Neuroleptics

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Pharm5
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Neuroleptics
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2011-03-25 15:26:23
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Neuroleptics
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  1. Does Schizophrenia represent a disorder that includes "split-personality"?
    NO
  2. What are some common behaviors associated with Schizophrenia?
    • -thought disorder
    • -hallucinations
    • -delusions
    • -bizarre behavior
    • (incidence of schizo is about 1-2%)
  3. What are the 2 ways to classify Schizophrenia?
    • 1. Positive symptoms
    • 2. Negative symptoms
  4. Symptoms of this classification of Schizo include: delusions, hallucinations, and thought disorder (disorganized and irrational):
    A. Positive
    B. Negative
    A. positive
  5. Symptoms of this classification of Schizo include a loss of normal behaviors such as poverty of speech and low initiative, social w/drawls and diminished affect, and Anhedonia (feeling dsphoric).
    A. Positive
    B. Negative
    Negative
  6. How can one classify the drugs that are used to treat Schizo?
    • 1. Typical drugs
    • 2. Atypical drugs
  7. Which class of drugs used to treat Schizo treast the positive symptoms of the disease only?
    A. Typical
    B. Atypical
    A. Typical
  8. The main 3 "Typical" Schizo drugs are:
    • 1. Haloperidol (Haldol)
    • 2. Chloropromazine (Thorazine)
    • 3. Thioridazine (Mellaril)
  9. Which class of Schizo-drugs is used to treat the positive and negative types of Schizo?
    A. Typical
    B. Atypical
    Atypical
  10. What are the 3 main "Atypical" Schizo drugs?
    • 1. Clozapine (Clozaril)
    • 2. Risperidone (Risperdol)
    • 3. Olanzazine (Zyprexa)
  11. What are the 2 major side effects of antipsychotic meds?
    • 1. Extrapyramidial (Parkinsons-like) side effects due to block of DA receptors
    • 2. Tardive dyskinesia- facial tics and gestures due to an over stimulation of DA receptors
  12. What are a few minor SE of antipsychotic meds?
    • 1. autonomic problems (dry mouth)
    • 2. skin-eye pigmentation
    • 3. breast development (inc. prolactin release after blockade of dopamine neurons)
  13. What regions of the brain are abnormal in Schizos?
    • Prefrontal cortex
    • Medial temporal lobes
    • medial diencephalon
  14. What are some potential causes of Brain damage in Schizo?
    • Birth Trauma
    • Viral Infections
    • Nutritional Issues
    • Maternal stress
  15. What is the current theory on Schizophrenia & Hypofrontality?
    • Hypofrontality= decreased activity of the dorsolateral prefrontal cortex
    • -damage to this prefrontal cortex impairs behavioral flexibility
    • -Schizos show dec activity in the prefrontal cortex
  16. What is the Dopamine theory of Schizo?
    • Dopamine hyperactivity in the CNS is believed to be mainly responsible for the positive symptoms of schizo.
    • -Theory is based on observations that drugs that inc. dopamine activity can cause syndromes in humans which is indistringuishable from Schizo (positive symptoms)
  17. What are the names of the two families of Dopamine receptors?
    • 1. D1
    • 2. D2
  18. Which Domapine receptor family is associated with increased cAMP?
    1. D1
    2. D2
    1. D1
  19. Which Dopamine receptor family is associated with decreased cAMP?
    1. D1
    2. D2
    2. D2
  20. Which Dopamine receptor family is more implicated in Schizo and neuroleptic pharmacotherapy?
    1. D1
    2. D2
    2. D2
  21. What 3 places are the D2 subtypes found in the CNS?
    • 1. Limbic system (mood, emotions)
    • 2. Corpus striatum (motor)
    • 3. Pituitary (inhibition of hormone release such as prolactin and GH)
  22. Where are the D3 and D4 subtypes mostly found in the CNS?
    the limbic system (which may explain their lack of extrapyramidial side effects in drugs such as Clozapine)
  23. Which atypical neuroleptic is reserved for refractory schizoprhenia?
    A. Clozapine (Clozaril)
    B. Olanzazine (Zyprexa)
    C. Risperidone (Risperdol)
    A. Clozapine (Clozaril)
    (this multiple choice question has been scrambled)
  24. Which atypical neuroleptic does not produce extrapyramidial side effects at the recommended dose?
    A. Clozapine (Clozaril)
    B. Olanzazine (Zyprexa)
    C. Risperidone (Risperdol)
    C. Risperidone (Risperdol)- it is a bit more selective than clozapine for dopamine receptor blockage; however, unlike clozapine, it has not been reported to produce bone marrow suppression
    (this multiple choice question has been scrambled)
  25. Which atypical neuroleptic is associated with significant weight gain and with other metabolic disturbances like an increased risk of diabetes?
    A. Clozapine (Clozaril)
    B. Olanzazine (Zyprexa)
    C. Risperidone (Risperdol)
    B. Olanzazine (Zyprexa)
    (this multiple choice question has been scrambled)
  26. What is the name of the new antipsychotic that has an Mech of action distinct from other typical and atypical antipsychotics?
    Aripiprazole (Abilify)
  27. What receptors is Abilify a PARTIAL AGONIST for?
    D2 dopamine receptors
  28. List the 4 dopamine pathways
    • 1. Nigrostriatal pathway
    • 2. Mesolimbic pathway
    • 3. Mesocortical pathway
    • 4. Tuberoinfundibular pathway
  29. In which dopamine pathway do cell bodies lie in substantia nigra (A9 cell group) and axons terminate in the corpus striatum?
    1. Nigrostriatal pathway
    2. Mesolimbic pathway
    3. Mesocortical pathway
    4. Tuberoinfundibular pathway
    1. Nigrostriatal
  30. In which dopamine pathway is there an association with motor control in the extrapyramidial system?
    1. Nigrostriatal pathway
    2. Mesolimbic pathway
    3. Mesocortical pathway
    4. Tuberoinfundibular pathway
    1. Nigrostriatal
  31. In which dopamine pathway do cell bodies mainly lie in the A10 cell group of the midbrain and project to limbic system and the nucleus accumbens?
    1. Nigrostriatal pathway
    2. Mesolimbic pathway
    3. Mesocortical pathway
    4. Tuberoinfundibular pathway
    2. Mesolimbic
  32. Which dopamine pathway is associated with behavior?
    1. Nigrostriatal pathway
    2. Mesolimbic pathway
    3. Mesocortical pathway
    4. Tuberoinfundibular pathway
    2. Mesolimbic
  33. Which dopamine pathway runs from the hypothalamus to the pituitary gland?
    1. Nigrostriatal pathway
    2. Mesolimbic pathway
    3. Mesocortical pathway
    4. Tuberoinfundibular pathway
    4. Tuberoinfundibular
  34. Which dopamine pathway is associated with endocrine control (inhibition of prolactin release)?
    1. Nigrostriatal pathway
    2. Mesolimbic pathway
    3. Mesocortical pathway
    4. Tuberoinfundibular pathway
    4. Tuberoinfundibular
  35. What CNS system are serotonin/5HT1 receptors found in?
    Limbic system (emotions)
  36. What role do anticholinergic drugs play in schizophrenics?
    Anticholinergic drugs antagonize some of the effects of D2 antagonists, so many patients are given these drugs too.
  37. The Limbic System is associated with --- symptoms of Schizo?
    A. positive
    B. negative
    positive
  38. The cortex is associated with --- symptoms of Schizo?
    A. positive
    B. negative
    negative
  39. These characteristics are assoc with which class of antipsychotic drugs: associated with EP motor effects, general equal efficiacy but vary in ptoency, used more often in public treatment because they are significantly cheaper.
    A. Typical
    B. Atypical
    Typical (these treat only positive symptoms of Schizo)
  40. What 2 drugs can be used to treat OD of either typical of atypical antipsychotics?
    • 1. Benztropine
    • 2. Trihexyphenidyl
    • (these are anticholinergic drugs)
  41. What chemical class of drug is Haloperidol (Haldol)?
    Butyrophenones
  42. This drug produces less interaction with ACH, therefore has more EPS:
    A. Haloperidol (Haldol)
    B. Thioridazine (Mellaril)
    • A. Haloperidol (Haldol)
    • -it selectively blocks dopamine receptors
  43. This drug has relatively strong anticholinergic effects, so therefore counteracts the EP side effects:
    A. Haloperidol (Haldol)
    B. Thioridazine (Mellaril)
    B. Thioridazine (Mellaril)
  44. T/F: Haloperidol does not produce many of the serious side effects occasionally observed in patients taking phenothiazines, but it cuases parkinsonian motor movements that are of the same or greater intensity as those induced by the high-potency phenothiazines.
    True
  45. The two classes of typical neuroleptics include:
    • 1. Butyrophenones (Haloperidol)
    • 2. Phenothiazines (Chloropromazine/Thorazine and Thioridazine/Mellaril)
  46. Which class of typical neuroleptics is more commonly used?
    1. Butyrophenones
    2. Phenothiazines
    2. Phenothiazines (less motor/parkinsonian effects)
  47. In addition to D2 receptors, waht are some other receptors that Phenothiazines block?
    • Acetylcholine receptors->dry mouth
    • NE receptors-> hypotension/sedation
    • histamine receptors-> sedation
  48. How do phenothiazines affect the pituitary gland?
    they reduce the amount of hormones released--> affects sex hormones. In men- ejaculation may be blocked; in women libido may be decresaed, ovulation may be blocked and normal menstrual cycles can be supressed
  49. What is the risk of dependency for phenothiazines?
    Low- they are not prone to compulsive abuse; they do not produce tolerance, physical dependence or psychological dependence.
  50. What are the 3 classes anti-D2 typical antipsychotics?
    • 1. Thioxanthines (thiothixines (Navane)
    • 2. Dibenzoxazeprine (loxapine (Loxitane)
    • 3. Dihydroindolone (molindone (Moban)
  51. Though the anti-DA typical antipsychotics have less antinoradrenergica nd antimuscarinic activity, are less assoc with sedation, hypotension and tachycardia and are useful as anti-emetics, what is a negative risk of the drugs?
    high incidence of extrapyramidial side effects
  52. In general, which drug class has fewer extrapyramidal side effects?
    A. typical antipsychotics
    B. atypical antipsychotics
    Atypical
  53. Which drug class is considered front line for newly diagnosed schizophrenia?
    A. typical antipsychotics
    B. atypical antipsychotics
    Atypical
  54. What is the biggest side effect of Clozapine (Clozaril)?
    Clozapine is an atypical antipsychotic that is only used for refractory schizo (if nothing else works). The major side effect of this drug is Agranulocytosis; and Leukopenia. Pt must get blook monitored weekl b/c it can be fatal.
  55. Which of these atypical antipsychotics is most freqently used?
    A. Clozapine (Clozaril)
    B. Risperidone (Risperdol)
    C. Olanzazine (Zyprexa)
    Olanzazine (Zyprexa)
  56. Involuntary movements of tongue, quivering lips and jaw and/or spasms of the limbs and body trunk are defined as:
    A. Parkinson-like syndrome
    B. Tardive dyskinesia
    C. Dystonic reactions
    D. Akathisia
    B. Tardive dyskinesia
    (this multiple choice question has been scrambled)
  57. Pacing or restlessness is called:
    A. Parkinson-like syndrome
    B. Dystonic reactions
    C. Akathisia
    D. Tardive dyskinesia
    C. Akathisia
    (this multiple choice question has been scrambled)
  58. Spasms of muscles of tongue and/or face, neck, and eyes is called:
    A. Tardive dyskinesia
    B. Akathisia
    C. Dystonic reactions
    D. Parkinson-like syndrome
    C. Dystonic reactions
    (this multiple choice question has been scrambled)
  59. What hormone does Dopamine inhibit the release of from the pituitary gland?
    • Prolactin (therefore if you have D2 receptor blockers, more prolactin is made and will have side effects such as:
    • -Gynecomastia (breast enlargement)
    • -Lactation (galactorrhea)
    • -amenorrhea
    • -pseudopregnancy
    • -weight gain
  60. Anticholinergic (M1) blockage is associated with what dental implication?
    dry mouth
  61. What are the 3 main dental implications of Schizo?
    • Advanced dental disease is seen freq in patients with schizo for several reasons:
    • 1. the disease impairs ability to plan and perform oral hygiene procedures
    • 2. some of the antipsychotic meds have adverse effects such as xerostomia or dry mouth
    • 3. limited access to tx bc of lack of financial resources and adequate number of dentists comfortable providing care
  62. What does the neruoleptic malignant syndrome consist of?
    Hyperthermia, muscular rigidity, autonomic dysfunction and fluctuating levels of consciousness. It is an allergic reaction to an antipsychotic.

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