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Mental Health > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

Second generation anitpsychotic examples

A

Clozapine
Amisulpride
Quetiapinne
Aripiprazole
Olanzapine
Risperidone

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2
Q

Examples of first generation antipsychotics

A

Haloperidol
Zuclopenthixol
Sulpiride
Chlorpromazine
Flupenthixol

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3
Q

How do first gen anitpsychotics work? e

A

Block dopamine 2 receptors

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4
Q

four dopamine pathways

A

Mesocortical
Mesolimbic
Nigrostriatal
Tuberoinfundibular

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5
Q

What dopamine pathway is ass with EPSE?

A

Nigrostriatal

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6
Q

Which dopamine pathway is ass with hyperprolactinaemia?

A

Tuberoinfundibular

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7
Q

Side effect profile of 1st generation antipsychotics

A

EPSE
Hyperprolactinaemia
Antimuscarininc side effects

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8
Q

Risks from antipsychotics

A

Sedations
EPSE - dystonia, arkathisia, parkinsonism, tardive dyskinesia
Neuroleptic malignant syndrome

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9
Q

Risks from antipsychotics

A

Sedations
EPSE - dystonia, arkathisia, parkinsonism, tardive dyskinesia
Neuroleptic malignant syndrome

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10
Q

How to manage dystonia

A

Anticholinergics eg procyclidine

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11
Q

How to manage akathisia?

A

Reduce the dose/change to an alternative antipsychotic drug
Reduction of symptoms - addition of low dose eg propanolol

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12
Q

Antipsychotics and physical health long term risks

A

Cardiovascular
Dyslipidemia
Weight gain
Diabetes
Hyperprolactinaemia
ESPSE

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13
Q

How can affect on cardiac conduction from antipscyhotics present?

A

Increased QT interval
Torsades de pointes
Ventricular fibrillation
Sudden death

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14
Q

What counts as a prolonged QTc intervl?

A

> 450ms is concerning
(women <470, men <440ms)
500ms - unquantifiable risk of leading to torsade de pointes - review and action

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15
Q

What antispychotics are ass with the highest risk of dyslipidemia?

A

Olanzapine and clozapine

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16
Q

What monitor with olanzapine and clozapine esp?

A

Lipid levels

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17
Q

How often monitor lipid levels on olanzapine and clozapine?

A

Full lipid profile at baseolinne
3 months
Then annually

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18
Q

When do you add atorvastatin 20mg daily on olanzapine or clozapine treatment>

A

CVD risk score >10% or >NICE guiidanve

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19
Q

What use to determine primary CV prevention if necessary (statins)>

A

QRISK3 tool

20
Q

When is risk of weight gain on antipsychotics highest

A

first 6 months treatment

20
Q

Why do antispychotics cause weight gain?

A

Unknown but related to sedative effect of H1 receptor binfing affinity/insulin resistance

21
Q

What causes hyperprolactinaemia in antispychotics?

A

Dopamine inhibits prolactin release, so dopamine antagonsits increase plasma prolactin levels

22
Q

What antipsyhcotics do not increase prolactin above normal range at standard dose?

A

Clozapine, olanzapine, quetiapine and aripiprazole

23
Q

What determines if an antipsychotic causes hyperprolactinaemia?

A

Dose realted - all have potnetual

24
Q

What are the symptoms of hyperprolactinaemia?

A

Galactorrhea, amernorrhea, gynaecomastia, hypogonadism, sexual dysfunction, reduction in BMD

24
Q

What are the symptoms of hyperprolactinaemia?

A

Galactorrhea, amernorrhea, gynaecomastia, hypogonadism, sexual dysfunction, reduction in BMD

25
Q

What does hyperprolactinaemia increase the risk of?

A

Osteoporosis and breast cancer

26
Q

What are depot antipsychptics>

A

Long acting formulation of antipsychotics

27
Q

How often are depot anitpsychotics used?

A

1-4 weekly, monthly and 3 monhtly deoending
only certain medciations availale as depot

28
Q

Advantages of depot antipsychotics

A

Useful in non complicant patients
Convenient who struggle with oral formulations

29
Q

Disadvantages of depot antipsychotic medications

A

Plasma lecels maintained for long time - ADRs, interactions
Unable to sitch antipsychotics quickly

30
Q

How long does it take for a drug to be eliminated?

A

5 half lives

30
Q

How long does it take for a drug to be eliminated?

A

5 half lives

31
Q

How long is half life of haloperidol?

A

21-28 dyas
minimum of 105 days

32
Q

What differentials would you have for:
* Patient has diaphoresis, tremor, rigidity, unsteady gait
* Tachycardia 125bpm
* Temp 38.3 C
* BP 120/84
* CK 6763 (25-200)
* CRP 54 (0-5)
* ESR 33
* AST 244 (0-40)
* ALT 102(0-40)

A

Neuroleptic Malignant Syndrome
* Malignant catatonia
* Serotonin syndrome
* Thyrotoxicosis
* Heatstroke
* CNS infection

33
Q

Cuases of neuroleptic malignant syndrome

A

Dopaminergic antagonism + context of physiological stressors/genetic predisposition
first (more common) and second gen antipsyhcotics, antidepressatns (SSRIs, lithium)
Combo

33
Q

Cuases of neuroleptic malignant syndrome

A

Dopaminergic antagonism + context of physiological stressors/genetic predisposition
first (more common) and second gen antipsyhcotics, antidepressatns (SSRIs, lithium)
Combo

34
Q

What combination of psychiatric drugs increases risk of NMS>

A

Antipsychotics and SSRIs

35
Q

Signs and symptoms of NMS?

A

Fever
Diaphoresis
Rigidity
Confusion
Fluctuating consciousness
Fluctuating BP
Tachycardia
Elevated creatinine kinase
Altered LFTs

35
Q

Signs and symptoms of NMS?

A

Fever
Diaphoresis
Rigidity
Confusion
Fluctuating consciousness
Fluctuating BP
Tachycardia
Elevated creatinine kinase
Altered LFTs

36
Q

How uquizkly can NMS be fatal?

A

1-3 dyas

37
Q

Risk factors for NMS - drug realted

A

High potency typical drigs
Recent or rapid dose increase
Rapid dose reduction
Abrupt withdrawal of anticholinergics
Genetic vulnerability

38
Q

Other risk factors for NMS (not drug related)

A

Catatonia - prodromal
Pscyhosis
Organic brain disease
Alcoholism
Parkinsons disease
agitated/overactive and/or in need of restraint or seclusion

39
Q

Diagnostic tests for NMS?

A

Raised CK
CK - elevated > 1000
AST/ALT
Few signs /symptoms

40
Q

How to treat NMS?

A

aNTIPSYCHOTICS, lithium, antidepressant withdrawal
Monitor temp, pulse, BP
Benzodiazapine - lorazepam
Correct any dehydration, hyperpyrexia
Med unit/A+E - rehydration, bromocriptine + dantrolene

41
Q

When are bromocrpitine and dantrolene used in A+E?

A

Muscle relaxants - Neuroleptic malignant syndrome

42
Q

How to restart antipsychtics after NMS?

A

STOP for at least 5 days
Reintroduce on v small dose, increase slowly, consider antipsychotic structurally undrealted or with low affinity for dopamine eg clozapine or quetiapine

Mental Health (57 decks)

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