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Chapter 4 > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

Which condition are antipsychotics mainly used in?

A

Schizophrenia

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2
Q

What type of symptoms can you get in schizophrenia ?

A

positive and negative symptoms

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3
Q

Name negative symptoms of schizophrenia

A

lack of motivation
lack of social interests
‘pulling away from things’

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4
Q

Name positive symptoms of schizophrenia

A

delusions
hallucinations
thought disorders
‘symptoms added into the brain’

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5
Q

How are antipsychotics classified as?

A

1st generation and 2nd generation

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6
Q

Which generation of antipsychotics best treat the negative symptoms?

A

2nd generation

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7
Q

What are the MOA of the first generation? Whats the problem with this?

A

primarily act by blocking the D2 receptors in the brain

They are non-selective so patients get a range of different side effects with it

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8
Q

What are the main S/E of 1st generation?

Name the EPSE?

A

Extra-pyramidal S/E:
haloperidol can cause this

  1. Parkinsonia (parkinsons like symptoms like tremor)
  2. Dystonia (abnormal muscle usually due to spasms)
    (remember it like dystonia (muscle tone))
  3. dyskinesia (impairment of voluntary movement)
  4. Akathisia (constantly moving)
  5. Tardive dyskinesia (specific to the jaw and the face)
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9
Q

What are also linked with the first generation antipsychotics? what differs between them?

A

phenothiazine derivatives (can be grouped into three subtypes)
S/E is what differs between them
They all cause antimuscarinic side effects (dry mouth, blurred vision), EPS/e

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10
Q

What side effects do group 1/2 and 3 of the phenothiazine derivates cause? Name a drug for each class

A

Group 1: Promazine
sedative effects

Group 2: pericyazine
Antimuscarinic S/E

Group 3: prochloperazine
EPSE

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11
Q

What are examples of second generation drugs?

A

Olanzapine
Risperidone
quetiapine

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12
Q

Why is there an advantage in terms of S/E of second generation drugs compared to first generation?

A

2generation act more specifically on different receptors
So S/E produced are more specific to each individual drug
They have a more distinct clinical profile

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13
Q

What are other side effects of antipsychotic drugs?

A

Drowsiness
Agitation
Dizziness

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14
Q

Is there a first line treatment when choosing an antipsychotic?

A

no.

it depends on patient factors, medical history

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15
Q

What are the monitoring requirements of a person on antipsychotics?

A 
urea and electrolytes 
liver function tests
full blood count 
weight
blood glucose - risk of getting diabetes (less with the 1st generation)
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16
Q

What antipsychotic that is used as last resort?

A

clozapine when patients are intolerant to all other antipsychotics

17
Q

If a patient is non-compliant with an antipsychotic, what should be given instead?

A

Depo-injection - haloperidol, risperidone

18
Q

What drugs are used for hypo-mania and mania? What is their purpose?

if these drugs are inadequate, what could be added onto that?

A

to control any scute attacks and prevent any recurrence

  • Olanzapine, risperidone, quetiapine

added on:
lithium
Sodium valproate

19
Q

When should Na valproate not be used?

A

woman who are pregnant or wanting to be pregnant coz they can have adverse effects on the baby (check MHRA)

20
Q

What else can olanzapine be used for?

A

bi-polar

21
Q

Can carbamazpine be used for bipolar?

A

Yes. If there are 4 or more effective episodes a year

22
Q

In what conditions can lithium be used for?

A

hypo-mania and mania and in depressive episodes in patients with bipolar disorder

23
Q

Whats the range you should aim for?

A

0.4 - 1 mmol/L

anything above 2 mmol/L indicates toxicity

24
Q

What are the toxicity signs of lithium?

A
  1. Hypothyroidism
  2. Polyuria & polydipsia
  3. persistent headache and visual disturbances (intercranial hypertension)
  4. Vomiting
  5. Diarrhoea
  6. Tremor, seizures
  7. Muscle weakness
    in serous toxicity it can lead to convulsions and comas
25
Q

Which drugs reduce lithium excretion and therefore increase the plasma concentration of lithium?

A
  1. ACE inhibitors (lisinopril)
  2. Diuretics (bendroflumethiazide)
  3. Aldosterone antagonists (spironolactone)
  4. Potassium-sparing diuretics (amiloride)
  5. NSAIDS (diclofenac)
26
Q

If a drug increases lithium excretion, what occurs to their overall plasma concentration?

A

reduces the plasma conc in the blood

27
Q

Which drug causes this effect?

A

aminophylline

28
Q

What should a patient on lithium do in order to prevent toxicity?

A

keep hydrated as dehydration can cause toxicity
and
maintain and constant diet of sodium! cant have too much salt and cant have too little salt
hypo and hypernatraemia

29
Q

What can affect bioavailability of lithium and what should you do in order to maintain the same bioavailability?

A

Keep to the same brand!

Chapter 4 (13 decks)

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