DBB - Exam 2 - Antipsychotics

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jdwein39
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DBB - Exam 2 - Antipsychotics
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2012-10-24 01:57:43
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  1. Positive and negative symptoms of schizophrenia
    • Positive symptoms: hallucinations (auditory/visual), delusions, disorganized speech (formal thought disorder)
    • Negative symptoms: lack of emotional response, lack of motivation, lack of interaction
  2. Medications that we learn about help (positive/negative) symtpoms of schizophrenia more
    Positive
  3. Subtypes of schizophrenia
    • Catatonic: alternating periods of immobility and excited agitation
    • Paranoid: delusions of grandeur
    • Hebephrenic: silly and immature emotionality with disorganized behavior
    • Undifferentiated: doesn't meet criteria of other subtypes
  4. Disorganization of cells in which brain region is found in schizophrenia?
    Hippocampus
  5. Dopaminergic cells are very commonly found in which two brain structures?
    • Substantia nigra
    • VTA
  6. Mesostriatal dopaminergic cells: What are they, what illnesses associated with them?
    • Go from substantia nigra to striatum
    • Associated with Parkinson's
  7. Mesolimbic dopaminergic cells: What are they, what illnesses associated with them?
    • Go from VTA to limbic system
    • Schizophrenia and drug abuse
  8. Mesocortical dopaminergic cells: What are they, what illnesses associated with them?
    • Go from VTA to cortex
    • Negative symptoms of schizophrenia
  9. Antipsychotics tend to be antagonists of which 2 receptors?
    • D2
    • 5-HT2
  10. D1 and D2 receptors are (ionotropic/metabotropic)
    Metabotropic
  11. Neurodevelopmental model of schizophrenia and how it explains positive and negative symptoms
    • Decrease in innervation of VTA from PFC (reduced mesocortical function), associated with negative symptoms
    • This removes inhibitory feedback on limbic structures, causing positive symptoms
  12. Blockade of both D2 and 5-HT2 receptors - advantage?
    • In striatum, 5-HT stimulation of 5-HT2 receptors blocks dopamine. So 5-HT2 blockade increases dopamine in striatum
    • 5-HT2 blockade doesn't have much effect in limbic system
    • D2 blockade in striatum leads to movement disorder side effects; a drug that blocks 5-HT2 and D2 antagonizes dopamine in limbic system but not as much in striatum; REDUCED MOVEMENT DISORDER SIDE EFFECTS
  13. D2 blockade leads to ___________ side effects
    Movement disorder
  14. In which brain area does D2 blockade lead to movement disorder side effects?
    Striatum
  15. Older antipsychotics
    • Phenothiazines (such as chlorpromazine)
    • Butyrophenones (such as halperidol)
  16. Side effects of old antipsychotics
    • Sedation
    • Orthostatic hypotension
    • Anticholinergic effects
    • Extrapyramidal side effects
  17. 4 extrapyramidal side effects associated with old antipsychotics
    • Akathisia: internal restlessness
    • Acute dystonia: spasming of a muscle group
    • Parkinsonism: tremor, muscle rigidity
    • Tardive dyskinesia: late acting, repetitive, uncontrollable movements (often in face)
  18. To reduce Parkinsonian side effects, use ____________. Why does this work? These drugs also help with what other side effect of old antipsychotics?
    • Anticholinergics
    • Blocking D2 with antipsychotic like the degeneration of DA cells in substantia nigra in Parkinson's, leading to Parkinsonian side effects
    • Loss of DA in substantia nigra --> less inhibition of ACh in striatum
    • Anticholinergics block ACh, reducing symptoms
    • Anticholinergics also help with acute dystonic reactions
  19. Compazine: What is it?
    Old generation phenothiazine
  20. Compazine: What does it do?
    Reduces nausea/vomiting by blocking D2 receptors
  21. Someone gets an acute dystonic reaction but never had psychosis. What was this person on and why? How do you reduce these side effects?
    • Compazine
    • Reduce nausea and vomiting
    • Reduce acute dystonia with anticholinergics
  22. Haldol-D: What is it? What are advantages and disadvantages?
    • Haldol-decanoate; slow IM form of Haldol, has a very long half-life (couple of weeks or so)
    • Advantages: Ensures patient receives medication, allows you to give ~1 injection per month (easier than a pill everyday)
    • Disadvantages: You can't stop once you're on it; if you have a severe side effect, sucks to suck
  23. Common side effect of new generation antipsychotics?
    Metabolic syndrome side effects (weight gain and other risk factors for heart disease/diabetes)
  24. A "truly different" antipsychotic; helpful, but many side effects and potentially dangerous
    Clozapine
  25. A new generation antipsychotic that has also been approved by the FDA for depression treatment
    Abilify

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