antipsychotic drugs Flashcards
what are the positive and negative symptoms of schizophrenia?
negative: social withdrawal/loss of interest in things
positive: hallucinations, delusions, thought disorder
which out of positive or negative symptoms of schizophrenia are antipsychotics better at treating?
positive
name some examples of 1st generation antipsychotics
end in ‘azines’ and ‘ol’
: azines are ol school
chlorpromazine levomepromazine promazine fluphenazine haloperidol and benperidol flupentixol and zuclopenthixol pimozide pericyazine prochlorperazine sulpride
list some examples of 2nd generation antipsychotics
APINE or ONE
- amisulpride
- aripiprazole
- clozapine
- lurasidone
- olanzapine
- paliperidone
- quetiapine
- risperidone
what are the main differences between 1st gen and 2nd gen antipsychotics?
1st gen: work by blocking D2 receptors and are non selective so cause more s/e especially EPSE s/e.
2nd gen: work on specific D receptors and are more selective so cause less s/e. are also better at treating negative symptoms of schizophrenia
which out of group 1, group 2 and group 3 phenothiazine derivatives has the MOST EPSE [extrapyramidal side effects]
group 3
what are examples of group 1 phenothiazine derivatives [3]?
chlorpromazine
levopromazine
promazine
what are group 2 of phenothiazine derivatives? [2]
periciazine
pipotiazine
what are examples of group 3 phenothiazines derivatives? [4]
prochlorperazine
trifluroperazine
fluphenazine
perphenazine
what are the risks of antipsychotics in elderly pt with dementia?
can increase risk of stroke/TIA and mortality in elderly pt with dementia
can cause postural hypotension and hyper/hypothermia
what are extrapyramidal side effects?
ADAPT
acute dystonia [involuntary movements of neck/face/muscles]
akathisia [restlessness and cant stay still]
parkinsonism symptoms [tremor]
tardive dyskinesia [involuntary movement of jaw/tongue/face]
What electrolyte imbalance is included in EPSE side effects and what do they cause?
hyperkalaemia
hyponatraemia
hypercalaemia
hyperprolactonaemia
hyperprolactinaemia [high prolactin levels]
causes sexual dysfunction, reduced bone density, breast enlargement, menstrual changes, galactorrhoea [milky discharge from breast]
which 2nd gen antipsychotic has fewer s/e compared to the others?
aripiprazole
name some other s/e that may occur with antipsychotics? [5]
blood dyscrasia diabetes/hyperglycaemia decreased libido hypotension weight gain
what can ALL antipsychotics cause? tachycardia arrhythmia hypotension QT interval prolongation all of the above
all of the above
which out of 1st gen or 2nd gen antipsychotics are more likely to cause insulin resistance and diabetes?
2nd gen
which 1st gen antipsychotics have the lowest risk of causing diabetes? [2]
- fluphenazine
- haloperidol
of the 2nd generation antipsychotics, which drugs have the lowest risk of diabetes? [2]
amisulpride and aripiprazole
which 2 antipsychotics have the LOWEST risk of sexual dysfunction?
aripiprazole and quetiapine
which parameters are monitored at the start of antipsychotic treatment and then annually? [3]
FBC
liver function
urea and electrolytes
which parameters are monitored once a year during antipsychotic treatment? [3]
blood pressure
prolactin conc
physical health monitoring [CVD risk]
what are the general monitoring requirements for antipsychotics?
blood lipids
weight
fasting blood glucose
ECG
How long may you monitor pt after withdrawal to check if signs of relapse occur? 1 year 3 months 2 years 6 months
2 years
what are the pt and carer advice associated with antipsychotics? [2]
photosensitisation - avoid direct sunlight
driving: drowsiness may affect performance of skilled tasks
what is the mechanism of action of clozapine?
it is a D1, D2, 5HT2A receptor
what is the indication of clozapine?
licensed for schizophenia in pt intolerant or unresponsive to conventional antipsychotics [last option]
what are the MHRA warnings of clozapine? [3]
potential risk of faecal impaction, intestinal obstruction and paralytic ileus. seek medical advice if constipation occurs
- monitor blood to manage risks of agranulocytosis
- monitor blood conc for toxicity when given with other anti-psychotics, in certain clinical situation eg stopping smoking, pneumonia, infection
what are the contraindications of clozapine? [8]
history of agranulocytosis bone marrow disorders drug intoxication history of neutropenia paralytic ileus severe cardiac disorders uncontrolled epilepsy severe cns depression
what are the monitoring requirements of clozapine? [5]
- prolactin levels
- leucocytes and blood count
- clozapine blood conc
- blood lipids and fasting glucose
- pt with schizophrenia should have physical health checks annually
what are the pt and carer advice for clozapine?
for suspension?
for orodispersible tablet?
- photosensitisation: avoid direct sunlight
- drowsiness may occur driving and skilled tasks affected
- oral suspension: shake well for 90s or if visibly settled and has been left out for 24 hours. other than that, shake well for 10 seconds before use and may be diluted with water
- orodispersible: place on tongue, allow to dissolve and swallow
when are long acting depot injections for antipsychotis used?
for adherence in maintenance treatment for ppl who cannot comply with oral formulation
which out of oral and depo injections antipsychotics contain the most EPSE s/e?
injections
