Antipsychotics Flashcards
1st Generation vs 2nd Generation Antipsychotics - MoA and SE
1st Gen - Da-, Extrapyramidal S/E
2nd Gen - Da-, Se+ , Metabolic S/E
1st Generation APx
Haloperidol
Chlorpromazine
2nd Generation APx
Olanzapine Risperidone Quetiapine Aripiprazole Clozapine
Effects of Dopamine:
D - Drive O - psychOsis P - parkinsonism A - attention M - motor I - inhibition of prolactin N - narcotics E - EPSE
Spectrum of EPSE with 1st Gen APx
Acute Dystonia - Muscle contraction
Akathisia - Rustle - jitteriness
Akinesia - Hustle - bradykinesia + tremor
Tardive dyskinesia?
constant involuntary movement of peri-orbital muscles
Can be irreversible if not treated early
Acute dystonia?
Torticollis - wry neck
Oculogyric crisis - bilateral upwards deviation of gaze
Neuroleptic Malignant Syndrome?
Reaction to Antipsychotic medication
Confusion + Agitation
Muscular rigidity
Significant Hyperthermia
Seizures
Treat with - Dantrolene + cooling measures
Dopamine antagonism effects
Mesolimbic - reduced +ve symptoms
Mesocortical - reduce -ve symptoms
Nigrostriatal - blockade –> EPSE, TD, NMS
Tuberoinfundibular blockade –> hyperprolactinaemia, ED, weight gain
Other side effects of APx
Anti-cholinergic - dry mouth, blurred vision, constipation
Anti-histamine - sedation, weight gain
Anti-adrenergic - drops blood pressure
Dyslipidaemia and diabetes
QTC prolongation in all
When should Clozapine be considered
After trial of 2 APx without success
S/E of Clozapine
weight gain
constipation / intestinal obstruction
excessive salivation
lowers seizure threshold
Severe:
cardiotoxic - myocarditis
arrhythmias
Agranulocytosis / neutropenia
Risperidone - details
Worst for hyperprolactinaemia
Less sedating
Olanzapine - details
2nd in efficacy behind Clozapine
Weight gain independent of calorific intake
Quetiapine - details
Similar to risperidone, but more sedative
Quetiapine = “quiet time”