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msra psych > Antipsychotics > Flashcards

Antipsychotics Flashcards

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1
Q

What conditions do antipsychotics help manage?

A

schizophrenia

psychosis

mania

agitation

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2
Q

What 2 groups are antipsychotics divided into?

A

Atypical - 2nd gen

Typical - 1st gen

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3
Q

Why were atypical antipsychotics developed?

A

due to the problematic effects of EPSEs associated with typical antipsychotics

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4
Q

What is the mechanism of typical antipsychotics?

A

Dopamine D2 receptor antagonists, blocking dopaminergic transmission in the mesolimbic pathways

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5
Q

What are the adverse effects of typical antipsychotics?

A

EPSEs

Hyperprolactinaemia

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6
Q

Examples of typical antipsychotics

A

haloperiodol

chlopromazine

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7
Q

What is the mechanism of atypical antipsychotics?

A

acts on variety of dopamine receptors

D2 D3 D4 5-HT

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8
Q

What are the adverse effects of Atypical antipsychotics?

A

Metabolic effects

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9
Q

Examples of atypical

A

Clozapine
Risperidone
Olanzapine

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10
Q

What are EPSEs?

A

1.Parkinsonism

  1. acute dystonia
    -sustained muscle contraction (e.g. torticollis, oculogyric crisis)
    -may be managed with procyclidine
  2. akathisia (severe restlessness)
  3. tardive dyskinesia (late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)
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11
Q

How is acute dystonia managed?

A

procyclidine

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12
Q

Why should antipsychotics be used with caution in the elderly?

A

increased risk of stroke

increased risk of VTE

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13
Q

What antimuscarinic effects do antipsychotics have?

A

dry mouth,
blurred vision,
urinary retention,
constipation

can’t see, drink, poop and pee

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14
Q

What impact do antipsychotics have on weight?

A

gain

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15
Q

what impact do antipsychotics have on energy levels

A

sedation

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16
Q

why is there raised prolactin in regards to antipsychotics and what does it cause?

A

due to inhibition of dopaminergic tuberoinfundibulnar pathway

galactorrhea

17
Q

what impact do antipsychotics have on glucose?

A

impaired

18
Q

What syndrome can antipsychotics cause and what are the symptoms ?

A

neuroleptic malignant syndrome

pyrexia and muscle stiffness

19
Q

what impact do antipsychotics have on seizures?

A

lowers threshold

20
Q

what impact does antipsyhotics especially haloperidol have on QT?

A

prolonged QT interval

21
Q

How do you monitor antipsychotics?

A

Bloods - abc, u&Es, cup, lfts, u&es, lipids

weight

fasting blood glucose and prolactin

bp

ecg

cardiovascular risk assessment

22
Q

What are the main adverse effects associated with atypical antipsychotics?

A

weight gain

clozapine agranulocytosis

hyperprolactinaemia

23
Q

examples of atypical antipsychotics

A

clozapine
olanzapine: higher risk of dyslipidemia and obesity
risperidone
quetiapine
amisulpride
aripiprazole: generally good side-effect profile, particularly for prolactin elevation

24
Q

when should clozapine be introduced?

A

introduced if schizophrenia is not controlled despite the sequential use of two or more antipsychotic drugs (one of which should be a second-generation antipsychotic drug), each for at least 6–8 weeks.

25
Q

adverse side effects of clozapine

A

agranulocytosis (1%), neutropaenia (3%)
reduced seizure threshold - can induce seizures in up to 3% of patients
constipation
myocarditis: a baseline ECG should be taken before starting treatment
hypersalivation

25
Q

adverse side effects of clozapine

A

agranulocytosis (1%), neutropaenia (3%)
reduced seizure threshold - can induce seizures in up to 3% of patients
constipation
myocarditis: a baseline ECG should be taken before starting treatment
hypersalivation

26
Q

what needs to be adjusted if smoking is started or stopped during treatment of clozapine

A

dose - has impact on potency of drug

msra psych (16 decks)

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