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Psychiatry SOH > Anti-psychotics > Flashcards

Anti-psychotics Flashcards

1
Q

Which were developed first: typical or atypical anti-psychotics?

A

Typical anti-phsychotics

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2
Q

Typical anti-psychotics - mechanism of action

A

Work primarily through inhibition of dopamine 2 receptor.

D2 Receptor blockade

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3
Q

Typical anti-psychotics - examples (5)

A 
Haloperidol
Chlorpromaxine
Thioridazine
Fluphenazine
Zuclopentixol
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4
Q

Typical anti-psychotics - side effects (broad category)

A

Extrapyramidal side effects

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5
Q

Typical anti-psychotics - extrapyramidal side effects

A

Parkinsonism
Acute dystonic reaction
Akathisia
Tardive dyskinesia

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6
Q

What is parkinsonism?

A

Signs of parkinsons disease (tremor, rigidity, dyskinesia) but it is drug induced

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7
Q

How do you manage parkinsonism?

A

Anti-cholinergics

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8
Q

Typical anti-psychotics - extrapyramidal side effects - acute dystonic reaction

A

Sudden painful muscle spasms

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9
Q

Typical anti-psychotics - extrapyramidal side effects - acute dystonic reaction is untreatable. True or false?

A

False

- completely treatable with IV anti-cholinergics

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10
Q

Typical anti-psychotics - extrapyramidal side effects - akathisia

A

Restlessness

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11
Q

Typical anti-psychotics - extrapyramidal side effects - akathisia responds well to anti-cholinergics. True or false?

A

False

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12
Q

Typical anti-psychotics - extrapyramidal side effects - Tardive dyskinesia

A

Repetitive involuntary purposeless movements (eg sticking out tongue)

Due to long term anti-psychotic use

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13
Q

Atypical anti-psychotics - mechanism of action

A

5-HT receptor blockade

Dopamine receptor blockade

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14
Q

Atypical anti-psychoics - better at treating positive or negative symptoms?

A

Negative symptoms

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15
Q

Atypical anti-psychotics - examples (6)

A 
Olanzapine 
Risperidone
Quetiapine
Clozapine
Aripiprazole
Amisulphride
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16
Q

Atypical anti-psychotics - side effects (broad category)

A

Metabolic syndrome

17
Q

Atypical anti-psychotics - side effects - metabolic syndrome

A 
Increased abdominal girth 
Type 2 diabetes
Hypertension
High cholesterol
Weight gain
18
Q

Atypical anti-psychotics have more side effects than typical anti-psychotics. True or false?

A

False

19
Q

When is clozapine indicated?

A

If the patient has had 2 FAILED trials of anti-psychotics

20
Q

Clozapine is the most effective antipsychotic. True or false?

A

True

21
Q

Why is clozapine not used routinely?

A

Severe side effects

  • Agranulocytosis
  • myocarditis

also

  • metabolic syndrome (weight gain, sedation)
  • constipation
  • hypersalivation
22
Q

Clozapine - investigations

A

Regular FBC monitoring
- weekly for first 6 weeks (looking for neutropenia - agranulocytosis)

ECG
- myocarditis

23
Q

Histamine H1 receptor blockade results in

A

Sedation

Increased appetite

24
Q

Alpha-adrenergic receptor blockade results in

A

Interruption of the baroreceptor reflex leading to

  • dizziness
  • light headedness
  • fainting
  • falls
25
Q

Muscarinic blockade results in

A 
Blurred vision
Dry mouth 
Constipation
Urinary retetntion
Sedation
Confusion
26
Q

What was the first ever anti-psychotic discovered?

A

Chlorpromazine

27
Q

What is the most effective anti-psychotic drug?

A

Clozapine

28
Q

Main 2 side effects of atypical anti-psychotics

A

Weight gain

Sedation

29
Q

What is the treatment for someone who is taking typical antipsychotics and gets extra-pyramidal side effects…in particular, an acute dystonic reaction?

A

Procycladine (anti-cholinergic)

this reduces ACh to a new relative balance with the lower dopamine levels

30
Q

What are the features of NMS (neuroleptic malignant syndrome) ?

A

Increased muscle tone (over hours/days)
Increase temperature
ANS instability (swinging changes in BP and pulse rate)

This can eventually lead to rhabdomyalisis -> AKI

31
Q

How do you manage NMS?

A

Refer to ICU urgently

  • rapid cooling
  • skeletal relaxants
32
Q

If you suspect NMS, which blood test should you do?

A

CK

- significant rise

33
Q

When starting people on an anti-psychotic medication, what is first line? typical antipsychotic or atypical antipsychotic?

A 
Atypical (2nd generation) 
--> 
Atypical (2nd generation) / typical (1st generation) 
-->
Clozapine (2nd generation)

Psychiatry SOH (19 decks)

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