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Drugs And The Brain > Antipsychotics > Flashcards

Antipsychotics Flashcards

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1
Q

what is DUP

A

duration of untreated psychosis

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2
Q

what is DUP a predictor of

A

poor outcomes in psychotic illness

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3
Q

what does the NHS offer for psychosis treatment?

A

multidisciplinary teams that offer service: early intervention in psychosis

aim to get people treated quickly
national target: treat 56% of people experiencing their first episode of psychosis in the first 2 weeks

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4
Q

what age are most EliP service users

A

younger adults

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5
Q

what will someone experiencing their first episode of psychosis typically be offered?

A

an antipsychotic drug, CBT and family therapy (‘family intervention’)

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6
Q

how long to people need to take antipsychotics after a single episode?

A

most people need to take antipsychotics for 1-2 years to minimise the chance of relapse

people who have multiple episodes may need to continue for life

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7
Q

who prescribes antipsychotic medication

A

specialists

i.e., psychiatrists attached to hospitals or community mental health services

when someone has been established on an effective treatment, their GP may take over responsibility for writing prescriptions and will be responsible for the routine health care of the patient

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8
Q

which drugs have lowest potencies

A

haloperidol
risperidone
pimozide
trifluoperazine

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9
Q

higher potency drugs

A

chlorpromazine
clozapine
sulpiride

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10
Q

most expensive drug

A

Clozapine is expensive because of its specialized prescribing procedures

However, the cost for this drug does not factor in monitoring, which can add as much as £12 per day (US costs so probably lower in UK).

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11
Q

common first choice antipsychotic

A

olanzapine, risperidone and quetiapine are common choices as they are low cost and usually the side effects are usually manageable

Aripiprazole is also becoming more common.

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12
Q

first effective antipsychotic (1952/1954)

A

chlorpromazine

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13
Q

CPZE

A

chlorpromazine equivalent - way of referring to potencies - standardisation

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14
Q

side effects of chlorpromazine

A

Very sedating

Moderate extrapyramidal (movement disorders)
Moderate muscarinic
Moderate galactorrhea

Neuroleptic malignant syndrome

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15
Q

first generation drug

A

earliest drugs to be developed

competitive antagonist at dopamine D2 receptors

high prevalence of extrapyramidal side effects

e.g. haloperidol

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16
Q

2nd generation drugs

A

newer drugs that are also termed “atypical” antipsychotics

antagonist at dopamine D2 receptors

have a lower prevalence of extrapyramidal side effects

Actions at a wide range of receptors such as 5HT2

clozapine

better efficacy against the negative symptoms of schizophrenia?

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17
Q

3rd generation

A

D2 partial agonist

newest drugs

aripiprozol

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18
Q

factors that may be important in the clinical efficacy of atypical drugs

A

High affinity at 5HT2A receptors compared to D2 receptors

High affinity at 5HT2C receptors compared to D2 receptors

A rapid dissociation rate from D2 receptors

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19
Q

least atypical drug

A

risperidone
only has high affinity for dopamine D2 and D3 receptors and 5HT2A receptors

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20
Q

most atypical drug

A

clozapine
targets widest range of receptors

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21
Q

what is the best drug for difficult cases of schizophrenia?

A

clozapine

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22
Q

secondary use of haloperidol

A

antiemetic and to treat Tourette’s syndrome

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23
Q

haloperidol side effects

A

lower sedative effects
fewer cholinergic side effect
high risk of EPS (extrapyramidal side effects)

(than chlorpromazine)

restlessness
neuroleptic malignant syndrome

24
Q

risperidone side effects

A

has a moderate risk of EPS

can cause sedation and weight gain in the early stages of treatment.

One of the most frequent side effects is galactorrhea (milky discharge from the nipples) in both men and women (though more common in women).

25
Q

olanzapine side effects

A

low risk of EPS
very sedating
high risk of hyperglycaemia
high level of muscarinic side effects

notorious for causing weight gain

26
Q

quetiapine side effects

A

characterized by having a very low risk of EPS

can cause moderate weight gain
a high risk of hyperglycaemia

It is also very sedating

has moderate anticholinergic actions.

27
Q

antipsychotics drugs associated with diabetes risk

A

quetiapine and olanzapine

28
Q

aripiprazol

A

has a relatively benign side effect profile

lower tendency to produce weight gain and EPS than some other atypicals.

29
Q

neuroleptic malignant syndrome

A

Like malignant hyperthermia, NMS is characterized by muscle contractions and tremors and a high body temperature

may also cause autonomic dysfunction and confusion/loss of consciousness.

30
Q

the mechanism of NMS

A

thought to arise because of antagonism of dopamine receptors

with polymorphisms in the D2 receptor also contributing a genetic risk factor

31
Q

what is malignant hypothermia a potential side effect of? what is the mechanism?

A

general anaesthetics
neuromuscular junction blocking drugs

due to mutations in the ryanodine receptors

32
Q

why was clozapine withdrawn?

A

agranulocytosis lead to suppressed immune system (1-2% patients)

infection

death

33
Q

when is clozapine prescribed

A

failure of at least two other drugs, on of which must have been an atypical drug

34
Q

side effects clozapine

A

agranulocytosis
cardiac effects
muscarinic effects
H1 histamine receptor effects

35
Q

cardiac effects clozapine

A

heart failure, myocarditis (rare)

hypotension, tachycardia (25% of patients)
-drop in blood pressure can induce tachycardia

36
Q

how to minimise cardiac effects with clozapine

A

start the patient on a very low dose of clozapine and gradually increase his to a therapeutic dose

37
Q

clozapine muscarinic side effects

A

complex effects at acetylcholine receptors

constipation: can be fatal (rupture the bowel)
-action as antagonist at M3 receptors
-can be managed using stool softeners and laxatives

hypersalivation

clozapine agonist at M4? metabolite of clozapine agonist at M1?

38
Q

action of clozapine as an H1 histamine receptor

A

highly sedating
weight gain/ induce type 2 diabetes

39
Q

what scheme do go on if on clozapine

A

national monitoring scheme

40
Q

clozapine monitoring

A

Often initiated as in-patient

Ramped in slowly

White blood cell count

Monitoring
-3rd day (1st week)
-weekly (18 weeks),
-Rest of the year biweekly (34 weeks)
-4 weekly for the rest of time on clozapine

> 2 days treatment missed: start initiation process over!

41
Q

blood testing for clozapine light meaning

A

Green light: given enough to last until next test

Amber result: enhanced monitoring

Red result: taken of clozapine immediately

42
Q

medication that overlaps between BP and schizophrenia

A

antipsychotic drugs play an important role in managing mania in bipolar disorder
-can be given in combination with classic mood stabilizers like lithium, valproate and lamotrigine.

Conversely, mood stabilizers are sometimes given to augment the effects of antipsychotics when treating schizophrenia.
-This can sometimes be useful in tackling treatment resistant schizophrenia.

43
Q

reason for non compliance with antipsychotics

A

lack of belief in illness

Consider side effects of medication to be worse than the illness itself

cognitive problems, disorganized life-style, therefore, may forget to fill their prescription

44
Q

how many antipsychotic prescriptions not filled

A

14%

non compliance rated may be as high as 76%

45
Q

types of antipsychotic formulation

A

oral (voluntary): most common

sustained release
-some available in the form

intramuscular injection

46
Q

benefit of sustained release drugs

A

only needs to be taken once a day, easier to remember and remain compliant with medication

47
Q

when are intramuscular injections used

A

involuntarily in psychiatric emergency situations

getting someone started on an antipsychotic when they enter a psychiatric hospital

48
Q

benefits of intramuscular depot injection

A

Useful for disorganized patients/ patient that forgets to take their medication on a regular basis

49
Q

benefits of intramuscular depot injection

A

Useful for disorganized patients/ patient that forgets to take their medication on a regular basis

only have to come to the clinic every 2/4 weeks for injection

eliminates covert non-compliance

50
Q

what drugs are available as depot

A

Risperidone (Risperdal consta)
Pipotiazine (depot only)
Haloperidol
Aripiprazole
Paliperidone (lasts up to 3 month depot)

51
Q

which drugs depot lasts up to 3 months

A

Paliperidone

useful for someone that struggles to manage their medication in tablet formation

52
Q

negatives of intramuscular depot injections

A

Sometimes effect delayed
-take a while for steady state to build up in patients plasma

Not all drugs available as depot

53
Q

how does an intramuscular depot injection work?

A

Inject a large amount of antipsychotic but it is either contained in biodegradable beads or is complexed with fatty acids
-inject into large muscle, often patients backside

beads/ compounds break down over time and release a steady stream of the antipsychotic into the patients blood stream (Over weeks, maybe months)

54
Q

antipsychotics use in dementia/ Alzheimer’s

A

Needs to be for as short a period and as low a dose as possible
-risperidone and haloperidol are currently the only antipsychotics licensed for this purpose (but many others used off-license)

extensive use in patients with dementia, taking use of sedative properties of drug
-use of antipsychotics as ‘chemical coshes’ has declined dramatically in recent years

Increased risk of stroke and sudden death

Risperidone licensed for short-term use (6 wks)

55
Q

non pharmacological treatments of schizophrenia

A

talking therapies

56
Q

talking therapies

A

CBT for psychosis can improve symptoms in people already receiving antipsychotic medication

cognitive therapy may also be useful if a patient is refusing to take antipsychotics

significant reduction in positive and negative symptoms in patients only receiving cognitive therapy

57
Q

talking therapies

A

CBT for psychosis can improve symptoms in people already receiving antipsychotic medication

cognitive therapy may also be useful if a patient is refusing to take antipsychotics

significant reduction in positive and negative symptoms in patients only receiving cognitive therapy

Drugs And The Brain (9 decks)

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