Antipsychotics Flashcards
most worrying S/E of clozapine?
agranulocytosis resulting in neutropenia
(↓ wbc, neutrophils, lymph)
(all patients are monitored with at least monthly blood tests)
requires immediate cessation of the drug and referral to a haematologist
extrapyramidal S/E?
mostly 1st gen + haloperidol
- parkinsonian (tremor, appears gradually)
- acute dystonia + dyskinesia (young ppl, after few doses)
- akathisia (restlessness) after large initial doses
- tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), normally w/ long-term therapy
most serious manifestation of extrapyramidal symptoms?
tardive dyskinesia
may be irreversible on withdrawing therapy
Tx is usually ineffective
main S/E of antipsychotics?
- EPSE
- ↑ prolactin (risperidone)
- sexual dysfunction (Risperidone and haloperidol)
- cardiac (↑ QT with haloperidol)
- hyperglycaemia and weight gain (clozapine, olanzapine, quetiapine, and risperidone)
- postural hypotension (clozapine, chlorpromazine, quetiapine)
- neuroleptic malignant syndrome
- agranulocytosis (clozapine)
Sx of neuroleptic malignant syndrome?
POTENTIALLY FATAL fever confusion muscle rigidity autonomic dysfunction ↑ HR and ↑ CK labile blood pressure sweating urinary incontinence
best antispychotic to avoid EPSE, ↑ QT interval, sexual dysfunction, ↑ glucose?
aripiprazole
what to prescribe for Tx-resistant schizophrenia?
clozapine
weekly bloods for 18 weeks
how to monitor antipsychotics in general?
- FBC, U+E, LFT at start and then annually
- blood lipids and weight at baseline, 3 months then yearly
- Fasting blood glucose at baseline, at 4–6 months, and then yearly
Before initiating, ECG (if cardiovascular risk) & BP monitoring advised
how to Tx acute dystonic EPSE?
Procyclidine
Tx alzheimers?
mild/moderate: AChE inhibitors
● only started by specialist doctors
● 3 licenced drugs: donepezil, rivastigmine and galantamine
● If moderate/severe dementia then treat with NMDA antagonist (memantine).
Tx acute dystonia secondary to antipsychotic treatment?
procyclidine hydrochloride 5 mg/mL injection
antimuscarinics 1st line
5-10mg IM/IV (preferred over PO as unsafe swallow)
first line treatment of anti-psychotic-induced parkinsonism, particularly Sx of tremors?
procyclidine (anti-cholinergic)