pharma II test II neuroleptics

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pharma II test II neuroleptics
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2013-03-06 22:34:45
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pharma II test II neuroleptics
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  1. positive schizophrenia symptoms
    • hallucinations
    • delusions
    • disordered thinking
    • disorganized speech
    • combativeness
    • agitation
    • paranoia
  2. negative schizophrenia symptoms
    • social withdrawal
    • emotional withdrawal
    • lack of motivation
    • poverty of speech
    • blunted affect
    • poor insight, judgement, and self care
  3. phenothiazine - aliphatic
    chlorpromazine - thorazine
  4. phenothiazine -piperazine
    • fluphenazine - prolixin
    • prochlorperazine - compazine
  5. phenothiazine - piperidine
    thioridazine - mellaril
  6. butyrophenones
    • haloperidol - haldol
    • droperidol
  7. 7 atypicals
    • clozapine - clozaril
    • risperidone - risperdal
    • olanzapine - zyprexa
    • quetiapine - seroquel
    • ziprasidone - geodon
    • ariprazole - abilify
    • palliperidone - invega
  8. 5 SE of tricyclic structures
    • anticholinergic actions
    • tachycardia; cardiac toxicity
    • weight gain
    • orthostatic hypotension
    • seizures
  9. MOA of typicals
    DA receptor block→ blocks postsynaptic DA receptors but also ↑ DA turnover (compensatory mechanism); after about 12 weeks of therapy, get inactivation (depolarization blockade) of DA neurons; correlates with antipsychotic effects
  10. 4 areas affecting the vomiting center
    • vestibular apparatus
    • sensor input (sight,smell,pain)
    • higher centers (anticipation,fear,memory)
    • CTZ
  11. 2 areas affecting the CTZ
    • stomach and small intestine
    • blood borne emetics
  12. 5 antiemetic MOA
    • serotonin antagonist
    • DA antagonist
    • cannabinoids
    • anticholinergic
    • antihistamine
  13. 4 extrapyramidal symptoms of phenothiazines
    • iatrogenic parkinsonism
    • akathisia
    • dystonias
    • tardive dyskinesia
  14. DA blockade in Mesolimbic pathway causes
    antipsychotic effect
  15. DA blockade in nigrostriatal pathway causes
    extrapyramidal effects
  16. Tx of dystonic reactions
    • anticholinergics (diphenhydramine, benztropine)
    • benzodiazepines
  17. Tx of parkinsonism
    • reduction of neuroleptic agent
    • anticholinergics
  18. Tx of akathisia
    • reduction of neuroleptic dose
    • anticholinergics
    • benzodiazepines
    • propranolol
  19. Tx of tardive dyskinesia
    • stop offending agent
    • add or increase neuroleptic dose
    • switch to another drug, atypical (clozapine)
    • prevent with drug holidays
    • anticholinergic agents (botulinum toxin) tetrabenazine - nitoman
    • reserpine
  20. MOA tardive dyskinesia
    • increase DA stores presynaptic
    • increase DA receptors postsynaptic
    • increase DA hypersensitivity
  21. NMS
    neuroleptic malignant syndrome - life threatening disorder that occurs in patients with extreme sensitivity to EPS of antipsychotics, more common in high potentcy agents
  22. Tx of NMS
    • dscontinue causative agent
    • supportive care
    • bromocriptine - DA agonist
    • dantrolene - direct acting skeletal muscle relaxant
  23. 5 AE of phenothiazines on endocrine system
    • menstrual irregularities
    • gynecomastia
    • decrease sex drive
    • weight gain
    • hyperglycemia & glycosuria
  24. 3 rare AE of phenothiazine hypersensitivity reactions
    • hematologic - blood dyscrasias
    • hepatic - cholestatic jaundice
    • dermatologic - contact dermatitis, photosensitivity
  25. MOA of atypicals
    5-HT2A & D2 antagonists
  26. most effective
    AE - agranulocytosis      
           seizures
    clozapine - clozaril
  27. more effective against decreasing (-) symptoms
    high dose = EPS and decrease BP
    risperidone - risperdal
  28. less side effect
    slow potential for drug interactions
    decreased weight gain
    olanzapine - zyprexa
  29. bipolar disorder
    seldom causes weight gain
    prolongation of QT interval
    ziprasidone - geodeon
  30. blocks multiple receptor types
    DA stabilizer
    little or no effect on weight
    ariprazole - abilify
  31. active metabolite of risperidone
    extended release
    paliperidone - invega
  32. 3 depot neuroleptics
    • haloperidol
    • fluphenazine
    • risperidone
  33. 3 major objectives of schizophrenia therapy
    • supression of acute episodes
    • prevention of acute exacerbations
    • maintenance of the highest possible level of functioning
  34. D2 block of the mesolimbic pathway
    inhibit the release of DA and thereby alleviate the positive symptoms of schizophrenia in the nucleus accumbens
  35. 5HT block of the mesocortical pathway
    5HT receptor blockers increase the release of DA and thereby alleviate the negative symptoms of schizophrenia in the prefrontal cortex

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