Anti-Psychotics Flashcards
What can anti-psychotics be subdivided into?
- Typical (first generation)
- Atypical (second generation)
Give 3 examples of typical anti-psychotics?
- Chlorpromazine
- Prochlorperazine
- Haloperidol
Give 4 examples of atypical anti-psychotics?
- Risperidone
- Quetiapine
- Olanzapine
- Clozapine
Why are older antipsychotic medications less commonly prescribed now?
Due to increased risk of extrpyramidal side effects
What type of anti-psychotic is first line in schizophrenia?
Atypical
When should clozapine be prescribed?
Only if treatment with two or more antipsychotics has failed
What is the mechanism of action of anti-psychotics?
Block post-synaptic dopamine D2 receptors in the brain, and thus increase dopamine levels
Why do typical anti-psychotics have more side effects?
They are non-specific and affect other receptors in addition to dopamine D2 receptors
What are the routes of delivery of anti-psychotics?
- PO
- IM
- SC
What should be done before starting a patient on an antipsychotic as a depot injection?
Should be given a test dose
What are the indications for antipsychotics?
- Schizophrenia
- Bipolar
- Agitation and restlessness in elderly
What should be done before prescribing an anti-psychotic for agitation and restlessness in the elderly?
Review each patient clinically before prescribing, and investigate the cause of agitation
What are the contraindications to typical anti-psychotics?
Parkinson’s
When should clozapine be used with caution?
Cardiovascular disease
When should all anti-psychotics be used with caution?
Elderly
Why should anti-psychotics be used with caution in the elderly?
More susceptible to antipsychotic side effects
When should anti-psychotics be avoided?
Dementia
Why should anti-psychotics be avoided in dementia?
Dementia and use of antipsychotics has been correlated with high risk of stroke and death
What might anti-psychotics interact with?
- Amiodarone
- Macrolides
- SSRIs
- Quinine
- Alcohol
- Opioids
What might happen if anti-psychotics are given with amiodarone, macrocodes, SSRIs, or quinine?
Increased risk of QT interval prolongation
What might happen if anti-psychotics are given with alcohol or opioids?
Sedation and increased CNS effects
What might clozapine interact with?
Carbamazepine
What might happen if clozapine is given with carbamazepine?
Increased risk of agranulocytosis
What might quetiapine interact with?
Grapefruit juice (increases exposure to quetiapine)
What should be done before starting an anti-psychotic?
- Weight
- Waist circumference
- Pulse rate
- BP
- Assessment of general health, including blood tests
- ECG
Why is a health check done before starting anti-psychotics?
Risk of metabolic disturbances being caused by antipsychotics, thus a baseline assessment of patients general health should be undertaken
What monitoring is required with clozapine?
Monitor FBC weekly for 18 weeks, then fortnightly until 1 year, then every 4 weeks
Why is it important to monitor FBC with clozapine?
Causes agranulocytosis in 1% of patients
What should be done if WCC <1.5x10^4 with clozapine?
Discontinue immediately
What monitoring is required with some anti-psychotics?
Prolactin concentration (idk which ones and I cba to look it up)
When should prolactin concentration be measured with some anti-psychotics?
At the start of therapy, at 6 months, then yearly
What should you do if patients who start to show signs of hyperprolactinaemia, with regards to monitoring?
Consider prolactin monitoring, even if this adverse effect is not commonly associated with their anti-psychotic drug
What are the general side effects of anti-psychotics?
- Sedation
- Extra-pyramidal side effects
- Weight gain, hypertension, diabetes mellitus, and hypercholestrolaemia
- Sexual dysfunction
How can the side effect of sedation be beneficial?
In agitated patients
What are the specific side effects of clozapine?
- Neutropenia
- Agranulocytosis
What are the specific side effects of risperidone?
- Gynaecomastia
- Galactorrhoea
Why does risperidone cause gynaecomastia and galactorrhea?
It raises prolactin
How should which antipsychotic to use be chosen?
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
Describe the use of anti-psychotics in pregnancy?
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
Can anti-psychotics be used in breastfeeding?
They should be avoided due to lack of information confirming short and long term safety
