Anti-psychotics Flashcards
What types of AP are there?
Typical (First generation)
Atypical (Second generation)
How do AP work?
block dopamine-2 receptors in the brain
They can also have significant effects on acetylcholine, histamine, norepinephrine, and serotonin pathways.
They can cause extrapyramidal symptoms (EPS) and a wide range of other adverse effects.
Which generation AP is associated with fewer EPS?
Second-generation AP, however are associated with weight gain, glucose intolerance, and hyperprolactinaemia
What are first lines?
second-generation antipsychotics (for example olanzapine, risperidone, or quetiapine) - due to lower EPS
Oral first-generation (typical)
Benperidol
Chlorpromazine
Flupenthixol
Haloperidol
Levomepromazine
Pericyazine
Perphenazine
Pimozide
Prochlorperazine
Promazine
Sulpiride
Trifluoperazine
Zuclopenthixol
Oral second-generation (atypical)
Amisulpride
Aripiprazole
Clozapine
Olanzapine
Paliperidone
Quetiapine
Risperidone
What to do if adverse effects is experienced with AP?
dose reduction or switching drugs
Examples of adverse effects?
EPS Weight gain Dyslipidaemia Hyperlactinaemia Sedation Sleep apnoea syndrome Anticholinergic effect - dry mouth, blurred vision, urinary retention, constipation Postural hypo-tension Hypertension Reduced seizure threshold QT interval prolongation Stroke risk VTE Neuroleptic malignant syndrome Pneumonia Neutropenia Abnormal LFTs Photo-sensitivity Misuse and abuse
What are some cautions with quetiapine?
It should be prescribed with caution in people who have a history of drug or alcohol abuse
Weight gain and dyslipidaemia - give lifestyle advice
Sleep apnoea syndrome - used with caution in people receiving concomitant central nervous system depressants and who have a history of, or are at risk for, sleep apnoea, such as those who are overweight/obese or are male
Quetiapine should be used with caution in peeple taking other drugs with anticholinergic effects
Postural hypotension
hypertension
Hyperglycaemia
What is hyperprolactinaemia?
most antipsychotics can cause hyperprolactenaemia that may lead to galactorrhoea, amenorrhoea, gynaecomastia, hypogonadism, sexual dysfunction, and an increased risk of osteoporosis. Clozapine, olanzapine, quetiapine, and aripiprazole do not increase prolactin above the normal range in standard doses.
Clozapine
Weight gain, dyslipidaemia sedation Anticholinergic effect Postural hypotension Hypertension Reduced seizure threshold Hyperglycemia and smt diabetes
Stopping smoking
Smoking induces the metabolism of olanzapine and clozapine. If the person stops smoking, monitor for increased adverse effects and seek advice about dose adjustment if necessar
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs increase levels of some antipsychotics, for example:
Haloperidol levels are increased by 20–30% by fluoxetine and by 20–60% by fluvoxamine.
Risperidone levels are increased by fluvoxamine, fluoxetine, and paroxetine.
Sertindole levels are increased two- to three-fold by fluoxetine and paroxetine.
Clozapine and olanzapine levels are increased by fluoxetine, fluvoxamine, paroxetine, sertraline, and possibly citalopram.
Where antipsychotic drug levels are increased, the person should be monitored and the dose adjusted accordingly.
Grapefruit juice
Advise the person not to drink grapefruit juice if they are taking pimozide. Grapefruit juice increases the levels of pimozide, possibly leading to torsades de pointes potentially fatal arrhythmias.
Carbamazepine (AED)
Carbamazepine reduces plasma levels of clozapine, haloperidol, and risperidone by half. Carbamazepine also reduces levels of aripiprazole, fluphenazine, olanzapine, quetiapine, and sertindole.
Monitor the person’s symptoms to ensure that antipsychotics remain effective.
Carbamazepine levels are increased by haloperidol, quetiapine, or risperidone, or chlorpromazine with amoxapine.
Monitor carbamazepine levels if these drugs are given together.
