Antipsychotics Flashcards
Chlorpromazine
1st gen antipsychotic
Trifluoperazine
1st gen antipsychotic
Flupentixol
1st gen antipsychotic
Fluphenazine
1st gen antipsychotic
Sulpride
1st gen antipsychotic
Haloperidol
1st gen antipsychotic
Olanzapine
2nd gen antipsychotic
Risperidone
2nd gen antipsychotic
Amisulpride
2nd gen antipsychotic
Quetiapine
2nd gen antipsychotic
Aripiprazole
2nd gen antipsychotic
Zotepine
2nd gen antipsychotic
Clozapine
2nd gen antipsychotic
SEs of 1st gen antipsychotics compared to 2nd gen
- more likely to cause EPSEs
- more likely to cause prolactinaemia
EPSEs
- acute dystonia
- akathisia
- parkinsonism
- tardive dyskinesia
Anticholinergic SEs
‘Can’t see, can’t pee, can’t shit, can’t spit… also tachycardia’
- blurred vision
- urinary retention
- constipation
- dry mouth
- tachycardia
Effects of prolactinaemia
- galactorrhoea, amenorrhoea, gynaecomastia, hypogonadism
- sexual dysfunction
- increased risk osteoporosis
SEs of antipsychotics
- EPSEs
- anticholinergic SEs
- hyperprolactinaemia
- sexual dysfunction
- weight gain
- DM
- cardiovascular effects
- seizure threshold lowered
What effect does smoking have on antipsychotics?
induces metabolism so DECREASES plasma AP levels (need higher dose)
When is clozapine used?
treatment resistant schizophrenia where 2 other APs (at least 1 being 2nd generation) have failed
Serious SEs of clozapine
- Agranulocytosis (typically neutropenia)
- Myocarditis and cardiomyopathy
- Intestinal obstruction
- Seizures
Think: ‘All Medicine Is Shit’
What level should clozapine be maintained at?
350-500 micrograms
Neuroleptic Malignant Syndrome (NMS) - mneumonic etc.
'FALTER' Fever Altered mental state (/delirium) Leukocytosis Tremors Elevated CK (rhabdomyolosis) Rigidity (lead-pipe)
- hyperthermia
- tachycardia/unstable HR
- tachypnoea
- unstable BP
Neuroleptic malignant syndrome - Cause
SE of antipsychotics, usually triggered by new AP or dose increase, or withdrawal of dopaminergic drugs in PD
Neuroleptic malignant syndrome - Mx
- stop APs immediately
- urgent medical Mx: admit, supportive Mx, often ICU
- treat rhabdomyolysis
- admit
What medications to consider for LBD/PD hallucinations
- anticholinesterase inhibitors (dementia drugs) 1st line
- low dose quetiapine
- very low dose clozapine
1st line rapid tranquillization
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
2nd line rapid tranquillization and when it is indicated
- 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
Best AP to avoid hyperprolactinaemia
Aripiprazole
What drug(s) are used to treat tardive dyskinesia?
tetrabenazine
What drug(s) are used to treat akathisia?
propranolol
What drug(s) are used to treat acute dystonia?
procyclidine and benztropine
