Antipsychotics Flashcards
mesocortical pathway
negative symptoms if too little dopamine
mesolimbic pathway
positive symptoms if too much dopamine
typical antipsychotics - MOA
dopamine D2 receptor antagonists,
blocking dopaminergic transmission in mesolimbic pathway
typical antipsychotics - common adverse effects
extra-pyramidal effects
hyperprolactinaemia - galactorrhoea
typical antipsychotics - Ex
haloperidol
chlopromazine
Atypical antipsychotics: MOA
act on variety of receptors
D2, D3, D5, 5-HT
Atypical antipsychotics - ex
clozapine
risperidone
olanzapine
extrapyramidal side effects
parkinsonism
acute dystonia
akathisia
tardive dyskinesia
how can acute dystonia secondary to antipsychotics be managed
procyclidine
warnings when antipsychotics used in elderly
inc risk stroke
inc risk VTE
antimuscarinic side effects
dry mouth
blurred vision
urinary retention
constipation
other side effects
sedation weight gain raised prolactin - galactorrhoea impaired glucose toleance Neuroplegic malignant syndrome reduced seizure threshold prolonged QT interval
neuroplegic malignant syndrome
pyrexia
muscle stiffness
adverse effects atypical antispsychotics
weight gain
agranulocytosis (clozapine)
hyperprolactinaemia
what parameters need monitored
FBC U&Es LFTs lipid weight fasting Glc prolactin BP ECG CVS risk assessment
FBC, U&Es, LFT monitoring
at start of therapy
annually
more often FBCs for clozapine - weekly initially
lipids and weight monitoring
at start of therapy
3mo
annually
fasting blood Glc monitoring
start of therapy
at 6mo
annually
prolactin monitoring
start of therapy
at 6mo
annually
BP monitoring
baseline
frequently during dose titration
monitoring ECG
baseline
monitoring CVS risk assessment
annually
clozapine - when to use
resistant schizophrenia
clozapine - adverse effects
agranulocytosis - freq FBC reduced seizure threshold constipation myocarditis - baseline ECG hypersalivation
effect of smoking on clozapine
smoking cessation can cause a rise in blood clozapine levels
