Antipsychotic medications Flashcards
What is the mechanism of action of antipsychotics?
Block dopamine receptors, particularly D2 receptors.
Clinical indications for antipsychotics
- Delusions
- Hallucinations
- Thought disorder
- Agitation
- Short term use for dementia symptoms
What are the main extra-pyramidal side effects of antipsychotic use? (anti-dopaminergic)
- Dystonia e.g. torticollis
- Akathisia - physical restlessness
- Parkinsonisms
- Tardive dyskinesia (involuntary movements of the neck and face)
Anti-adrenergic side effects of antipsychotics
- sedation
- postural hypotension
- inability to ejaculate
Anticholinergic side effects of antipsychotics
- dry mouth
- constipation
- blurred vision/dry eyes
Cardiac side effects of antipsychotics
- prolongation of the QT interval > Torsades de Pointes and sudden death
(RARE)
What is the 3rd line treatment for schizophrenia?
Clozapine
Why is Clozapine not used much/third line?
Has severe side effects e.g.
Agranulocytosis, myocarditis
Hypersalivation, sedation, weight gain, constipation
Monitoring regime for Clozapine
Weekly FBC for first 18 weeks
Then fortnightly until 1 year.
Thereafter monthly
What are extra-pyramidal side effects?
- Parkinsonism
- Acute dystonia
- Akathisia
- Tardive dyskinesia
What drug is given to patients with acute dystonia e.g. torticollis and oculogyric crisis?
Procyclidine
How does Procyclidine work?
blocking central cholinergic receptors and balancing the cholinergic-dopamine activity in the basal ganglia
What are the 2 specific warnings issued about antipsychotics in elderly patients?
- Increased risk of stroke
- Increased risk of Venous thromboembolism
What anti-psychotic is switched to if a patient experiences galactorrhoea/elevated prolactin?
Aripiprazole
