Antipsychotics Flashcards
what is the risk associated with the use of antipsychotics in elderly
increased risk of stroke and VTE
how do antipsychotics work
block dopamine receptors therefore reduce pathological over-activity
antipsychotics have antimuscarinic side effects - what are these
dry mouth
blurred vision
urinary retention
constipation
haloperidol chlorpromazine thioridazine fluphenazine zuclopenthixol
are examples of what antipsychotics
typical
what is the biggest concern with typical antipsychotics
extra pyramidal side effects
what are EPSEs
acute dystonia
akathasia
parkinsonism
tardive dyskinesia
what is acute dystonia
painful sustained contraction of muscles usually in the eyes, jaw or neck
what is acute dystonia of the eyes called
oculogyric crisis
what is acute dystonia of the neck called
torticollis
how is acute dystonia reversed
procyclidine
what is akathasia
feeling of restlessness and constant need to wander
what are the features of parkinsonism seen in EPSE of typical antipsychotics
shuffling gait
tremor
reduced facial expression
what is tardive dyskinesia
repetitive, uncontrollable contraction of the muscles of the face, tongue and upper body –> excessive blinking, lip smacking, jaw pouting, chewing, facial grimacing
what endocrine disturbances can be seen with typical antipsychotics
hyperprolactinaemia
impaired glucose tolerance
typical antipsychotics, particularly haloperidol cause what change on an ECG
QT prolongation
True/False
Typical antipsychotics can cause sedation, increased appetite and weight gain
true
Name some atypical antipsychotics
olanzapine quetiapine aripiprazole risperidone amisulpride
what is the main advantage in the use of atypical antipsychotics
reduction in EPSEs
List some side effects of atypical antipsychotics
hyperprolactinaemia impaired glucose tolerance (T2DM) increased appetite and weight gain drowsiness sexual dysfunction
atypical antipsychotics increase/decrease risk of seizure
increased risk of seizure by reducing seizure threshold
which atypical antipsychotics is particularly good for prolactin elevation
aripiprazole
weight gain is most pronounced with which atypical antipsychotic
olanzapine
clozapine
what are the conditions for the use of clozapine
treatment resistant schizophrenia - when a patient has trialled 2 different antipsychotics for at least 6 weeks with no improvement, one of which is an atypical
what are the 2 main concerning side effects of clozapine
myocarditis
agranulocytosis
how are myocarditis and agranulocytosis avoided/monitored with clozapine use
ECG before starting
regular blood testing to see FBC
how often should a FBC be taken with someone on clozapine
weekly for the first 6 months
then every 2 weeks for next 6 months and then monthly thereafter
when should FBC be done when stopping clozapine
1 month after
how do you safety net a patient starting clozapine
say if they have a sore throat or any other kind of infection to immediately go to their GP to get FBC
what are other side effects of clozapine
weight gain hypersalivation cardiomyopathy pulmonary embolism neutropenia reduced seizure threshold constipation
how can you treat hypersalivation with clozapine use
hyocine hydrobromide
what is the significance of smoking with regard to clozapine
smoking reduces clozapine levels so suddenly quitting smoking could dramatically increase blood levels
