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MRCPSYCH_Paper B_MENTOR & More_Dr. ART > Adverse Events -Antipsychotics- Maudsley > Flashcards

Adverse Events -Antipsychotics- Maudsley Flashcards

1
Q

Antipsychotic (AP) with least sedation? (Very low -)

A

Amisulpride -

Aripiprazole -

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2
Q

AP with most sedation ( High incidence +++)

A

Clozapine +++

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3
Q

AP with some moderate sedation

A

Olanzapine ++
Quetiapine ++
Zuclopenthixol ++

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4
Q

AP with Most weight gain AEs

A

Clozapie +++
Olanzapie +++

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5
Q

AP with Least weight gain

A

Aripiprazole +/-

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6
Q

AP with with moderate weight gain

A

Zuclopenthixol ++
Risperidone ++
Quetiapine ++
Paliperidone ++
Flupentixole ++
Chlopromazine ++

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7
Q

AP with +++ for diabetes?

A

Clozapine +++
Olanzapine +++

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8
Q

AP with ++ (moderare incidence) of diabetes

A

Quetiapine

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9
Q

AP with - (very low) incidence of diabetes

A

Aripirazole (Aro30)
Pimozide

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10
Q

AP with +++ of EPSE

A

Haloperidol +++
Fluphenazin +++

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11
Q

AP with ++ of EPSE

A

Zuclopenthixol ++
Flupentixol ++

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12
Q

AP with - of EPSE

A

Clozapine

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13
Q

AP with +++ of anticholinergic AEs (Adverse events)

A

Clozapine

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14
Q

AP with - anticholinergic

A

Aripiprazole (Aro30)
Asenapine
Amisulpride (I miss 1200)

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15
Q

AP with - (very low incidence) of postural hypotension

A

Amisulpride ( I miss 1200) -
Asenapine -
Aripiprazole (Aro30) -

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16
Q

AP with High incidence (+++) of postural hypotension

A

Clozapine (900 clues open)

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17
Q

Most commonly shared AEs in 1st gen APs

A

Prolactine elevation

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18
Q

AP with - of prolactine elevation?

A

Quetiapine

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19
Q

Likely cause for weight gain in AP

A

Increase appetite and decreased activity

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20
Q

Mechanisms behind inc. in weight after taking APs:

A

***Increase in

Ghrelin
Leptin
Prolactin

***Antagonism of
D2 &D3
2A &2C (5-HT)
H1 &M3

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21
Q

Management of weight gain according to Maudsley

A

Calorie restriction
low glycemic index
Exercise

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22
Q

What if exercise and food restriction did not work in AP induced weight gain?

A

Aripiprazol
Ziprasidone
Lurasidone

23
Q

Additional recommendation for AP induced weight gain

A

_Aripiprazole augmentation
_Metformin
_Orlistat
_Liraglutide
_Topiramate

24
Q

When aripirazole augment is recommended in AP induced weight gain?

A

In Olan and Clozapine induced weight gain

25
Q

When Liraglutde is recommended for AP induced weight gain?

A

For clozapine induced weight gain

26
Q

Rate of Tardive dyskinesia (TD) affecting face (typically)

A

3/4

27
Q

Rate of Tardive dyskinesia (TD) affecting trunk (typically)

A

1/4

28
Q

Rate of Tardive dyskinesia affecting Limb (typically)

A

1/2

29
Q

Effect of emotional arousal on Tardive Dyskinesia

A

Increase

30
Q

Effect of relaxation on TD

A

decrease

31
Q

Effect of sleep on TD

A

disappear

32
Q

Effect of Voluntary Muscle Movement on TD

A

decrease

33
Q

Effect of mental arithmetic on TD

A

worsen

34
Q

True or false

Increase dose of neuroleptic may lessen the TD severity

A

True

35
Q

True or False
Anticholinergics will make TD worse

A

True

36
Q

when does TD starts after start of neuroleptics

A

months to years

37
Q

when can TD start earlier after initiation of neuroleptics?

A

in elderly in a month

38
Q

is it possible for TD to occur in treatment naive schizophrenia patient?

A

yes

39
Q

significance of TD in Rx naive schizophrenia?

A

might be a symptom of schizo pathology

40
Q

Course of TD

A

fluctuating with some spontaneous remission

41
Q

Effect of reduction in psychotic drugs (sometimes)

A

unmasking TD

42
Q

Most persistent hypothesis for TD development

A

Post synaptic D2 hypersensitivity

43
Q

other hypothesis for TD development

A

Cholinergic interneuron burnout hypothesis
Presynaptic dopaminergic/noradrenergic hyperactivity
Excitatory/oxidative stress hypothesis
Synaptic plasticity hypothesis

44
Q

non-modifiable Risk factors for TD

A

Advance Age
Female
Ethnicity (white and africans)
Longer illness duration
Intellectual disability
Brain damage
Negative symptoms in schizophrenia
Mood disorders

45
Q

Modifiable risk factors for TD

A

Diabetes
Smoking
Alcohol & subs. misuse
FGA vs SGA Rx
Higher antipsychotic dose
akathisia

46
Q

Rx of TD

A

stop anticholinergic - poor support by evidence
Reduce antipsychotics - poor support by envidence
Change to safe antipsychotic

47
Q

which antipsychotic is safer for TD?

A

Clozapine

48
Q

alternative to clozapine for antipsychotics safe for TD

A

Olan, QUe and Aripiprazole

49
Q

addon options to Rx TD

A

Tetrabenazine
Vitamin E
Amantadine (RareEly used but affective)

50
Q

what do evidence show about vitamin E in Rx of TD?

A

slowing the rate

51
Q

what is tertrabenzine?

A

VMAT-2 inhibitor
vesicular monoamine transporter inhibitor

52
Q

where is tetrabenazine is used ?

A

chorea in huntington

53
Q

what do VMAT-2 inhibitors do?

A

depletion of dopamine in nerve terminals

54
Q

the only Rx licensed for TD in the UK

A

tetrabenazin

MRCPSYCH_Paper B_MENTOR & More_Dr. ART (69 decks)

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