Antipsychotics Flashcards
give some examples of 1st generation antipsychotics
Chlorpromazine
Molidone
droperidol
Haloperidol
What is the MOA of 1st generation antipsychotics
Blocks d2 receptors therefore decreasing dopamine
What are the risks with haloperidol
Cardiac arrhythmia
Causes prolong QT interval
What are the ADRs for 1st gen antipsychotics
Extra pyramidal effects
- dystonia - muscle spasms
- Akathasia - restlessness –> anxiety
- Pseudoparkinsonism - rigidity, bradykinesia, shuffling gait, stooped posture and tremor
- Tardive dyskinesia - involuntary lower facial movements (IRREVERSIBLE)
Hyperprolactinaemia - dopamine blocks prolactin production
- sexual dysfunction, amenorrhoea, galactorrhoea, breast changes, gynocaemastia, decreased fertility
- torticollis - abnormal/asymmetrical movement of the head and neck
Give some examples of 2nd gen antipsychotics
Clozapine Olanzapine Aripiprazole Sulphide Iloperidone
What is the MOA of 2nd gen
Blocks d2 receptors and 5HT2 receptors so blocks both dopamine and serotonin
What are the ADRs of 2nd gen
Metabolic effects
- weight gain
- Increased blood glucose and blood lipids
(hypercholesterolaemia) - increased BP
important ADR of clozapine - AGRANULOCYTOSIS
weekly blood tests needed before clozapine can be administered
Can cause extra-pyramidal effects
- reduced seizure threshold
- increase in prolactin - galactorrhoea, amenorrhoea
What are antipsychotics used for
Schizophrenia
Psychosis
Acute mania
Psychotic depression
TR depression (augmented with antidepressants)
TR anxiety (augmented with anxiolytics)
Some behavioural disturbances (exceptional circumstances)
What is neuroleptic malignant syndrome
RARE response to neuroleptics (antipsychotics and psychotropics) Causes autonomic system to go into overdrive - hyperpyrexia - tachycardia - urinary incontinence - unstable BP - Salivation - Excessive sweating - increased muscle tone and rigidity
What abnormality occurs in the blood in neuroleptic malignant syndrome?
Creatine Kinase increases
What are the complications of neuroleptic malignant syndrome
Renal failure Thrombo-embolism dehydration and electrolyte imbalance MI Cardiomyopathy Cardiac arrhythmias - torsades de pointes and cardiac arrest Resp failure - chest wall rigidity, aspiration pneumonia DIC Thrombocytopenia Seizures Hepatic failure
How is neuroleptic malignant syndrome treated?
stop causative medication
Treat hyperthermia aggressively with cooling packs
airway and breathing support
Benzos to sedate patient
IV fluids - rehydration to reduce risk of renal failure
Dialysis may be necessary
Dopamine agonists - bromocriptine
LMWH to reduce risk of DVT
Dantrolene - skeletal muscle relaxant, reduces heat production and rigidity
What are the risks when using antipsychotics in the elderly
Increased risk of stroke
increased risk of VTE
