Exam 2: MH701 / MH 701 (Latest
Update )
Psychopharmacologic / Neuroscience
Foundations of Mental Health Care
| Questions with Answers | 100%
Correct - Frontier
Question:
What are all the contraindications for use of 1st generation antipsychotics
Answer:
-Neuroleptic Malignant Syndrome
-Seizures (can lower seizure threshold)
-Especially
Hypotension and antihypertensives
-Cardiac arrhythmias
-Pregnancy (never in the first trimester) & Lactation
-Agranulocytosis - Decr granulocytes (incr risk of infection)
-Leukopenia - Decr WBC count, specifically neutrophils
,Question:
What are the positive therapeutic indications for 1st generation of
antipsychotics
Answer:
hallucinations and delusions, Borderline, Tourettes and Huntington's,
SEVERE AGITATION/VIOLENCE: (Repeat administration in children is
controversial)
Question:
NO FGA has been FDA approved for
Answer:
dementia-related agitation due to Incr risk of sudden death & CVA.
Question:
How many adverse reactions 1st generation of antipsychotics
Answer:
GAM = "God-Awful Many"
,Question:
Blocks Noradrenergic, Cholinergic and Histaminergic receptors effects
Answer:
-Noradrenergic - Prolonged atrial + ventricular conduction and refractory;
decrease cardiac contractility. Low potency is worse than high potency.
Prolonged QTc and Torsades/sudden death
Anti-Alpha 1 effects: Postural hypotension
-Cholinergic: Dry mouth, constipation, urinary retention, agitation,
disorientation, hallucinations, seizures, high fever, dilated pupils, stupor,
coma - Physostigmine to treat, w/ caution
-Histaminergic: sedation (H1 blocking effect) - Chlorpromazine/Thorazine is
most sedating
, Question:
Ways Neuroleptics Affects 4 pathways: ---Mesocortical, Mesolimbic,
Nigrostriatal, and Tuberoinfundibular pathways
Answer:
Mesocortical - worsen negative symptoms of cognitive impairment, blunted
emotions, social ...
Mesolimbic - Antipsychotic effects block hallucinations, delusions, and
agitation (positive sx) - what we want!
Nigrostriatal - EPS: Parkinson-like S.E. and Tardive Dyskinesia
-Acute dystonia - (hours to days after initiation) - acute muscle contractions
-Akathisia - (days to weeks ...) restless, jittery, like a caffeine rush
-Parkinsonism - (weeks to months ... ) tremor, cog-wheel rigidity, hypokinesia
-Tardive Dyskinesia - (months to years ...) hyperkinesis, perioral movements
-TD is IRREVERSIBLE - risk increases 3% every year patient is on the drug
Tuberoinfundibular- Dopamine acts as Prolactin-inhibiting factor; D2 block
increases prolactin levels = gynecomastia, sexual S.E., osteoporosis,
amenorrhea, galactorrhea
Update )
Psychopharmacologic / Neuroscience
Foundations of Mental Health Care
| Questions with Answers | 100%
Correct - Frontier
Question:
What are all the contraindications for use of 1st generation antipsychotics
Answer:
-Neuroleptic Malignant Syndrome
-Seizures (can lower seizure threshold)
-Especially
Hypotension and antihypertensives
-Cardiac arrhythmias
-Pregnancy (never in the first trimester) & Lactation
-Agranulocytosis - Decr granulocytes (incr risk of infection)
-Leukopenia - Decr WBC count, specifically neutrophils
,Question:
What are the positive therapeutic indications for 1st generation of
antipsychotics
Answer:
hallucinations and delusions, Borderline, Tourettes and Huntington's,
SEVERE AGITATION/VIOLENCE: (Repeat administration in children is
controversial)
Question:
NO FGA has been FDA approved for
Answer:
dementia-related agitation due to Incr risk of sudden death & CVA.
Question:
How many adverse reactions 1st generation of antipsychotics
Answer:
GAM = "God-Awful Many"
,Question:
Blocks Noradrenergic, Cholinergic and Histaminergic receptors effects
Answer:
-Noradrenergic - Prolonged atrial + ventricular conduction and refractory;
decrease cardiac contractility. Low potency is worse than high potency.
Prolonged QTc and Torsades/sudden death
Anti-Alpha 1 effects: Postural hypotension
-Cholinergic: Dry mouth, constipation, urinary retention, agitation,
disorientation, hallucinations, seizures, high fever, dilated pupils, stupor,
coma - Physostigmine to treat, w/ caution
-Histaminergic: sedation (H1 blocking effect) - Chlorpromazine/Thorazine is
most sedating
, Question:
Ways Neuroleptics Affects 4 pathways: ---Mesocortical, Mesolimbic,
Nigrostriatal, and Tuberoinfundibular pathways
Answer:
Mesocortical - worsen negative symptoms of cognitive impairment, blunted
emotions, social ...
Mesolimbic - Antipsychotic effects block hallucinations, delusions, and
agitation (positive sx) - what we want!
Nigrostriatal - EPS: Parkinson-like S.E. and Tardive Dyskinesia
-Acute dystonia - (hours to days after initiation) - acute muscle contractions
-Akathisia - (days to weeks ...) restless, jittery, like a caffeine rush
-Parkinsonism - (weeks to months ... ) tremor, cog-wheel rigidity, hypokinesia
-Tardive Dyskinesia - (months to years ...) hyperkinesis, perioral movements
-TD is IRREVERSIBLE - risk increases 3% every year patient is on the drug
Tuberoinfundibular- Dopamine acts as Prolactin-inhibiting factor; D2 block
increases prolactin levels = gynecomastia, sexual S.E., osteoporosis,
amenorrhea, galactorrhea
