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Antipsychotic Drugs

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alapaj's version from 2017-01-21 12:45

Section 1

Question Answer
What are the indications for anti-psychotic drugs?Schizophrenia, acute mania, tourette;s syndrome, disturbed behavior in alzheimer's patients,drug induced psychosis, stress-related psychosis
What are the positive symptoms of schizophrenia?paranoid delusions, hallucinations, disorganized speech, disorganized or catatonic behavior
What are the negative symptoms of schizophrenialoss of emotions, showing withdrawal, loss of speech, loss of motivation
What is the pathology of schizophrenia?increased dopaminergic activity, mesolimbic neurons cause positive symptoms, mesocoritcal neurons cause negative symptoms
What are the main tenets of the Dopamine hypothesis of schizophrenia?Many antipsychotic block D2 receptors, Drugs that increase DA activity can aggravate schizophrenia or some forms of psychosis, they increase D2 receptors density in the nucleus accumbens, caudate, and putamen of schizophrenics who have not received treatment.
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Section 2

Question Answer
What is the function of Mesolimbic-Mesocortical dopaminergic pathway?Controls behavior and psychosis
What is the function of Nigrostriatal dopaminergic pathway?Controls voluntary movement and coordination
What is the function of the Tuberoinfundibular system?Inhibits prolactin secretion from anterior pituitary
What occurs when the mesolimbic-mesocortical dopaminergic pathway is inhibited?Antipsychotic effects
What occurs when the nigrostriatal dopaminergic pathway is inhibited?Extrapyramidal side effects
What occurs when the tuberinfundibular system is inhibited?Hyperprolactinemia
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Section 3

Question Answer
What is the difference in mechanism between typical and atypical antipsychotic drugs?Typical antipsychotic block D2 receptors only, in contrast atypical antipsychotics block 5-HT2a , D2, and D4 (clozapine only) receptors
what receptors are blocked in both typical and atypical anti psychotics?D2 receptors and HAM receptors (Histamine, alpha-adreno, Muscarinic)
What percentage of D2 receptor occupancy is needed to achieve anti-psychotic efficacy?60%
what are the three major classes of Typical Antipsychotics?Phenothiazie Derivatives, Thioxathene Derivatives, Butyrophenone Derivatives
Describe the interactions of atypical anti-psychotics and their receptorsAytpical anti-psychotics have a low affinity and fast dissociation from D2 receptors, but a higher degree of occupancy of the 5HT2a receptors
Why might atypicals be preferred over typical anti-psychotics?Atypicals are effective in both positive and negative symptoms of schizo, higher compliance and greater effectiveness, lower propensity for EPS, absence of Hyperprolactinemia with the exception of risperidone
Why might typicals be preferred over atypical anti-psychotics?Typical anti-psychotics are cheaper than atypicals
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Section 4

Question Answer
What is the class and the specific side effects for Clozapine?Atypical...Hyperglycemia, weight gain, seizures, and agranulocytosis
What is the class and the specific side effects for Risperidone?Aytpical...Hyper prolactinemia
What is the class and the specific side effects for Ziprasidone?Atypical....Increased mortality in elderly with dementia and prolonged QT interval
What is the class and the specific side effects for Thioridazine?Typical....causes minor abnormalities with T waves and a prolong QT interval, overdose can cause ventricular arrhythmias and sudden death, can causes deposits in retina
What is the class and the specific side effects for Chlorpromazine?Typical...Deposits in Cornea and lens, lowers seizure threshold, significant sedation from blocking histamine receptors, highest risk for orthostatic hypotension by blocking alpha-adreno receptors, SLUD through blockade of muscarinic receptors
What are the adverse neurologic effects more common for typical anti-psychotics?Extra-pyramidal symptoms (Akinesia and akathisia), Dystonia, Tardive Dyskinesia, Neuroleptic Malignant syndrome
How is tardive dyskinesia caused?Sensitization of DA receptors due to chronic use of anti-psychotics in the caudate and putamen area
If you want minimal blockade of muscarinic receptors which anti-psychotic will you use?Risperidone, Ziprasidone, and Haloperidol
Which patient have a high risk for developing NMS?Patients showing EPS, catatonia, on high potency anti-psychotics, agitated patient receiving IM injection at high/rapidly escalating dose
What are the life threataning symptoms of NMS?Muscle rigidity (lead pipe), sweating impairment, hyperpyrexia, autonomic instability, delirium, extreme agitation
What are the changes in body biochemistry with NMS?Muscle-typic creatine kinase is elevated signifying muscle damage, and myoglobinuria is present
What are the interventions for NMS?Stop the medication, treat the muscle rigidity with muscle relaxants (diazepam, dantrolene, bromocriptine, amantidine), Physical cooling measures and close monitoring accomplished
What can be done after NMS is resolved in regard to anti=psychotic therapy?It is recommended to start with an atypical antipsychotic at low dose and slowly titrate it up in a monitored setting to avoid recurrent NMS
What symptoms are common in both NMS and Serotonin syndrome?Muscle rigidity, and tremor
What symptoms are different between NMS and Serotonin Syndrome?NMS has excess dopamine receptor blockade vs. excess serotonin, NMS is slower onset vs rapid onset, NMS has bradykinesia vs. hyperreflexia, myoclonus, NMS has elevated muscle type creatine kinase and myoglobinuria wheareas Serotonin syndrome has hyperactive bowel sounds
What is the difference in treatment between NMS and Serotonin syndrome?NMS is treated with Bromocriptine (D2 agonist) and Serotonin Syndrome is treated with Cyproheptadine
What anti-psychotic is indicated in treatment resistant populations?Clozapine
What anti-psychotic is indictated in patients with high risk of suicide?Clozapine
What are some of the challenges in Schizophrenia treatment?They are often treatment resistant, they have a high risk for suicide, patients are generally children and adolescents, there is frequent relapse due to non-adherence of treatment because of unpleasant side effects of their medications
Which anti-pyschotic is marketed as an anti-depressant adjuvant?Aripiprazole
Which anti-psychotic can be used an anti-emetic?Prochlorperazine
Which anti-psychotic can be used as a anti-pruritic?Promathazine
what class of drug is Olanzapine?Atypical anti-pyschotic
what class of drug is Paliperidone?Atypical anti-pyschotic
what class of drug is Lurasidone?Atypical anti-pyschotic
what class of drug is Droperidol and its potency?Typical Anti-pyschotic, Butyrophenone derivative with high potency
what class of drug is Haloperidol and its potency?Typical Anti-psychotic, Butyrophenone derivative with high potency
what class of drug is Trifluperazine and its potency?Typical Anti-psychotic, Phenothiazine derivative with high potency
what class of drug is Fluphenazine and its potency?Typical Anti-pyschotic, Phenothiazine derivative with high potency
With what antipsychotics would you treat patient with diabetes, hypertension and high cholesterol?Aripiprazole, Ziprasidone, Haloperidol
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