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Psychiatry extras > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

What are the 4 dopamine pathways of the brain?

A

Mesolimbic

Mesocortical

Tuberoinfundibular

Nigrostriatal

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2
Q

What is the mesolimbic pathway in schizophrenia?

A

Overactive in schizophrenia due to too much dopamine
- Causes positive symptoms

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3
Q

What is the mesocortical pathway in schizophrenia?

A

Underactive in schizophrenia due to reduced dopamine
- Causes negative symptoms

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4
Q

When antipsychotics are administered, this affects the tuberoinfundibular pathway, what side-effects are produced?

A

(Increased prolactin) galactorrhoea, gynaecomastia, amenorrhoea and sexual dysfunction.

Typically due to 2nd gen (atypical antipsychotics).

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5
Q

When antipsychotics are administered, this affects the nigrostriatal pathway, what side-effects are produced?

A

Extra-pyramidal side effects include:

Parkinsonism

Acute dystonia (muscle spasm)

Akathisia (severe restlessness – fidgeting, pacing, constant need to move)

Tardive dyskinesia (late onset of chorea, lip smacking, pouting of jaw, chewing, sticking tongue out, blinking)

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6
Q

What does blocking of alpha receptors (alpha blockers) lead to?

A

Orthostatic hypotension

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7
Q

What does blocking of cholinergic receptors (anti-cholinergic drugs) lead to?

A

Dry mouth

Blurred vision

Constipation

Urinary retention

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8
Q

What does blocking of H1 receptors lead to?

A

Sedation

Weight gain

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9
Q

Examples of 1st gen (typical) antipsychotics?

A

Haloperidol

Prochlorperazine

Fluphenazine

Chlorpromazine

Trifluperazine

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10
Q

Mechanism of action for 1st gen antipsychotics?

A

NON-SELECTIVELY block D2 (D2 antagonists) and other receptors

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11
Q

Benefit of 1st gen antipsychotics in schizophrenia?

A

Reduce positive symptoms (acting on mesolimbic pathway)

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12
Q

Downside of 1st gen antipsychotics in schizophrenia?

A

Worsens negative symptoms

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13
Q

Side effects of 1st gen antipsychotics?

A

Extra-pyramidal side effects (main side-effects)

Gynaecomastia

Galactorrhoea

Amenorrhoea

Sexual dysfunction

Orthostatic hypotension

Anti-cholinergic side effects

Sedation

Weight gain

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14
Q

What is haloperidol commonly used for?

A

Delirium or psychosis

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15
Q

What are side-effects of specifically haloperidol?

A

Prolonged QT

Neuroleptic malignant syndrome (pyrexia/fever + muscle stiffness)

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16
Q

Examples of 2nd gen (atypical) antipsychotics?

A

Olanzapine

Risperidone

Quetiapine

Aripiprazole

Clozapine

Amisulpride

Lurasidone

17
Q

Mechanism of action for 2nd gen antipsychotics?

A

Work on D2 and 5HT-3 (serotonin) to reduce side effect profile

Also works on H1, alpha and cholinergic

18
Q

Benefits of 2nd gen antipsychotics in schizophrenia?

A

Improves positive symptoms

No worsening of negative symptoms

Less likely to cause extra-pyramidal side effects

19
Q

What 2nd gen antipsychotic is most likely to cause increased extra-pyramidal side effects and increased prolactin side effects?

A

Risperidone

20
Q

Specific side-effects for olanzapine?

A

Metabolic syndrome (hyperglycaemia, hyperlipidaemia, weight gain and sedation)

21
Q

Specific side-effects for quetiapine?

A

Sedation and weight gain

22
Q

Specific side-effect for risperidone?

A

Galactorrhoea

23
Q

Specific side-effects for clozapine?

A

Agranulocytosis (decreased granulocyes i.e. basophils, neutrophils, eosinophils)

Neutropenia (decreased neutrophils)

Seizures

Metabolic syndrome

Weight gain

Sedation

24
Q

What 2 tests should be done before starting patient on clozapine?

A

ECG (since can cause metabolic syndrome and myocarditis so baseline ECG required)

FBC (full blood count)

25
Q

What antipsychotic is used for treatment resistant schizophrenia?

A

Clozapine

26
Q

How often is FBC carried out with clozapine therapy?

A

FBC every week for 18 weeks then every 2 weeks thereafter

After 1 year of monitoring, check FBC every 4 weeks

27
Q

What must patient notify clinician about during clozapine therapy?

A

Patient must notify if started or stopping smoking

28
Q

Treatment for tardive dyskinesia?

A

tetrabenazine

29
Q

Treatment for acute dystonia?

A

pyrocyclidine

Psychiatry extras (4 decks)

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