Anti-psychotics Flashcards
How long do you treat schizophrenia with anti-psychotics?
1st episode >6months
2nd episode >1 year or more
3rd or 4th: indefinite
What is the major difference between typicals and atypicals?
Atypicals cause EPS at a much lower rate
What are the most used anti-psychotics?
Risperidone and Olanzapine
Quetiapine (seroquel)
Clozapine
Aripiprazole
What considerations must be made when using clozapine in terms of adverse affects?
Agranulocytosis - monitor FBE
Cardiomyopathy - Echo and ECG
What is advantage of depot use?
Forms reservoir in muscle and has prolonged effect
What must be done with lithium mx?
- Must have baseline TFT, ECG, UEC, FBE
- Repeat thyroid function every 6 months as lithium is antithyroid and nephrotoxic
- Must monitor plasma level of lithium as it’s renally excreted only and is nephrotoxic
What are the side effects of anti-psychotics?
North Pole SWEAT CAMPS
Neuroleptic malignant syndrome
Prolactinaemia
Sedation Weight gain EPS Anti-cholinergic or reflex hyper-cholinergic Tremors
Cardiac - QT prolongation, cardiomyopathy, myocarditis (Clozapine)
Agranulocytosis (Clozapine)
Metabolic syndrome
Postural hypotension
Seizures and effect of Smoking (Clozapine)
Which group of anti-psychotics put the patient at higher risk of metabolic syndrome?
Second generation
What are some anti-psychotics are better in terms of metabolic syndrome?
Which ones are worse?
Risperidone
Quetiapine
Aripirazole
Amisulpride
Clozapine
Olanzapine
How do you monitor patients on clozapine?
+/- Admission
18 weeks of FBEs
1 year: Echo, ECG
Which antipsychotics can be used in a depot?
2nd Gen
Olanzapine (monthly, less used due to monitoring requirement at the time of depot)
Risperidone (fortnightly, Constra)
Aripiprazole (monthly)
1st Gen
Zuclopenthixol (Acuphase)
Haliperidone (monthly)
Which anti-psychotic is commonly used off label?
Quetiapine (seroquel) eg 15mg
