antipsychotics Flashcards
indication antipsychotics
schizophrenia, psychosis, agitation
mechanism typical antipsychotics
D2 antagonists (block dopamine)
examples typical antipyschotics
haloperidol, chlopromazine
most common SE typical antipsychotics
extrapyramidal, hyperprolactinaemia
common extrapyramidal side effects
parkinsonism // acute dystonia // akathisia (restless) // tradive dyskinesia
symptoms acute dystonia in antipsychotic SE
sustained muscle contraction eg torticollis, oculogryic crisis
symptoms oculogryic crisis
restlessness, agitation, upward deviation of eyes
causes oculogryic crisis
antipsychotics (esp typical), metoclopramide, postencephalitis parkinsons
mx oculogryic crisis
IM benzotropine or procylidine
mx acute dystonia antipsychotics
procyclidine
symptoms tardive dyskinesia antipsychotic SE
late onset, choriod movement eg chewing and pouting jaw
antimuscarinic symptoms antipsychotics
dry mouth, blurred vision, urinary retention, constipation
endocrine symptoms antipsychotics
weight gain, impaired glucose tolerance, raised prolactin, neuroleptic malignant syndrome
what is neuroleptic malignant syndrome
pyrexia, rigid muscle, hypertension, tachycardia, tachypnoa, delirium, agitated
blood results neuroleptic malignant syndrome
raised CK (rhabdomyolisis), AKI, leukocytosis (raised WCC)
neuroleptic malignant syndrome
stop antipsychotic // IV fluids // dantrolene, brocriptine (dopamine agonist)
seizure effect antipsychotics
reduced threshold
ECG typical antipsychotics
prolonged QT syndrome - esp haloperidol
action atypical antipsychotics
variety of receptors (D2, D3, D4, 5HT)
more common side effects of atypical antipsychotics
metabolic eg weight gain!!! (extrapyramidal and hyperprolactin less common)
examples atypical antipsychotics
clozapine, olanzapine, risperidone, quatepine, ariprazole
which atypical antipsychotics has a good SE profile
aripiprazole - esp good for raised prolactin
bad SE clozapine
agranulocytosis // reduced seizure threshold // constipation // myocarditis
what must be monitored on clozapine
FBC for agranulocytosis
effect of smoking on clozapine
may need dose adjustment - stopping smoking raises clozapine blood levels
indication starting clozapine
treatment resistant schizophrenia // trialed a typical and atypical antipsychotic for 6-8 weeks each
risks starting elderly on antipsychotics
stroke and VTE
when does FBC, U+E, LFT need to be checked with antipyschotics
initially, annually (more for clozapine)
when does lipids and weight need to be checked on antipyschotics
initially, 3 months, annually
when does glucose and prolactin need to be checked on antipyschotics
initially, 6 months, annually
