Adverse Events -Antipsychotics- Maudsley Flashcards
Antipsychotic (AP) with least sedation? (Very low -)
Amisulpride -
Aripiprazole -
AP with most sedation ( High incidence +++)
Clozapine +++
AP with some moderate sedation
Olanzapine ++
Quetiapine ++
Zuclopenthixol ++
AP with Most weight gain AEs
Clozapie +++
Olanzapie +++
AP with Least weight gain
Aripiprazole +/-
AP with with moderate weight gain
Zuclopenthixol ++
Risperidone ++
Quetiapine ++
Paliperidone ++
Flupentixole ++
Chlopromazine ++
AP with +++ for diabetes?
Clozapine +++
Olanzapine +++
AP with ++ (moderare incidence) of diabetes
Quetiapine
AP with - (very low) incidence of diabetes
Aripirazole (Aro30)
Pimozide
AP with +++ of EPSE
Haloperidol +++
Fluphenazin +++
AP with ++ of EPSE
Zuclopenthixol ++
Flupentixol ++
AP with - of EPSE
Clozapine
AP with +++ of anticholinergic AEs (Adverse events)
Clozapine
AP with - anticholinergic
Aripiprazole (Aro30)
Asenapine
Amisulpride (I miss 1200)
AP with - (very low incidence) of postural hypotension
Amisulpride ( I miss 1200) -
Asenapine -
Aripiprazole (Aro30) -
AP with High incidence (+++) of postural hypotension
Clozapine (900 clues open)
Most commonly shared AEs in 1st gen APs
Prolactine elevation
AP with - of prolactine elevation?
Quetiapine
Likely cause for weight gain in AP
Increase appetite and decreased activity
Mechanisms behind inc. in weight after taking APs:
***Increase in
Ghrelin
Leptin
Prolactin
***Antagonism of
D2 &D3
2A &2C (5-HT)
H1 &M3
Management of weight gain according to Maudsley
Calorie restriction
low glycemic index
Exercise
What if exercise and food restriction did not work in AP induced weight gain?
Aripiprazol
Ziprasidone
Lurasidone
Additional recommendation for AP induced weight gain
_Aripiprazole augmentation
_Metformin
_Orlistat
_Liraglutide
_Topiramate
When aripirazole augment is recommended in AP induced weight gain?
In Olan and Clozapine induced weight gain
When Liraglutde is recommended for AP induced weight gain?
For clozapine induced weight gain
Rate of Tardive dyskinesia (TD) affecting face (typically)
3/4
Rate of Tardive dyskinesia (TD) affecting trunk (typically)
1/4
Rate of Tardive dyskinesia affecting Limb (typically)
1/2
Effect of emotional arousal on Tardive Dyskinesia
Increase
Effect of relaxation on TD
decrease
Effect of sleep on TD
disappear
Effect of Voluntary Muscle Movement on TD
decrease
Effect of mental arithmetic on TD
worsen
True or false
Increase dose of neuroleptic may lessen the TD severity
True
True or False
Anticholinergics will make TD worse
True
when does TD starts after start of neuroleptics
months to years
when can TD start earlier after initiation of neuroleptics?
in elderly in a month
is it possible for TD to occur in treatment naive schizophrenia patient?
yes
significance of TD in Rx naive schizophrenia?
might be a symptom of schizo pathology
Course of TD
fluctuating with some spontaneous remission
Effect of reduction in psychotic drugs (sometimes)
unmasking TD
Most persistent hypothesis for TD development
Post synaptic D2 hypersensitivity
other hypothesis for TD development
Cholinergic interneuron burnout hypothesis
Presynaptic dopaminergic/noradrenergic hyperactivity
Excitatory/oxidative stress hypothesis
Synaptic plasticity hypothesis
non-modifiable Risk factors for TD
Advance Age
Female
Ethnicity (white and africans)
Longer illness duration
Intellectual disability
Brain damage
Negative symptoms in schizophrenia
Mood disorders
Modifiable risk factors for TD
Diabetes
Smoking
Alcohol & subs. misuse
FGA vs SGA Rx
Higher antipsychotic dose
akathisia
Rx of TD
stop anticholinergic - poor support by evidence
Reduce antipsychotics - poor support by envidence
Change to safe antipsychotic
which antipsychotic is safer for TD?
Clozapine
alternative to clozapine for antipsychotics safe for TD
Olan, QUe and Aripiprazole
addon options to Rx TD
Tetrabenazine
Vitamin E
Amantadine (RareEly used but affective)
what do evidence show about vitamin E in Rx of TD?
slowing the rate
what is tertrabenzine?
VMAT-2 inhibitor
vesicular monoamine transporter inhibitor
where is tetrabenazine is used ?
chorea in huntington
what do VMAT-2 inhibitors do?
depletion of dopamine in nerve terminals
the only Rx licensed for TD in the UK
tetrabenazin
