Antipsychotics Flashcards

1
Q

most worrying S/E of clozapine?

A

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

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2
Q

extrapyramidal S/E?

mostly 1st gen + haloperidol

A
  • 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
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3
Q

most serious manifestation of extrapyramidal symptoms?

A

tardive dyskinesia
may be irreversible on withdrawing therapy
Tx is usually ineffective

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4
Q

main S/E of antipsychotics?

A
  • 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)
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5
Q

Sx of neuroleptic malignant syndrome?

A
POTENTIALLY FATAL
fever
confusion
muscle rigidity
autonomic dysfunction
↑ HR and ↑ CK
labile blood pressure
sweating
urinary incontinence
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6
Q

best antispychotic to avoid EPSE, ↑ QT interval, sexual dysfunction, ↑ glucose?

A

aripiprazole

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7
Q

what to prescribe for Tx-resistant schizophrenia?

A

clozapine

weekly bloods for 18 weeks

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8
Q

how to monitor antipsychotics in general?

A
  • 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

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9
Q

how to Tx acute dystonic EPSE?

A

Procyclidine

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10
Q

Tx alzheimers?

A

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).

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11
Q

Tx acute dystonia secondary to antipsychotic treatment?

A

procyclidine hydrochloride 5 mg/mL injection

antimuscarinics 1st line
5-10mg IM/IV (preferred over PO as unsafe swallow)

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12
Q

first line treatment of anti-psychotic-induced parkinsonism, particularly Sx of tremors?

A

procyclidine (anti-cholinergic)

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