Anti-psychotics Flashcards
Which were developed first: typical or atypical anti-psychotics?
Typical anti-phsychotics
Typical anti-psychotics - mechanism of action
Work primarily through inhibition of dopamine 2 receptor.
D2 Receptor blockade
Typical anti-psychotics - examples (5)
Haloperidol Chlorpromaxine Thioridazine Fluphenazine Zuclopentixol
Typical anti-psychotics - side effects (broad category)
Extrapyramidal side effects
Typical anti-psychotics - extrapyramidal side effects
Parkinsonism
Acute dystonic reaction
Akathisia
Tardive dyskinesia
What is parkinsonism?
Signs of parkinsons disease (tremor, rigidity, dyskinesia) but it is drug induced
How do you manage parkinsonism?
Anti-cholinergics
Typical anti-psychotics - extrapyramidal side effects - acute dystonic reaction
Sudden painful muscle spasms
Typical anti-psychotics - extrapyramidal side effects - acute dystonic reaction is untreatable. True or false?
False
- completely treatable with IV anti-cholinergics
Typical anti-psychotics - extrapyramidal side effects - akathisia
Restlessness
Typical anti-psychotics - extrapyramidal side effects - akathisia responds well to anti-cholinergics. True or false?
False
Typical anti-psychotics - extrapyramidal side effects - Tardive dyskinesia
Repetitive involuntary purposeless movements (eg sticking out tongue)
Due to long term anti-psychotic use
Atypical anti-psychotics - mechanism of action
5-HT receptor blockade
Dopamine receptor blockade
Atypical anti-psychoics - better at treating positive or negative symptoms?
Negative symptoms
Atypical anti-psychotics - examples (6)
Olanzapine Risperidone Quetiapine Clozapine Aripiprazole Amisulphride
Atypical anti-psychotics - side effects (broad category)
Metabolic syndrome
Atypical anti-psychotics - side effects - metabolic syndrome
Increased abdominal girth Type 2 diabetes Hypertension High cholesterol Weight gain
Atypical anti-psychotics have more side effects than typical anti-psychotics. True or false?
False
When is clozapine indicated?
If the patient has had 2 FAILED trials of anti-psychotics
Clozapine is the most effective antipsychotic. True or false?
True
Why is clozapine not used routinely?
Severe side effects
- Agranulocytosis
- myocarditis
also
- metabolic syndrome (weight gain, sedation)
- constipation
- hypersalivation
Clozapine - investigations
Regular FBC monitoring
- weekly for first 6 weeks (looking for neutropenia - agranulocytosis)
ECG
- myocarditis
Histamine H1 receptor blockade results in
Sedation
Increased appetite
Alpha-adrenergic receptor blockade results in
Interruption of the baroreceptor reflex leading to
- dizziness
- light headedness
- fainting
- falls
Muscarinic blockade results in
Blurred vision Dry mouth Constipation Urinary retetntion Sedation Confusion
What was the first ever anti-psychotic discovered?
Chlorpromazine
What is the most effective anti-psychotic drug?
Clozapine
Main 2 side effects of atypical anti-psychotics
Weight gain
Sedation
What is the treatment for someone who is taking typical antipsychotics and gets extra-pyramidal side effects…in particular, an acute dystonic reaction?
Procycladine (anti-cholinergic)
this reduces ACh to a new relative balance with the lower dopamine levels
What are the features of NMS (neuroleptic malignant syndrome) ?
Increased muscle tone (over hours/days)
Increase temperature
ANS instability (swinging changes in BP and pulse rate)
This can eventually lead to rhabdomyalisis -> AKI
How do you manage NMS?
Refer to ICU urgently
- rapid cooling
- skeletal relaxants
If you suspect NMS, which blood test should you do?
CK
- significant rise
When starting people on an anti-psychotic medication, what is first line? typical antipsychotic or atypical antipsychotic?
Atypical (2nd generation) --> Atypical (2nd generation) / typical (1st generation) --> Clozapine (2nd generation)
