions - spastic retrocollis or torticollis

Antipsychotic Drugs Study this set online at: http://www.cram.com/flashcards/935151 Whose reality is 'The real

Antipsychotic Drugs

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Whose reality is 'The real reality" ??

Us or them