NURS 660 Exam 1- Antipsychotic
Medications
3 classes of classical/ FGA - answer1) phenothiazines
2) thioxanthenes
3) butyrophenones
prototypical SGA - answerclozapine
chlorpromazine (THORAZINE) - answer-lowest potentcy antipsychotic
-significant alpha-1 adrenergic blockade --> sedation, hypotention
-DA blockage in basal ganglia --> EPS
classic example of butyrophenone (FGA) - answer haloperidol (HALDOL)
haloperiol (HALDOL) - answer-potent D2 blockade --> acute treatment of psychosis
-high EPS, sedation
-less weight gain, anticholinergic effects, hypotension
drug usually used to treat acute psychotic episodes - answerhaloperidol (HALDOL)
first generation antipsychotics block what receptors? - answerblock D2 receptors-
therapeutic efficacy correlates with D2 blockade
which antipsychotics alleviate mainly positive symptoms, and carry higher risk of EPS
and tardive dyskinesia with high doses and long-term use - answerfirst generation/
typical antipsychotics
-haloperidol
-chlorpromazine
SGA have greater affinity for which receptors - answer-affinity for serotonin >>
dopamine
SGA characteristics - answer-block more than 1 type of receptor
-help positive and negative sxs
-improve cognitive fx
-less EPS/TD
SGA/ atypical (5+) - answer1) clozapine (CLOZARIL)
2) risperidone (RIPERDAL)
3) olanzapine (ZYPREXA)
, 4) quetiapine (SEROQUEL)
5) ziprasidone (GEODON)
unique MOA of aripiprazole (ABILIFY) - answeracts as partial agonist of D2 receptors -
stabilizes DA hyperactivity and hypoactivity
at what receptors/ areas does aripiprazole act as an agonist? - answer-at presynaptic
D2 receptors
-in regions where DA is low -- PFC in SCZ
at what receptors/ areas does aripiprazole act as an ANTagonist? - answer-at
postsynaptic D2 receptors
-in regions where DA is high -- limbic regions in SCZ
in what brain regions are DA levels ELEVATED in SZC patients? - answerlimbic
regions/ subcortical areas (remove inhibitory control of GABA --> positive symptoms
in what brain regions are DA levels REDUCED in SZC patients - answerPFC -->
negative symptoms
key antipsychotic side effects (9) - answer1) EPS (TD)
2) metabolic (weight, lipids, DM)
3) cardiac (QT prolongation)
4) endocrine (hyperprolactinemia)
5) adrenergic (orthostasis)
6) anticholinergic
7) antihistaminergic
8) akathisia (restlessness)
9) neuroleptic malignant syndrome (muscular rigidity, fever- fatality)
nigrostriatal pathway and dopamine effects (SCZ) - answernormal fx = voluntary
movement
D2 receptor blockage = EPS
mesolimbic pathways and dopmaine effects (SCZ) - answernormal fx = arousal,
memory, motivation
excess DA = positive sxs
D2 blockage = resolution of psychosis
mesocortical pathways and dopamine effects (SCZ) - answernormal fx = cognition,
communication, stress, social fxing
hypoDA = negative sxs
FGAs may worsen negative sxs through this pathway more than SGA (5HT
antagonism)
Medications
3 classes of classical/ FGA - answer1) phenothiazines
2) thioxanthenes
3) butyrophenones
prototypical SGA - answerclozapine
chlorpromazine (THORAZINE) - answer-lowest potentcy antipsychotic
-significant alpha-1 adrenergic blockade --> sedation, hypotention
-DA blockage in basal ganglia --> EPS
classic example of butyrophenone (FGA) - answer haloperidol (HALDOL)
haloperiol (HALDOL) - answer-potent D2 blockade --> acute treatment of psychosis
-high EPS, sedation
-less weight gain, anticholinergic effects, hypotension
drug usually used to treat acute psychotic episodes - answerhaloperidol (HALDOL)
first generation antipsychotics block what receptors? - answerblock D2 receptors-
therapeutic efficacy correlates with D2 blockade
which antipsychotics alleviate mainly positive symptoms, and carry higher risk of EPS
and tardive dyskinesia with high doses and long-term use - answerfirst generation/
typical antipsychotics
-haloperidol
-chlorpromazine
SGA have greater affinity for which receptors - answer-affinity for serotonin >>
dopamine
SGA characteristics - answer-block more than 1 type of receptor
-help positive and negative sxs
-improve cognitive fx
-less EPS/TD
SGA/ atypical (5+) - answer1) clozapine (CLOZARIL)
2) risperidone (RIPERDAL)
3) olanzapine (ZYPREXA)
, 4) quetiapine (SEROQUEL)
5) ziprasidone (GEODON)
unique MOA of aripiprazole (ABILIFY) - answeracts as partial agonist of D2 receptors -
stabilizes DA hyperactivity and hypoactivity
at what receptors/ areas does aripiprazole act as an agonist? - answer-at presynaptic
D2 receptors
-in regions where DA is low -- PFC in SCZ
at what receptors/ areas does aripiprazole act as an ANTagonist? - answer-at
postsynaptic D2 receptors
-in regions where DA is high -- limbic regions in SCZ
in what brain regions are DA levels ELEVATED in SZC patients? - answerlimbic
regions/ subcortical areas (remove inhibitory control of GABA --> positive symptoms
in what brain regions are DA levels REDUCED in SZC patients - answerPFC -->
negative symptoms
key antipsychotic side effects (9) - answer1) EPS (TD)
2) metabolic (weight, lipids, DM)
3) cardiac (QT prolongation)
4) endocrine (hyperprolactinemia)
5) adrenergic (orthostasis)
6) anticholinergic
7) antihistaminergic
8) akathisia (restlessness)
9) neuroleptic malignant syndrome (muscular rigidity, fever- fatality)
nigrostriatal pathway and dopamine effects (SCZ) - answernormal fx = voluntary
movement
D2 receptor blockage = EPS
mesolimbic pathways and dopmaine effects (SCZ) - answernormal fx = arousal,
memory, motivation
excess DA = positive sxs
D2 blockage = resolution of psychosis
mesocortical pathways and dopamine effects (SCZ) - answernormal fx = cognition,
communication, stress, social fxing
hypoDA = negative sxs
FGAs may worsen negative sxs through this pathway more than SGA (5HT
antagonism)
