Term
| Why use an atypical over a typical antipsychotic? (4) |
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Definition
Efficacy, especially negative symptoms
Low likelihood of extrapyramidal S/E
No tardive dyskinesias
None-small increase in plasma PRL |
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Term
| Atypical antipsychotics: MOA |
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Definition
Block 5HT2 > D2R
Inhibits 5HT-inhibition of DA release = increased DA in nigrostriatal and mesocortical pathways
Inhibits D2R in mesolimbic pathway = prevent positive symptoms
Doesn't really block D2R in tubuloinfundibular pathway = no blockage of DA-inhibition of PRL secretion |
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Term
| ___ in the mesolimbic pathway produces positive psychotic symptoms. ___ in the mesocortical pathway produces negative psychotic symptoms |
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Definition
Excess DA in the mesolimbic
Decreased DA in the mesocortical pathway |
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Term
| Enhanced activity in the mesolimbic pathway causes ___ |
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Definition
Positive psychotic symptoms
Therefore inhibition of this pathway would ameliorate the positive symptoms |
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Term
| Psychosis ___ activity in the mesocortical projections |
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Definition
Decreases activity
Therefore removal of the inhibition would ameliorate positive and negative symptoms |
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Term
| Aripiprazole: MOA, why it's unique |
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Definition
Partial D2 agonist
-Acts as agonist if there's no DA
-Blocks DA if it's present |
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Term
| 5HT2 nerves __ firing onto DA nerves, which ___ the release of DA in the striatum and cortex. ___ could increase release of DA in these areas. |
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Definition
5HT2 nerves decrease firing onto DA nerves
Decreases the release of DA
5HT2 blockers could increase DA |
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Term
| 5HT1A ___ could increase DA release in the accumbens and cortex. Many ___ have direct or indirect activity at these receptors. |
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Definition
5HT1A agonists could increase DA release
Atypicals have direct or indirect activity at these receptors |
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Term
| Typical antipsychotics (2) |
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Definition
Chlorpromazine
Haloperidol |
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Term
| Typical drugs primarily ___ positive symptoms while atypical drugs ___ positive symptoms and ___ negative symptoms. |
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Definition
Decrease positive symptoms
Atypicals decrease positive symptoms and improve negative ones |
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Term
| Chronic treatment with typical antipsychotics decreases DA firing in ___ and ___ pathways. |
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Definition
Nigrostriatal
Mesocortical |
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Term
| Chronic treatment with atypical antipsychotics decreases DA firing in ___ pathway. |
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Definition
| Mesolimbic pathway, which is probably why atypicals allow for maintenance of good prefrontal functioning |
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Term
| Atypicals cause greater increase of DA release in the ___ than in the ___ |
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Definition
Prefrontal cortex
Striatum
This isn't the case with typicals |
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Term
| Typical antipsychotics: adrenergic (2), cholingergic (4), histamine (2), general (4) S/E |
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Definition
Antiadrenergic (a1 and 2) -Sedation -Orthostatic hypotension
Anticholinergic (like TCA S/E) -Dry mouth -Blurred vision -Urinary retention, constipation -Tachycardia
Antihistamine: sedation, weight gain
General -Photosensitivity -Jaundice -Ventricular arrhythmias -AGRANULOCYTOSIS |
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Term
| Typical antipsychotics: MOA |
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Definition
D2 antagonist
Inhibits D2R in the nigrostriatal pathway = EPS
Inhibits D2R in mesolimbic pathway = prevent positive symptoms
Inhibits D2R in mesocortical pathway = blocking what needs more stimulation = making negative symptoms worse
Inhibits D2R in tubuloinfundibular pathway = blockage of DA-inhibition of PRL secretion = increased PRL |
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Term
| Typical antipsychotics: neuroendocrine S/E (1.4) |
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Definition
DA blockade in hypothal/pit tract
Increased prolactin
-Gynecomastia
-Galactorrhea
-Amenorrhea
-Weight gain |
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Term
| Typical antipsychotics: neurologic/EPS S/E (4) |
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Definition
DA blockade in BG
Acute dystonia
Pseudoparkinsonism
Akathisia
Tardive dyskinesia |
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Term
| Low potency typicals are more ___, ___, and ___. High potency typicals are more ___ but ___. |
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Definition
More anticholinergic, sedative, likely to produce orthostatic hypotension
More likely to produce EPS but not autonomic S/E |
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Term
| Atypical antipsychotics: autonomic S/E |
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Definition
Same as typical
Risperidone and quetiapine not anticholinergic |
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Term
| Atypical antipsychotics: neurologic/EPS S/E |
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Definition
No dystonia or tardive dyskinesia (clozapine can actually decrease tardive dyskinesia in patients who develop it with typicals)
Some akathesia
Neuroleptic malignant syndrome
Risperidone: incidence is dose-related |
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Term
| Clozapine: S/E (big deal) |
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Definition
Agranulocytosis, not dose-related
Discontinue if WBC ct <2000 |
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Term
| Aripiprazole, ziprasidone, maybe risperidone: neuroendocrine S/E |
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Definition
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Term
| Clozapine, olanzapine: major S/E |
|
Definition
| Weight gain! Subsequent NIDDM and hyperlipidemia |
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Term
|
Definition
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Term
|
Definition
Antimania: takes a few days to work but decreases risk of suicide
Prophylaxis: decreases frequency and severity of mood swings |
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Term
| Lithium has a half life of ___ and is excreted by the ___ so use cautiously in patients ___ |
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Definition
24 hr
Kidneys
Receiving diuretics |
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Term
|
Definition
DI
Hypothyroidism
Dysrhythmias |
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Term
| Anticonvulsants: properties wrt bipolar |
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Definition
Same efficacy as Li, similar time course
Lamotrigine: prophylaxis and depressive episodes |
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Term
| Anticonvulsants used for bipolar (3) |
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Definition
Carbamazepine
Valproate
Lamotrigine |
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Term
| Non-lithium drugs for mania (3) |
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Definition
Valproate
Atypical antipsychotic
Aripiprazole |
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Term
| Atypical antipsychotics: indications for bipolar |
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Definition
Acute mania, efficacy similar to lithium
Olanzapine, aripiprazole: prophylaxis |
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Term
| Non-lithium drugs for depression in bipolar (2) |
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Definition
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Term
| Atypical antipsychotics: (6) "Atypical Compounds Quietly Restore One's Zest" |
|
Definition
Aripiprazole
Clozapine
Quetiapine
Risperidone
Olanzepine
Ziprasidone |
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