Neuroleptic Drugs Overview
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Questions and Answers

Which of the following best describes the mechanism of action of traditional neuroleptics in treating schizophrenia?

  • Increasing dopamine levels in the brain
  • Blocking dopamine receptors (correct)
  • Stimulating acetylcholine release
  • Blocking serotonin receptors

    • Which of the following drugs is an atypical neuroleptic?

  • Fluphenazine
  • Haloperidol
  • Risperidone (correct)
  • Chlorpromazine

    • Which of the following is a negative symptom of schizophrenia?

  • Emotional blunting (correct)
  • Hallucinations
  • Delusions
  • Paranoia

    • Which of the following drugs is most likely to induce psychosis when administered?

    <p>Amphetamine (D)</p> Signup and view all the answers

    What is the primary anatomical difference observed in the brains of individuals with schizophrenia?

    <p>Enlarged cerebral ventricles (A)</p> Signup and view all the answers

    Which of the following is NOT a typical neuroleptic (traditional antipsychotic)?

    <p>Olanzapine (A)</p> Signup and view all the answers

    Which of the following is a potential adverse effect associated with the use of typical neuroleptics?

    <p>Tardive dyskinesia (B)</p> Signup and view all the answers

    Which of the following statements regarding the efficacy of typical neuroleptics is TRUE?

    <p>All typical neuroleptics have the same efficacy in treating positive symptoms. (C)</p> Signup and view all the answers

    Which of the following antipsychotics is NOT associated with the development of tardive dyskinesia?

    <p>Clozapine (C)</p> Signup and view all the answers

    Which of the following is a common symptom of neuroleptic malignant syndrome?

    <p>Hypotension (A)</p> Signup and view all the answers

    A patient on an antipsychotic medication develops involuntary movements, including jaw movements and tongue protrusions. Which of the following is the most likely diagnosis?

    <p>Tardive dyskinesia (C)</p> Signup and view all the answers

    Which of the following anticholinergic medications is used to treat acute dystonia?

    <p>Benztropine (A)</p> Signup and view all the answers

    A patient on lithium experiences polyuria, polydipsia, and tremors. What is the most likely explanation for these symptoms?

    <p>Lithium toxicity (A)</p> Signup and view all the answers

    Which of the following medications is NOT typically used for the management of acute mania?

    <p>Lamotrigine (A)</p> Signup and view all the answers

    Which of the following antipsychotic medications is associated with the risk of agranulocytosis?

    <p>Clozapine (B)</p> Signup and view all the answers

    What is the primary mechanism of action of lithium in treating bipolar disorder?

    <p>Unknown (A)</p> Signup and view all the answers

    Which of the following is a potential adverse effect of chlorpromazine?

    <p>Photosensitivity (D)</p> Signup and view all the answers

    A patient on an antipsychotic medication experiences dry mouth, urinary retention, and constipation. What is the primary cause of these symptoms?

    <p>Anticholinergic effects (C)</p> Signup and view all the answers

    Which of the following medications can be used to reduce muscle rigidity associated with neuroleptic malignant syndrome?

    <p>Dantrolene (A)</p> Signup and view all the answers

    A patient on antipsychotic medication develops orthostatic hypotension and reflex tachycardia. What is the most likely explanation?

    <p>Alpha-adrenergic blockade (A)</p> Signup and view all the answers

    Which of the following drugs is contraindicated in patients with seizure disorders?

    <p>Chlorpromazine (B)</p> Signup and view all the answers

    What is the recommended maintenance treatment duration for patients who have experienced two or more schizophrenic episodes?

    <p>At least 5 years (C)</p> Signup and view all the answers

    Which of the following drugs can potentially exacerbate the adverse effects of antipsychotic medications due to additive anticholinergic effects?

    <p>Tricyclic antidepressants (C)</p> Signup and view all the answers

    Which of the following is a potential side effect of lithium therapy?

    <p>Hypothyroidism (C)</p> Signup and view all the answers

    Which of the following atypical antipsychotics is specifically indicated for reducing the risk of suicide in schizophrenic patients?

    <p>Clozapine (D)</p> Signup and view all the answers

    Which neuroleptic drug is associated with retinal deposits and the potential for fatal ventricular arrhythmias at high doses?

    <p>Thioridazine (D)</p> Signup and view all the answers

    Which atypical antipsychotic is known to have the highest affinity for the D4 receptor, potentially explaining its reduced extrapyramidal side effects?

    <p>Clozapine (A)</p> Signup and view all the answers

    Which of the following are side effects commonly associated with atypical antipsychotics? (Select all that apply)

    <p>Agranulocytosis (B), Weight Gain (C), Prolonged QT Interval (D)</p> Signup and view all the answers

    What is the primary mechanism of action for most neuroleptic drugs in treating schizophrenia?

    <p>Blocking dopamine receptors in the mesolimbic system (C)</p> Signup and view all the answers

    Which of the following drugs is NOT an atypical antipsychotic?

    <p>Haloperidol (B)</p> Signup and view all the answers

    Which of the following statements is TRUE regarding the therapeutic uses of neuroleptic drugs?

    <p>They can be used to manage agitated and disruptive behavior in addition to treating schizophrenia. (B)</p> Signup and view all the answers

    What is the primary mechanism by which neuroleptic drugs reduce the positive symptoms of schizophrenia?

    <p>By blocking dopamine receptors in the mesolimbic system (D)</p> Signup and view all the answers

    Which of the following is a common side effect of blocking alpha-adrenergic receptors by neuroleptic drugs?

    <p>Orthostatic hypotension (B)</p> Signup and view all the answers

    Which atypical antipsychotic is known to cause the most significant weight gain and potentially increase the risk of diabetes mellitus?

    <p>Olanzapine (A)</p> Signup and view all the answers

    Which neuroleptic drug is commonly used to treat intractable hiccups?

    <p>Chlorpromazine (C)</p> Signup and view all the answers

    Which of the following is NOT a typical antipsychotic drug?

    <p>Clozapine (A)</p> Signup and view all the answers

    Which of the following statements is TRUE regarding the metabolism of neuroleptic drugs?

    <p>They undergo significant first-pass metabolism in the liver. (A)</p> Signup and view all the answers

    Which neuroleptic drug is commonly used to treat the motor and phonic tics of Tourette Syndrome?

    <p>Pimozide (D)</p> Signup and view all the answers

    What is the primary mechanism by which the neuroleptic drugs induce sedation?

    <p>By blocking histamine receptors (C)</p> Signup and view all the answers

    Which neuroleptic drug is available in a slow-release depot form?

    <p>Fluphenazine (A), Haloperidol (C)</p> Signup and view all the answers

    Flashcards

    Neuroleptic drugs

    Medications that block dopamine receptors to treat psychosis symptoms.

    Atypical neuroleptics

    Antipsychotics that cause fewer extrapyramidal side effects and target both positive and negative symptoms.

    Thioridazine

    A neuroleptic that can cause retinal deposits and fatal ventricular arrhythmias at high doses.

    Clozapine

    An atypical neuroleptic effective for treatment-resistant schizophrenia and reducing suicide risk.

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    Dopamine receptor blockade

    Primary mechanism of action for neuroleptic drugs affecting psychosis symptoms.

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    Serotonin receptor inhibition

    A possible action mechanism of atypical neuroleptics, improving mood and cognition.

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    Positive symptoms

    Symptoms of schizophrenia like hallucinations and delusions, responsive to antipsychotics.

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    Negative symptoms

    Symptoms of schizophrenia like apathy and lack of emotion, harder to treat.

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    Prolactin elevation

    Increased levels of prolactin caused by neuroleptic drugs blocking D2 receptors in the pituitary.

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    Orthostatic hypotension

    A drop in blood pressure when standing up, common side effect of neuroleptics.

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    Extrapyramidal side effects (EPS)

    Motor control symptoms like tremors or rigidity caused by neuroleptics's dopamine blocking.

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    Weight gain and diabetes

    Common side effects from using Clozapine and Olanzapine, contributing to metabolic syndrome.

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    Antimuscarinic effects

    Side effects including dry mouth and constipation due to neuroleptic-induced receptor blockade.

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    Long half-life (10-24 hours)

    Duration of action for many neuroleptic drugs, impacting dosing schedules.

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    First pass metabolism

    Initial liver metabolism reducing drug concentration before systemic circulation.

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    Low Potency Neuroleptics

    Neuroleptics that have lesser strength and include Chlorpromazine and Thioridazine.

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    High Potency Neuroleptics

    More potent neuroleptics used in treating schizophrenia like Fluphenazine and Haloperidol.

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    Positive Symptoms of Schizophrenia

    Symptoms that reflect an excess of normal functioning, such as hallucinations and delusions.

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    Negative Symptoms of Schizophrenia

    Symptoms characterized by a decrease in normal functions, like apathy and emotional blunting.

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    Extrapyramidal Symptoms (EPS)

    Movement disorders that occur as side effects of typical neuroleptics.

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    Neuroleptic Malignant Syndrome

    A severe reaction to neuroleptics, characterized by muscle rigidity and elevated CPK.

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    Adverse effects

    Negative reactions to medications, common in 80% of patients.

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    Extrapyramidal side effects

    Movement disorders like dystonias and akathisia from antipsychotics.

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    Cholinergic influence in antipsychotics

    Imbalance from blocked dopamine leading to excess cholinergic activity.

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    Tardive dyskinesia

    Involuntary movements occurring after prolonged antipsychotic use.

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    Acute dystonia

    Sudden and severe muscle spasms often early in treatment.

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    Akathisia

    A state of restless agitation caused by antipsychotics.

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    Parkinsonian-like syndrome

    Symptoms mimicking Parkinson's disease from antipsychotic use.

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    Clozapine's side effects

    May cause bone marrow depression and agranulocytosis.

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    Anticholinergic effects

    Side effects like dry mouth and constipation from blocking ACh.

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    Weight gain from neuroleptics

    Significant weight increase leading to treatment non-compliance.

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    Lithium side effects

    Toxicity includes tremors, confusion, and can impair thyroid function.

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    Drug interactions with antipsychotics

    Antipsychotics can enhance sedatives and potentiate anticholinergics.

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    Maintenance therapy for schizophrenia

    Recommended after multiple episodes, often lasting 5+ years.

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    Study Notes

    Neuroleptic Drugs

    • Classification: Neuroleptics are categorized into typical and atypical, based on their potency and side effect profiles.
    • Typical Neuroleptics (Low Potency): Chlorpromazine, Prochlorperazine, Promethazine, Thioridazine
    • Typical Neuroleptics (High Potency): Fluphenazine, Haloperidol, Pimozide, Thiothixene
    • Atypical Neuroleptics: Aripiprazole, Clozapine, Olanzapine, Quetiapine, Risperidone, Ziprasidone, Sertindole
    • Primary Use: Primarily for schizophrenia and other psychotic disorders (mania, delirium)
    • Typical Neuroleptic Mechanism: Block dopamine receptors. Potency varies (e.g., Chlorpromazine is low, Fluphenazine is high).
    • Atypical Neuroleptic Mechanism: Fewer extrapyramidal side effects (EPS). Appear to act by blocking serotonin receptors.
    • Psychosis-Producing Drugs: Levodopa, CNS stimulants (cocaine, amphetamines), apomorphine, phencyclidine, khat, cathinone, and methcathinone
    • Note: Atypical neuroleptics are generally more effective against negative symptoms and have better EPS profiles than typical neuroleptics.

    Schizophrenia

    • Characteristics: Delusions, hallucinations (often voices), disorganized thoughts/speech.
    • Positive Symptoms: Increased sensations: hallucinations, delusions, paranoia, ideas of reference
    • Negative Symptoms: Decreased sensations: apathy, social withdrawal, anhedonia, emotional blunting, cognitive deficits, lack of motivation
    • Prevalence: 1% of the population (similar to diabetes mellitus)
    • Etiology: Strong genetic component. Proposed cause is excess dopaminergic neurons.
    • Anatomy: Schizophrenics often display enlarged cerebral ventricles, cortical layer atrophy, and reduced basal ganglia volume.

    Typical Neuroleptics: Adverse Effects

    • Extrapyramidal Syndrome (EPS): Occurs at clinically effective doses.
    • Tardive Dyskinesia: Involuntary movements, often irreversible.
    • Neuroleptic Malignant Syndrome (NMS): Muscle rigidity, high fever, altered mental status, elevated CPK & WBC - potentially fatal. Treatment involves neuroleptic withdrawal, cooling, dantrolene, or bromocriptine.
    • Prolactin Elevation: Possible gynecomastia, galactorrhea.
    • Thioridazine: Retinal deposits, potentially fatal ventricular arrhythmias at high doses.
    • Sertindole: Prolonged QT interval, potential arrhythmias.
    • Weight Gain: A common side effect.

    Atypical Neuroleptics: Adverse Effects & Benefits

    • EPS: Generally less frequent than typical neuroleptics
    • Weight Gain: Common.
    • Improved Negative Symptoms: More effective in treating negative symptoms.
    • Cognitive Improvements: Some.
    • D2/D1 antagonism: Balanced dopamine receptor blockage.
    • 5-HT2 antagonism: Action through blocking serotonin receptors.
    • Clozapine: Significant risk of agranulocytosis (blood dyscrasias), but effective in treatment-resistant cases, and indicated for suicide risk reduction.
    • Other atypical neuroleptics: Olanzapine and risperidone are suitable for bipolar disorder adjunctive therapy with lithium; Quetiapine, lurasidone, and olanzapine with fluoxetine are also for bipolar disorder; low doses are for agitation in Alzheimer's/Parkinson's; aripiprazole for major depression; injections for agitation control in bipolar or schizophrenia.

    Neuroleptic Drugs: General Mechanism & Actions

    • Mechanism of Action: Block dopamine receptors in brain and periphery, primarily D2 receptors in the mesolimbic system. Atypical agents also affect serotonin receptors.
    • Actions: Reduce hallucinations, delusions (positive symptoms). Less effective on negative symptoms, but some atypical drugs ameliorate. Anti-anxiety effect, and reduced spontaneous movement.
    • Adverse Effects: Include anticholinergic effects (dry mouth, constipation, urinary retention), alpha-adrenergic blockade (orthostatic hypotension), histamine blockade (sedation), hyperprolactinemia, and temperature dysregulation, and weight gain in many cases
    • Therapeutic Uses: Schizophrenia, prevention of severe vomiting/nausea, agitation control, chronic pain, intractable hiccups, Tourette's, Alzheimer's behavioural disturbances.
    • Absorption/Metabolism: Oral administration, significant first-pass metabolism, long half-lives, active metabolites in some cases
    • Tolerance/Dependence: Some tolerance, little physical dependence

    Treatment of Mania and Bipolar disorder

    • Lithium: Used for prophylactic treatment of manic disorders. Unknown mechanism. Very toxic, low therapeutic index, significant side effects (ataxia, tremor, confusion, polyuria).
    • Other Drugs: Carbamazepine, lamotrigine, valproic acid, and calcium channel blockers (CCBs) can also be useful in treating or preventing mania. Some antipsychotics are also approved for bipolar disorders (Aripiprazole, olanzapine, quetiapine, risperidone, and ziprasidone).

    Overdose & Interactions

    • Overdose: Rarely fatal, but potential for significant adverse effects.
    • Drug Interactions: May potentiate sedative effects with other CNS depressants. Increase anticholinergic effects with other drugs with anticholinergic activity.

    Adverse effects summaries

    • Extrapyramidal side effects arise from disrupted dopamine-acetylcholine balance. First-generation agents have a high risk.
    • Tardive dyskinesia is characterized by involuntary movements and generally occurs after months/years of use; it is frequently irreversible.
    • Neuroleptic malignant syndrome is a severe, potentially fatal reaction characterized by muscle rigidity, fever, and altered mental status; requires immediate medical attention.
    • Other effects can include drowsiness, orthostatic hypotension, weight gain, sexual dysfunction, and hyperprolactinemia. Increased seizure risk and blood dyscrasias are specific concerns with certain drugs.

    Cautions and Contraindications

    • Avoid use in patients with seizure disorders (certain neuroleptics).
    • Consider long-term maintenance therapy for recurrent schizophrenic episodes.

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    Description

    This quiz covers the classification and mechanisms of neuroleptic drugs, detailing typical and atypical types. It focuses on their primary uses for treating schizophrenia and psychosis, as well as their effects on dopamine and serotonin receptors. Test your knowledge of these essential psychiatric medications.

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