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Pharm blk4- A-Psych

Anti- Psychotic

besides schizophrenia and related disorders, what two things are some antipsychotics prescribed for 1) "manic" phase of bipolar disorder; 2) anti-emetics
what are the three groups of schizophrenia symptoms 1) positive; 2) negative; 3) cognitive
what are the four general findings that implicate dopamine and dopamine receptors in schizophrenia 1efficacy of drugs corresponds to affinity for drug at dopamine receptors 2drugs that increase dopamine levels can precipitate psychotic sx 3DA-R density in post-mortem tissue is higher in schizophrenic people 4) PET scans show increased dopamine R
how many dopamine receptor types are there, and what is their structure like five types, all are G-protein coupled receptors
what are the two classes of DA receptors, and which class stimulates / inhibits two classes: D1 like (stimulatory); D2 like (inhibitory)
what are the D1-like and D2-like receptors D1-like: D1 and D5; D-2-like: D2, D3, and D4
what second messenger pathway do dopamine receptors act on cAMP --> PKA
what typical antipsychotics must we know (2) 1) haloperidol; 2) chlorpromazine
what atypical antipsychotics must we know (5) 1) clozapine; 2) risperidone; 3) olanzapine; 4) quetiapine; 5) ziprasidone
what are atypical antipsychotics effective at doing, and for what purpose are they less effective very potent at relieving positive symptoms of schizophrenia, but much less effective at relieving the negative symptoms
what serious type of side effects do they commonly cause extrapyramidal disturbances
what disease are these symptoms like, and what are three extrapyramidal symptoms mentioned Parkinson-like symptoms: 1) tremor; 2) dystonia; 3) tardive dyskinesia
what is usually the limiting factor for typical antipsychotic therapy intolerable levels of tardive dyskinesia
what is tardive dyskinesia, and where in the body does it occur (2) tics, especially in: 1) face; 2) neck muscles
what is particularly devastating about some cases of extrapyramidal effects irreversible
what is potency for alleviating positive symptoms proportional to (specific) drug's affinity for D2-type dopamine receptors
what else is proportional to this propensity to cause extrapyramidal disturbances
what are two advantages of atypical antipsychotics 1) less extrapyramidal disturbances; 2) may have efficacy in treating negative symptoms (as well as alleviating positive symptoms)
how does affinity to D2 receptors compare to typical agents lower
what may the lower incidence of extrapyramidal side effects be due to actions on (2 and/or) 1) 5HT receptors' 2) muscarinic acetylcholine receptors
what autonomic adverse effects are listed (list) loss of accomodatoin, dry mouth, constipation, difficulty urinating, orthostatic hypotension, impotence, failure to ejaculate
what CNS adverse effects are listed (list) Parkinson's syndrome, akathisia (inner restlessness), dystonias (movement disorder), tardive dyskinesia, toxic-confusional state
what endocrine effects can occur (3) 1) amenorrhea-galactorrhea; 2) infertility; 3) impotence
what adverse effect occurs, particularly in atypical antipsychotics weight gain
what adverse effect occurs most in typical antipsychotics, and what may it be due to sedation - may be due to action on histamine receptors
what can happen to mood from antipsychotics blunt affect, lack of pleasure, dysphoria
do they cause nausea no, they actually have antiemetic actions
what is perhaps the most serious adverse effect (and rarest) of antipsychotic medications neuroleptic malignant syndrome
what is the classic triad of symptoms in neuroleptic malignant syndrome 1) rigidity; 2) fever; 3) cognitive changes
when do symptoms usually begin (90% of the time) for neuroleptic malignant syndrome within two weeks of starting treatment
how can muscle rigidity be detected (laboratory test) increased creatine phosphokinase levels
what other symptoms frequently occur (over 50%) in neuroleptic malignant syndrome (4) 1) EEG slowing (50%); 2) tachypnea (78%); 3) diaphoresis (60%); 4) labile blood pressure (54%)
what is the course of symptoms (how do they progress, when do they peak, and how long can they last (range)) they progress rapidly, peak within three days, and can last from hours to 5 or 6 weeks
what factors put one at risk for NMS (3 - test question bold) 1) YOUNG AGE [FOR MALES]; 2) dehydration; 3) hyponatremia
what is critical to treatment of neuroleptic malignant syndrome early diagnosis
what drug is most likely to cause neuroleptic malignant syndrome haloperidol
what supportive measures should be taken (3) 1) respiration; 2) hydration; 3) cooling
what test should be done, and why arterial gas sampling to determine if metabolic acidosis is a concern (alkalizing agents may be indicated)
what change should be initiated in antipsychotic treatment discontinue
what drugs should the patient be given (2 and/or) 1) dantrolene; 2) bromocriptine
in what manner are these drugs often given in combination (mode of administration of each, and which is maintained longer) dantrolene: IV; bromocriptine: oral - dantrolene can be discontinued and bromocriptine maintained
how long should treatment continue at least ten days
how much time should pass before antipsychotic treatment is initiated again, and what drug should be used clinician should not reintroduce antipsychotic medications for at least two weeks, and a different antipsychotic should be tried
what was chloropromazine developed as an antiemetic
what led to its decline in favor of other atypical antipsychotics severe extrapyramidal side effects
what is chlorpromazine still commonly used for, and why because of its powerful sedative side effects, it is commonly used to tranquilize non-compliant patients in emergency situations
is chlorpromazine a viable treatment option for any psychotic symptoms yes - it works for positive symptoms and it is relatively cheap
how potent is haloperidol compared to chlorpromazine as an antipsychotic far more potent (about 50X)
what is it the most common antipsychotic associated with neuroletpic malignant syndrome
what other adverse effect(s) does it cause more commonly than chlorpromazine, and why extrapyramidal effects (due to high affinity for D2 receptors)
what else is different about the range of side effects caused by haloperidol compared to chlorpromazine, and why narrower range of side effects (dry mouth, constipation, hypotension, weight gain, etc.) - less affinity for some non-D2 receptors
what three receptors was haloperidol mentioned to have low affinity for 1) cholinergic; 2) seritonergic; 3) histaminergic
what was clozapine, the first atypical antipsychotic, recently approved for (additional use) schizophrenic patients at risk for suicide
what drug's effectiveness is it equal to in relieving positive symptoms chlorporomazine
what other symptoms is it effective against negative symptoms
what other major advantage does it have over typicals very few extrapyramidal side effects
what is the limiting factor for prescribing clozapine (serious adverse effect) and what % of patients experience this agranulocytosis (can be fatal) in 1-2% of patients
what four new, atypical antipsychotics must we know 1) olanzipine; 2) quetiapine; 3) risperidone; 4) ziprasidone
what % of new prescriptions for schizophrenia and related disorders were made up by these drugs 90%
what is the main reason these are desirable alternatives to typicals lower incidence of extrapyramidal adverse effects
which of these agents were mentioned to still cause some degree of extrapyramidal side effects (2 specifically mentioned) 1) olanzapine; 2) risperidone
what adverse effect do all of these agents, with one exception, cause, and what is the exception all of these agents, with the exception of ziprasidone, cause considerable weight gain
how consistent is patient responsiveness to these agents highly variable
what is one major factor restricting the use of atypicals compared to typicals atypicals are far more expensive - typicals may still provide the most cost-effective treatment for some patients
why is compliance to these medications very low (4) 1) initial sedative effects; 2) blockade of reward circuit; 3) weight gain; 4) many sufferers do not believe they are ill
what is sometimes done to improve compliance intramuscular depots
what process may a physician have to use to find the best drug and dose, and why trial and error - patients respond very differently
why is close monitoring of dosage essential adverse effects
what effects of other agents can most antipsychotics potentiate CNS depressant effects of other agents
what reason was mentioned for this many antipsychotics inhibit CYP2D6, which is important for metabolizing many alagesic,s anesthetics, and sedatives
what drug in particular are schizophrenics at greater risk for abusing nicotine
what other abused drugs were mentioned to exacerbate symptoms and/or reduce symptoms of antipsychotics (3) 1) PCP; 2) cocaine; 3) meth
how effective are drugs at treating schizophrenia not effective alone
what additional things are important (2) 1) supportive (family) environment; 2) sufficient stimulation
Created by: mcafej02