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A - MSRA Drugs [4] > Anti-Psychotics > Flashcards

Anti-Psychotics Flashcards

1
Q

What can anti-psychotics be subdivided into?

A
  • Typical (first generation)

- Atypical (second generation)

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2
Q

Give 3 examples of typical anti-psychotics?

A
  • Chlorpromazine
  • Prochlorperazine
  • Haloperidol
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3
Q

Give 4 examples of atypical anti-psychotics?

A
  • Risperidone
  • Quetiapine
  • Olanzapine
  • Clozapine
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4
Q

Why are older antipsychotic medications less commonly prescribed now?

A

Due to increased risk of extrpyramidal side effects

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5
Q

What type of anti-psychotic is first line in schizophrenia?

A

Atypical

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6
Q

When should clozapine be prescribed?

A

Only if treatment with two or more antipsychotics has failed

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7
Q

What is the mechanism of action of anti-psychotics?

A

Block post-synaptic dopamine D2 receptors in the brain, and thus increase dopamine levels

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8
Q

Why do typical anti-psychotics have more side effects?

A

They are non-specific and affect other receptors in addition to dopamine D2 receptors

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9
Q

What are the routes of delivery of anti-psychotics?

A
  • PO
  • IM
  • SC
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10
Q

What should be done before starting a patient on an antipsychotic as a depot injection?

A

Should be given a test dose

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11
Q

What are the indications for antipsychotics?

A
  • Schizophrenia
  • Bipolar
  • Agitation and restlessness in elderly
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12
Q

What should be done before prescribing an anti-psychotic for agitation and restlessness in the elderly?

A

Review each patient clinically before prescribing, and investigate the cause of agitation

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13
Q

What are the contraindications to typical anti-psychotics?

A

Parkinson’s

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14
Q

When should clozapine be used with caution?

A

Cardiovascular disease

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15
Q

When should all anti-psychotics be used with caution?

A

Elderly

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16
Q

Why should anti-psychotics be used with caution in the elderly?

A

More susceptible to antipsychotic side effects

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17
Q

When should anti-psychotics be avoided?

A

Dementia

18
Q

Why should anti-psychotics be avoided in dementia?

A

Dementia and use of antipsychotics has been correlated with high risk of stroke and death

19
Q

What might anti-psychotics interact with?

A
  • Amiodarone
  • Macrolides
  • SSRIs
  • Quinine
  • Alcohol
  • Opioids
20
Q

What might happen if anti-psychotics are given with amiodarone, macrocodes, SSRIs, or quinine?

A

Increased risk of QT interval prolongation

21
Q

What might happen if anti-psychotics are given with alcohol or opioids?

A

Sedation and increased CNS effects

22
Q

What might clozapine interact with?

A

Carbamazepine

23
Q

What might happen if clozapine is given with carbamazepine?

A

Increased risk of agranulocytosis

24
Q

What might quetiapine interact with?

A

Grapefruit juice (increases exposure to quetiapine)

25
Q

What should be done before starting an anti-psychotic?

A
  • Weight
  • Waist circumference
  • Pulse rate
  • BP
  • Assessment of general health, including blood tests
  • ECG
26
Q

Why is a health check done before starting anti-psychotics?

A

Risk of metabolic disturbances being caused by antipsychotics, thus a baseline assessment of patients general health should be undertaken

27
Q

What monitoring is required with clozapine?

A

Monitor FBC weekly for 18 weeks, then fortnightly until 1 year, then every 4 weeks

28
Q

Why is it important to monitor FBC with clozapine?

A

Causes agranulocytosis in 1% of patients

29
Q

What should be done if WCC <1.5x10^4 with clozapine?

A

Discontinue immediately

30
Q

What monitoring is required with some anti-psychotics?

A

Prolactin concentration (idk which ones and I cba to look it up)

31
Q

When should prolactin concentration be measured with some anti-psychotics?

A

At the start of therapy, at 6 months, then yearly

32
Q

What should you do if patients who start to show signs of hyperprolactinaemia, with regards to monitoring?

A

Consider prolactin monitoring, even if this adverse effect is not commonly associated with their anti-psychotic drug

33
Q

What are the general side effects of anti-psychotics?

A
  • Sedation
  • Extra-pyramidal side effects
  • Weight gain, hypertension, diabetes mellitus, and hypercholestrolaemia
  • Sexual dysfunction
34
Q

How can the side effect of sedation be beneficial?

A

In agitated patients

35
Q

What are the specific side effects of clozapine?

A
  • Neutropenia

- Agranulocytosis

36
Q

What are the specific side effects of risperidone?

A
  • Gynaecomastia

- Galactorrhoea

37
Q

Why does risperidone cause gynaecomastia and galactorrhea?

A

It raises prolactin

38
Q

How should which antipsychotic to use be chosen?

A

Prior to starting antipsychotic medication, the doctor should discuss different options for antipsychotic drugs with the patient, and explain the benefits, risks, and side effects of each drug. The patient should be asked which side effects they are willing to accept, and should be involved in the final decision of which antipsychotic to start

39
Q

Describe the use of anti-psychotics in pregnancy?

A

There have been reports of extra-pyramidal side effects and withdrawal symptoms in the neonate when antipsychotic medications have been taken in the 3rd trimester. In this case, neonates must be monitored for respiratory distress and CNS effects such as agitation and hypotonia

40
Q

Can anti-psychotics be used in breastfeeding?

A

They should be avoided due to lack of information confirming short and long term safety

A - MSRA Drugs [4] (79 decks)

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