Antipsychotics Flashcards
What conditions do antipsychotics help manage?
schizophrenia
psychosis
mania
agitation
What 2 groups are antipsychotics divided into?
Atypical - 2nd gen
Typical - 1st gen
Why were atypical antipsychotics developed?
due to the problematic effects of EPSEs associated with typical antipsychotics
What is the mechanism of typical antipsychotics?
Dopamine D2 receptor antagonists, blocking dopaminergic transmission in the mesolimbic pathways
What are the adverse effects of typical antipsychotics?
EPSEs
Hyperprolactinaemia
Examples of typical antipsychotics
haloperiodol
chlopromazine
What is the mechanism of atypical antipsychotics?
acts on variety of dopamine receptors
D2 D3 D4 5-HT
What are the adverse effects of Atypical antipsychotics?
Metabolic effects
Examples of atypical
Clozapine
Risperidone
Olanzapine
What are EPSEs?
1.Parkinsonism
- acute dystonia
-sustained muscle contraction (e.g. torticollis, oculogyric crisis)
-may be managed with procyclidine - akathisia (severe restlessness)
- 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)
How is acute dystonia managed?
procyclidine
Why should antipsychotics be used with caution in the elderly?
increased risk of stroke
increased risk of VTE
What antimuscarinic effects do antipsychotics have?
dry mouth,
blurred vision,
urinary retention,
constipation
can’t see, drink, poop and pee
What impact do antipsychotics have on weight?
gain
what impact do antipsychotics have on energy levels
sedation
why is there raised prolactin in regards to antipsychotics and what does it cause?
due to inhibition of dopaminergic tuberoinfundibulnar pathway
galactorrhea
what impact do antipsychotics have on glucose?
impaired
What syndrome can antipsychotics cause and what are the symptoms ?
neuroleptic malignant syndrome
pyrexia and muscle stiffness
what impact do antipsychotics have on seizures?
lowers threshold
what impact does antipsyhotics especially haloperidol have on QT?
prolonged QT interval
How do you monitor antipsychotics?
Bloods - abc, u&Es, cup, lfts, u&es, lipids
weight
fasting blood glucose and prolactin
bp
ecg
cardiovascular risk assessment
What are the main adverse effects associated with atypical antipsychotics?
weight gain
clozapine agranulocytosis
hyperprolactinaemia
examples of atypical antipsychotics
clozapine
olanzapine: higher risk of dyslipidemia and obesity
risperidone
quetiapine
amisulpride
aripiprazole: generally good side-effect profile, particularly for prolactin elevation
when should clozapine be introduced?
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.
adverse side effects of clozapine
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
adverse side effects of clozapine
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
what needs to be adjusted if smoking is started or stopped during treatment of clozapine
dose - has impact on potency of drug
