Antipsychotics Flashcards
what is mechanism of action of typical antipsychotics?
dopamine D2 receptor antagonists
blocking dopaminergic transmission in the mesolimbic pathways
what is the mechanism of action of atypical antipsychotics?
act on a variety of receptors (D2, D3, D4, 5-HT)
what are the adverse effects of typical antipsychotics?
- extrapyramidal side effects
- hyperprolactinaemia
what are the adverse effects of atypical antipyschotics?
- extrapyramidal side effects
- hyperprolactinaemia
- metabolic effects
extrapyramidal and hyperprolactinaemia is less common than with typical antipsychotics
typical or atypical antipsychotic?
haloperidol
typical
typical or atypical antipsychotic?
chlopromazine
typical
typical or atypical antipsychotic?
clozapine
atypical
typical or atypical antipsychotic?
risperidone
atypical
typical or atypical antipsychotic?
olanzapine
atypical
what are extrapyramidal side-effects?
- parkinsonism
- acute dystonia
- akathisia
- tardive dyskinesia
what is acute dystonia?
sustained muscle contraction (e.g. torticollis, oculogyric crisis)
how is acute dystonia managed?
procyclidine
what is akathisia?
severe restlessness
what is tardive dyskinesia?
condition where your face, body or both make sudden, irregular movements which you cannot control
e.g. chewing and pouting
what risks are increased in elderly patients prescribed antipsychotics?
- increased risk of stroke
- increased risk of venous thromboembolism
what side-effect is particularly associated with haloperidol?
prolonged QT interval
what are the antimuscarinic side-effects?
- dry mouth
- blurred vision
- urinary retention
- constipation
what side-effects are associated with clozapine?
- agranulocytosis
- reduced seizure threshold
- constipation
- myocarditis
- hypersalivation
typical or atypical antipsychotic?
quetiapine
atypical
typical or atypical antipsychotic?
amisulpride
atypical
typical or atypical antipsychotic?
aripiprazole
atypical
how should a patient with poor compliance be managed?
monthly IM antipsychotic depot injections
when clozapine prescribed?
resistant psychosis following trials of two other antipsychotics
in what condition should typical antipsychotics be avoided?
parkinson’s disease
what antipsychotic should be trialed in a patient who has already tried a antipsychotic and experienced galactorrhoea?
apriprazole
tolerable side effect profile, particularly for prolactin elevation
what antipsychotic is best prescribed if the patient is worried about weight gain?
aripiprazole
what should be done before starting clozapine?
- FBC - to monitor white blood cells
- baseline ECG - to monitor for myocarditis
what is one of the most common side effects of clozapine?
constipation/intestinal obstruction
what is the next point of action if clozapine has been missed for 2 days?
slowly re-titrate dose
