antipsy Flashcards
3 dopaminergic pathways
Tuberoinfundibular
MEsocortical/mesolimbic
Nigrostriatal
What pathway do antipsychotics work
Antagonism of mesocortiyal/mesolimbic pathway
WHat can blockade of the tuberoinfundinbular pathway result in
Hyperprolactinaemia
What can blockade of the nigrostriatal pathway result in
Extrapyramidal side- effects
What investigations to do before treatment
ECG Weight/height BP FBC U&E LFT Prolactin Glucose/HVa1c Fasting lipids
Atypical antipsychotics
Clozapine Aripiprazole Olanzapine Quetiapine Risperidone
Typical antipsychotics
Supiride Pipothiazine Haloperidol Flupentixol Trifluoperazine
Mode of action of typical antipsychotics
Dopamine receptor 2 antagonism
Side effect of typical antipsychotics
Neuroleptic malignant syndrome
Seizure threshold lowered
Sedation
EPSE
BP
Metabolic syndrome
Temperature
Hypersensitivity reactions- liver, bone marrow, skin
Endocrine- raised prolactin
Psychiatric- apathy, confusion, depression
Peripheral autonomic nervous system- muscarinic receptor blockade, Alpha1 adrenoceptor blockade
Extrapyramidal side-effects
Akathisia- subjective feelings of restlessness
Parkinsonism- antipsychotic and idiopathic Parkinsonism are clinically identical (tremor, rigidity and bradykinesia)
Acute dystonia- involuntary muscle spasms which produce briefly sustained abnormal postures
Tardive dyskinesia- Abnormal involuntary hyperkinetic movements. Abnormal movements include abnornal tongue movements, pouting/smacking of lips, chewing, head nodding, grimacing, rocking movements
Features of metabolic syndrome caused by typicals
central obesity Insulin resistance Impaired glucose regulation Hypertension Raised plasma triglycerides Raised LDL cholesterol and/or low HDL cholesterol level
Features of neuroleptic malignant syndrome
Hyperthermia Muscle rigidity Confusion Tachycardia Hyper/hypotension Tremor Raised Creatine Kinase (CK) Low pH – metabolic acidosis
Mode of action of atypical
D2 antagonism +- 5-HT receptor antagonism
Half life
Side effects of aripiprazole
Mode of action
Long half life
Nausea Restlessness Insomnias May initial exacerbation of psychosis Least weight gain Minimal metabolic effect
Mode: Partial dopamine agonist
Side effects of olanzapine
Sedation +++ Weight gain ++++ Raised triglycerides Proglycaemic Dizziness anticholinergic side-effects
