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Y4: Psych > Antipsychotics > Flashcards

Antipsychotics Flashcards

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1
Q

Chlorpromazine

A

1st gen antipsychotic

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2
Q

Trifluoperazine

A

1st gen antipsychotic

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3
Q

Flupentixol

A

1st gen antipsychotic

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4
Q

Fluphenazine

A

1st gen antipsychotic

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5
Q

Sulpride

A

1st gen antipsychotic

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6
Q

Haloperidol

A

1st gen antipsychotic

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7
Q

Olanzapine

A

2nd gen antipsychotic

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8
Q

Risperidone

A

2nd gen antipsychotic

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9
Q

Amisulpride

A

2nd gen antipsychotic

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10
Q

Quetiapine

A

2nd gen antipsychotic

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11
Q

Aripiprazole

A

2nd gen antipsychotic

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12
Q

Zotepine

A

2nd gen antipsychotic

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13
Q

Clozapine

A

2nd gen antipsychotic

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14
Q

SEs of 1st gen antipsychotics compared to 2nd gen

A
  • more likely to cause EPSEs

- more likely to cause prolactinaemia

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15
Q

EPSEs

A
  • acute dystonia
  • akathisia
  • parkinsonism
  • tardive dyskinesia
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16
Q

Anticholinergic SEs

A

‘Can’t see, can’t pee, can’t shit, can’t spit… also tachycardia’

  • blurred vision
  • urinary retention
  • constipation
  • dry mouth
  • tachycardia
17
Q

Effects of prolactinaemia

A
  • galactorrhoea, amenorrhoea, gynaecomastia, hypogonadism
  • sexual dysfunction
  • increased risk osteoporosis
18
Q

SEs of antipsychotics

A
  • EPSEs
  • anticholinergic SEs
  • hyperprolactinaemia
  • sexual dysfunction
  • weight gain
  • DM
  • cardiovascular effects
  • seizure threshold lowered
19
Q

What effect does smoking have on antipsychotics?

A

induces metabolism so DECREASES plasma AP levels (need higher dose)

20
Q

When is clozapine used?

A

treatment resistant schizophrenia where 2 other APs (at least 1 being 2nd generation) have failed

21
Q

Serious SEs of clozapine

A
  • Agranulocytosis (typically neutropenia)
  • Myocarditis and cardiomyopathy
  • Intestinal obstruction
  • Seizures

Think: ‘All Medicine Is Shit’

22
Q

What level should clozapine be maintained at?

A

350-500 micrograms

23
Q

Neuroleptic Malignant Syndrome (NMS) - mneumonic etc.

A 
'FALTER'
Fever
Altered mental state (/delirium)
Leukocytosis
Tremors
Elevated CK (rhabdomyolosis)
Rigidity (lead-pipe)
  • hyperthermia
  • tachycardia/unstable HR
  • tachypnoea
  • unstable BP
24
Q

Neuroleptic malignant syndrome - Cause

A

SE of antipsychotics, usually triggered by new AP or dose increase, or withdrawal of dopaminergic drugs in PD

25
Q

Neuroleptic malignant syndrome - Mx

A
  • stop APs immediately
  • urgent medical Mx: admit, supportive Mx, often ICU
  • treat rhabdomyolysis
  • admit
26
Q

What medications to consider for LBD/PD hallucinations

A
  • anticholinesterase inhibitors (dementia drugs) 1st line
  • low dose quetiapine
  • very low dose clozapine
27
Q

1st line rapid tranquillization

A

take into account any advance statements

Offer oral Mx

  • if already on AP: lorazepam or promethazine (avoids risks of combining APs)
  • if not already on AP: olanzapine, quetiapine, risperidone or haloperidol
  • repeat after 45-60 mins
28
Q

2nd line rapid tranquillization and when it is indicated

A
  • if 2 doses (1t line) fail, or if patient is placing themselves or others at significant risk
  • consider IM Mx
  • consider patient’s legal status, contact seniors
  • lorazepam IM diluted with water (have flumazenil (antidote) to hand incase of respiratory depression)
  • promethazine IM (useful in benzo-tolerant patient; can be repeated)
  • olanzapine IM (NOT with IM benzo)
  • haloperidol last choice as high risk of acute dystonia (ensure IM procyclidine to hand); can be repeated
29
Q

Best AP to avoid hyperprolactinaemia

A

Aripiprazole

30
Q

What drug(s) are used to treat tardive dyskinesia?

A

tetrabenazine

31
Q

What drug(s) are used to treat akathisia?

A

propranolol

32
Q

What drug(s) are used to treat acute dystonia?

A

procyclidine and benztropine

Y4: Psych (8 decks)

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