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Phase 3a Psych > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

how do antipsychotics work?

A

Dopamine 2 receptor antagonism

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2
Q

what pathways do they work on?

A

mesolimbic
nigrostriatal
mesocortical
tuberoinfundibular

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3
Q

what do antipsychotics do to the mesolimbic and nigrostriatal pathways?

A

Decrease the mesolimbic pathway therefore decreasing POSITIVE Sx eg. 3rd person auditory hallucinations

Decrease nigrostriatal pathway (extra pyramidal Side effects eg. Parkinsons Sx)

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4
Q

what do antipsychotics do to the mesocortical and tuberinfundibular pathway?

A

Mesocortial - Negative Sx

Tuberinfundibular - Prolactin

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5
Q

what condition can interference with the tuberinfundibular pathway cause and why? Sx?

A

DA blockade can cause HYPERPROLACTINEMIA
(prolactin = inhibited by DA therefore low DA = HIGH prolactin)
Sx= Lactation, low libido, infertility

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6
Q

how are antipsychotics reduced and why?

A

gradual reduction when stopping (over 3+ months) to prevent relapse

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7
Q

are antipsychotics addictive?

A

no

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8
Q

what tests are done at a review and how often are reviews done?

A

12 monthly reviews
FBC, U+E, LFT, HbA1C, BMI, Prolactin

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9
Q

what are the 2 types of antipsychotics?

A

Typical (1st gen)
Atypical (2nd gen)

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10
Q

name 2 typical antipsychotics?

A

haloperidol
chlorpromazine

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11
Q

what are the typical antipsychotics associated with?

A

extrapyramidal SE (EPSEs)

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12
Q

What 4 SE do typical antipsychotics give?

A

acute dystonic reaction
akathisia
Parkinsonism
tardive dyskinesia

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13
Q

what is acute dystonic reaction?
Tx?

A

involuntary muscle contractions

Rapid onset oligogyric crisis (involve eyeball movements, eyes are up)
or TORTICOLLIS (stiff neck, hard to turn)

Tx = IM/IV procyclidine (anti Ach)
and switch to 2nd gen or benzotropine

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14
Q

what is akathisia?
Tx?

A

rapid onset LL motor restlessness
Tx = PO Propanolol (BB)

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15
Q

Parkinsonism
Tx?

A

LDOPA

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16
Q

what is tardive dyskinesia?
Tx?

A

Years after, irregular dyscoordinated, purposeless movement

Tx = PO tetrabenazine (VMAT2-i)
Switch to 2nd gen

17
Q

what are 2 things antipsychotics cause/exacerbate?

A

exacerbate parkinsons
cause VTE + stroke in elderly

18
Q

Name a few atypical antipsychotics?

A

Risperidone
Olanzipine
quetiapine
aripiprazole
clozapine

19
Q

what are atypical antipsychotics associated with?

A

metabolic syndromes (eg. T2DM + cushings)

20
Q

when do we prescribe clozapine?
why?

A

last line after 2 different antipsychotics trialled

Only antipsychotic proven to treat NEGATIVE Sx

(mesocortical pathway involved in -ve Sx pathway)

21
Q

why is it such a good drug compared to other antipsychotics?

A

antipsychotics usually exert their force on the mesolimbic pathway only but clozapine acts on both mesolimbic and mesocortical

22
Q

what monitoring takes place for clozapine and how often?

A

18 weeks - WEEKLY
16 weeks - 2 WEEKS
then monthly

monitor FBC, U+E, LFT, prolactin, BMI, SE

23
Q

what are some side effects of clozapine?

A

AGRANULOCYTOSIS (sore throat with clozapine)
hyper salivation
weight gain
constipation (to become a bowel obstruction)

24
Q

what are 2 reasons you would need to reiterate the antipsychotic?

A

Dose missed >48hrs
if smoking status changes

25
Q

why does smoking status cause a change In clozapine?

A

smoking = high metabolism = low bioavailability

26
Q

which atypical antipsychotic causes the least SE?

A

Low SE profile = ARIPIPRAZOLE (only partial DA blockade)

27
Q

What is a major complication of antipsychotics?

A

Neuroleptic malignant syndrome (high antipsychotic)

28
Q

what are the symptoms of NMS?

A

HypOreflexia, rigidity, Normal pupils, autonomic Sx
Have raised CK +/- High WCC

29
Q

Treatment of NMS?

A

ABCDE + Stop antipsychotic
IM Dantrolene
Bromocriptive

30
Q

what type of drugs are dantrolene and bromocriptive?

A

Ryanodine - R - Antagonist
Dopamine agonist

31
Q

2 Complications of NMS?

A

Rhabdomyolysis, AKI

Phase 3a Psych (11 decks)

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