Psychopharm Exam I Study Guide
Antipsychotics
NOTE: Antipsychotics must occupy more than 80% of D2 receptors to cause EPS
Mesolimbic Pathway “reward/pleasure”
• Associated with positive symptoms of schizophrenia (i.e. hallucinations,
delusions etc)
Mesocortical Pathway
• Associated with the negative symptoms of Schizophrenia (i.e. cognition, affect,
apathy, behavior etc.)
Tuberoinfundibular Pathway
• Note: Dopamine inhibits prolactin.
• Therefore, blockade of dopamine= ↓DA= ↑ Prolactin
Nigrostriatal Pathway
• Blockade of DA in this pathway produces increased motor movements
e.g. EPS (Pseudo parkinsonism, Akathisia, dystonia & TD)
Neurotransmitters:
↑Dopamine in the mesolimbic area
↓Dopamine activity in the Mesocortical area
↓Serotonin (down regulation) in the frontal cortex
**Antipsychotic polypharmacy can increase the risk of or re-hospitalization, diabetes,
EPS, sedation, seizures, metabolic effects, mortality, and sudden cardiac death.
Positive Symptoms Negative Symptoms – 5As
Delusions (T,M) Affect (flat, constricted) (T,M)
Conceptual Alogia (absence of speech)
disorganization (T,M) (T,M)
Excitement Apathy/Avolition (T,M)
, Grandiosity (T,M) Attention (poor, lacking) (T,M)
Hostility (T,M) Anhedonia (T,M)
Hallucinations (T,M) Asociality
Cognitive Symptoms
*Low potency= Low EPS= High antiadrenergic, anticholinergic and antihistaminic s/e,
more lethal in overdose d/t QTC prolongation
*High potency= High EPS= Low antiadrenergic, anticholinergic and antihistaminic s/e
FGAs – manage positive symptoms of schizophrenia
Haloperidol (Haldol) – IM administration in Acute agitation or psychosis
FGA Side Effects:
QTC prolongation – obtain baseline EKG
Orthostasis- blockade of α1 receptors
Elevated liver enzymes, EPS (Akathisia, dystonia, Parkinsonism)
hyperprolactinemia - (decreased libido, galactorrhea, gynecomastia, impotence,
amenorrhea)
• Men= Gynecomastia, erectile dysfunction, low libido, galactorrhea
• Women = galactorrhea and absence of menses, low libido
EPS – due to alpha 1 blockade
Tardive dyskinesia – contraction of neck muscles – torticollis
**Mostly irreversible
-Risk factors: High doses, long duration, old age, women, hx of EPS,
substance abuse (heavy smoking), diabetes
-Management: benztropine (Cogentin); Dose reduction; D/C med;
switch to an atypical antipsychotic; Clonazepam, Amantidine,
Tetrabenazine.
Antipsychotics
NOTE: Antipsychotics must occupy more than 80% of D2 receptors to cause EPS
Mesolimbic Pathway “reward/pleasure”
• Associated with positive symptoms of schizophrenia (i.e. hallucinations,
delusions etc)
Mesocortical Pathway
• Associated with the negative symptoms of Schizophrenia (i.e. cognition, affect,
apathy, behavior etc.)
Tuberoinfundibular Pathway
• Note: Dopamine inhibits prolactin.
• Therefore, blockade of dopamine= ↓DA= ↑ Prolactin
Nigrostriatal Pathway
• Blockade of DA in this pathway produces increased motor movements
e.g. EPS (Pseudo parkinsonism, Akathisia, dystonia & TD)
Neurotransmitters:
↑Dopamine in the mesolimbic area
↓Dopamine activity in the Mesocortical area
↓Serotonin (down regulation) in the frontal cortex
**Antipsychotic polypharmacy can increase the risk of or re-hospitalization, diabetes,
EPS, sedation, seizures, metabolic effects, mortality, and sudden cardiac death.
Positive Symptoms Negative Symptoms – 5As
Delusions (T,M) Affect (flat, constricted) (T,M)
Conceptual Alogia (absence of speech)
disorganization (T,M) (T,M)
Excitement Apathy/Avolition (T,M)
, Grandiosity (T,M) Attention (poor, lacking) (T,M)
Hostility (T,M) Anhedonia (T,M)
Hallucinations (T,M) Asociality
Cognitive Symptoms
*Low potency= Low EPS= High antiadrenergic, anticholinergic and antihistaminic s/e,
more lethal in overdose d/t QTC prolongation
*High potency= High EPS= Low antiadrenergic, anticholinergic and antihistaminic s/e
FGAs – manage positive symptoms of schizophrenia
Haloperidol (Haldol) – IM administration in Acute agitation or psychosis
FGA Side Effects:
QTC prolongation – obtain baseline EKG
Orthostasis- blockade of α1 receptors
Elevated liver enzymes, EPS (Akathisia, dystonia, Parkinsonism)
hyperprolactinemia - (decreased libido, galactorrhea, gynecomastia, impotence,
amenorrhea)
• Men= Gynecomastia, erectile dysfunction, low libido, galactorrhea
• Women = galactorrhea and absence of menses, low libido
EPS – due to alpha 1 blockade
Tardive dyskinesia – contraction of neck muscles – torticollis
**Mostly irreversible
-Risk factors: High doses, long duration, old age, women, hx of EPS,
substance abuse (heavy smoking), diabetes
-Management: benztropine (Cogentin); Dose reduction; D/C med;
switch to an atypical antipsychotic; Clonazepam, Amantidine,
Tetrabenazine.
