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Psychiatry > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

What are the 5 main dopamine pathways in the brain?

A 
Mesolimbic pathway 
mesocortical pathway 
nigrostriatal pathway 
tuberoinfundibular pathway 
hypothalamospinal pathway
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2
Q

What are the dopaminergic side effects?

A

extra pyramidal side effects + neuroleptic malignant syndrome + hyperprolactinaemia + akathesia/restless legs

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3
Q

What are 3 examples of extra pyramidal side effects?

A

Acute dystonic reaction
parkinsonism
tardive dyskinesia

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4
Q

Describe acute dystonia presentation?

A
  • onset in minutes
  • increasing muscle tone
  • energetic
  • torticolis (head to one side as neck muscles contracted)
  • oculogyric crisis (eye muscles all contract, eyes deviate upwards)
  • tongue protrusion
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5
Q

What other drugs other than antipsychotics can cause acute dystonia?

A

Antihistamines

antiemetics

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6
Q

Describe tardive dyskinesia presentation.

A

often after years of treatment - permanent
involuntary repetitve oro-facial movements
blinking, grimacing, pouting, lip-smacking common
may involve limbs and/or trunk

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7
Q

Why are anticholinergic drugs used to treat extra-pyramidal side effects of antipsychotics?

A

to balance out the acetylcholine and dopamine = there is less dopamine as dopamine has been inhibited and so acetylcholine is in excess in comparison to dopamine

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8
Q

List 3 anticholinergic drugs used to alleviate side effects from antipsychotics

A

procyclidine
trihexyphenidyl
orphenadrine

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9
Q

In neuroleptic malignant syndrome what dopamine pathways are affected?

A

Hypothalamic

Nigrostriatal

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10
Q

Tardive dyskinesia is treatable. True/false

A

False - very difficult to treat once caused by antipsychotics

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11
Q

How does neuroleptic malignant syndrome present?

A 
1-3 days onset
gradually increasing muscle tone
hyperpyrexia
autonomic instability
often FATAL!! if not treated
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12
Q

How does neuroleptic malignant syndrome lead to death?

A

increasing muscle tone -> rhabdomyolysis -> Acute renal failure -> coma -> death

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13
Q

What is the key investigation for neuroleptic malignant syndrome?

A

Creatinine Kinase

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14
Q

What is the treatment for neuroleptic malignant syndrome?

A

A&E!!!

  • Stop antipsychotic
  • renal support
  • rapid cooling
  • skeletal muscle relaxants e.g. dantroline
  • dopamine agonists e.g. bromocriptine
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15
Q

What dopaminergic pathway is affected in hyperprolactinaemia side effect of antipsychotics?

A

Tuberoinfundibular

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16
Q

What dopaminergic pathway is affected in akathisia caused by antipsychotics?

A

Hypothalamic spinal pathway

17
Q

How many patients report akathisia?

A

1/5

18
Q

How does akathisia present?

A 
within days-weeks
pacing 
rocking from foot to foot
unable to sit still
bad sleep as result 
leads to suicide risk
19
Q

What are the treatments for akathisia?

A

first line: beta blockers e.g. propranolol

second line: long acting benzodiazepines e.g. clonazepam

20
Q

What are 3 anti-cholinergic effects?

A

dry mouth
blurred vision
constipation

21
Q

What are 5HT2 side effects?

A

weight gain -> metabolic syndrome -> T2DM

22
Q

What is an example of anti-adrenergic effect?

A

Postural hypotension

23
Q

What neurotransmitter do benzodiazepines enhance?

A

GABA which is a neurotransmitter that suppresses the activity of nerves

24
Q

What are 3 other side effects of antipsychotics?

A

hepatotoxicity
prolonged QTc interval
photosensitivity

25
Q

Generally first/second generation antipsychotics are thought to cause more weight gain and sedation and first/second generation antipsychotics are thought to cause more extra-pyramidal side effects side effects?

A

Second gen - weight gain & sedation

First gen - EPSE

26
Q

approx. what percentage of patients experience neuroleptic malignany

A
27
Q

What is the best antipsychotic including for the negative syndrome?

A

Clozapine

28
Q

What are the side effects of clozapine?

A

agranulocytosis - need white cell count monitoring regularly
myocarditis - need ECG monitoring regularly
constipation (most dangerous side effect!!)
weight gain
sedation
sialorrhoea

29
Q

What approach is used when picking an antipsychotic for treating schizophrenia?

A

First step: 2nd generation titrate to adequate dose for 6-8wks
If not working, next: 1st/2nd generation titrate to adequate dose for 6-8 wks
Next: check diagnosis, consider psychological input, check compliance
Last: clozapine or combine two antipsychotics

30
Q

Which are considered first line in treating schizophrenia - typical/atypical? Give two examples of both.

A

Atypical first
Atypical examples: risperidone, olanzapine
Typical examples: haloperidol, chlorpromazine

31
Q

Which type (typical/atypical) of antipsychotics are better when treating negative syndrome schizophrenia?

A

Atypical

31
Q

Which type (typical/atypical) of antipsychotics are better when treating negative syndrome schizophrenia?

A

Atypical

32
Q

What is the main mechanism behind antipsychotics?

A

Dopamine antagonists - aim to block D2 receptors but block others too

33
Q

What pharmacological options is there for when a patient with schizophrenia becomes agitated, uncooperative, aggressive?

A

Benzodiazepines: Lorazepam oral/IM
Antipsychotics: Haloperidol/olanzapine oral/IM
Sedating antihistamines: promethazine oral/IM

Psychiatry (17 decks)

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