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Pharmacology Drugs > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

What are the groups of antipsychotics?

A
  • Typical
  • Atypical
  • Anxiolytics
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2
Q

What are examples Typical?

A
  • Haloperidol (used for emergencies)

- Chlorpromazine

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3
Q

What is the main mechanism of action of Typical antipsychotics?

A

-Act as dopamine antagonists (D2 receptor)

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4
Q

What are some other mechanisms of action of Typical antipsychotics

A
  • Dopamine receptor blockage
  • Anticholinergic effects
  • Alpha-adrenergic blockage
  • Antihistamine effect
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5
Q

What are extrapyrimadial side of Typical antipsychotics?

A
  • Dystonia = sustained muscle contraction resulting in abnormal fixed posture
  • Akathisia = internal feeling of restlessness.(moving around a lot, can lead to suicide)
  • Tardive dyskinesia = abnormal, involuntary, repetitive movements e.g. grimacing, sticking out the tongue or smacking of the lips
  • Pseudo-parkinsonism = rigidity, tremor and increased tone
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6
Q

What are the side effects of Typical antipsychotics as a result of acting at other receptors?

A
  • Anticholinergic: dry mouth, urinary retention, blurred
  • Serotonergic: nausea, sexual dysfunction, insomnia (also due to anti-adrenergic)
  • Metabolic syndrome: increased blood glucose, obesity, increased cardiovascular risk (most have significantly reduced life expectanc
  • Antidopaminergic
  • Endocrine changes
  • Pigmentation
  • Postural hypotension
  • Neuroepileptic Malignant Syndrome
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7
Q

What is neuroepiletptic syndrome?

A

-Life threatening reaction within 2 weeks of initiating antipsychotics characterised by: fever, altered mental status, muscle rigidity, and autonomic dysfunction (tachycardia, labile BP, flushing), hyperthermia, increased CPK, autonomic lability

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8
Q

What are the uses of typical antipsychotics?

A
  • Schizophrenia

- More sedating

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9
Q

What are examples of atypical antipsychotics?

A
  • Clozapine (most effective but 3rd line due to side effects)
  • Risperidone
  • Quetiapine
  • Aripiprazole
  • Olanzapine (causes weight gain)
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10
Q

What is the mechanism of action of atypical antipsychotics?

A

-Act at serotonin (5HT2) receptors as agonists as well as dopamine antagonists so more effective in reducing negative symptoms of schizophrenia

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11
Q

What are side effects of atypical antipsychotics?

A
  • Dystonia = sustained muscle contraction resulting in abnormal fixed posture
  • Akathisia = internal feeling of restlessness
  • Tardive dyskinesia = abnormal, involuntary, repetitive movements e.g. grimacing, sticking out the tongue or smacking of the lips
  • Pseudo-parkinsonism = rigidity, tremor and increased tone

Neuroepileptic syndrome

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12
Q

What are the specific side effects of Clonazapine?

A
  • Cause agranulocytosis resulting in neutropenia so requires FBC monitoring.
  • Severe constipation
  • Sedation
  • Hyper salivation
  • Weight gain.
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13
Q

How is Clonazapine prescriptions regulated?

A

If neutropenic no more clozapine given.

If FBC isn’t given clozapine isn’t used.

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14
Q

What are the advantages of Atypical antipsychotics?

A
  • Different preparations e.g. dissolvable
  • Some once daily dosage
  • Differing side effect profiles can be matched to patient characteristics
  • First line treatment in schizophrenia now as recommended by NICE
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15
Q

What are examples of Anxiolytics (Benzodiazepines)?

A
  • Lorazepem
  • Midazolam
  • Diazepem
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16
Q

What is the mechanism of action of Benzodiazepines?

A
  • Enhance the action of GABA (main inhibitory neurone)
  • Increase opening of chloride channels – hyperpolarized membrane
  • Increased depression of cortical transmission is a hypothesis
  • Act as full agonists at these receptor sites
17
Q

What are features of benzodiazepines?

A
  • Highly addictive
  • Develop tolerance to the drug in the short term
  • Can only be used in the short term
  • Can make patient more likely to act on suicidal impulses and are dangerous in overdose
18
Q

What are side effects of benzodiazepines?

A
  • Drowsiness
  • Dizziness
  • Psychomotor impairment
  • Dry mouth
  • Blurred vision
  • Gastrointestinal upset
  • Ataxia
  • Headache
  • Reduced blood pressure
  • Rare (amnesia, restlessness, rash)
19
Q

What are side effects of benzodiazepines being used in pregnancy?

A
  • Cleft lip and palate if used in pregnancy

- If taken late in pregnancy may cause respiratory depression and feeding difficulties in baby

20
Q

What is used to reverse benzodiazepines action?

A

-Flumazenil an antagonist/partial inverse agonist at benzodiazepines receptors may be useful in reversing effects of benzodiazepines

21
Q

How are benzodiazepines used?

A
  • Anxiolytic in the short term to treat anxiety (orally)
  • Anticonvulsant in acute seizure (IM, IV, buccal)
  • Sedative
22
Q

What are the properties of benzodiazepines?

A
  • Highly lipid soluble
  • Renal excretion
  • Long half life
  • Bioavailability following oral admin. Almost complete
23
Q

What is the action of all antipsychotics?

A
  • Sedation within hours
  • Tranquilisation within hours
  • Antipsychotic – several days or weeks
  • Activating effect within weeks – negative symptoms
  • Production of extrapyramidal side effect – hour or days
24
Q

What is the toxicity of antipsychotics?

A
  • Central nervous system depression
  • Cardiac toxicity
  • Risk of sudden death with high dose
25
Q

What are dementia medications?

A
  • Acetyl Cholinesterase Inhibitors

- NMDA antagonist

26
Q

What are examples of acetyl-cholinesterase used for dementia?

A
  • Donepezil
  • Galantamine
  • Rivastigmine
27
Q

Why are acetyl-cholinesterase inhibitors used for dementia?

A
  • Acetyl-choline plays a role in arousal, memory, attention and mood.
  • NICE guidance advices the medication to be available for mild and moderate dementia (was only moderately severe before).
  • Slows down progression of Alzheimer’s Disease
28
Q

What are side effects of acetyl cholinesterase inhibitors?

A
  • Nausea
  • Vomiting
  • Anorexia
  • Diarrhoea
  • Fatigue
  • Insomnia, headache
  • Bradycardia
  • Worsening of COPD
  • Gastric/duodenal ulcers
29
Q

What is memantine?

A
  • Licensed for moderate to severe dementia
  • NMDA receptor blocker
  • Usually well tolerated
30
Q

What are side effect of memantine?

A
  • Hypertension
  • Dyspnoea
  • Headache
  • Dizziness
  • Drowsiness

Pharmacology Drugs (22 decks)

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