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Psychiatry > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

Give examples of first generation/typical antipsychotics

A 
Chlorpromazine
Haloperidol
Prochlorpromazine
Fluphenazine
Zuclopenthixol
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2
Q

What is the mechanism of action for typical antipsychotics?

A

Dopamine D2 receptor blockers

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3
Q

Give examples of second generation/atypical antipsychotics

A 
Aripiprazole
Clozapine
Olanzapine
Rispiridone
Quetiapine
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4
Q

What is the mechanism of action for atypical antipsychotics?

A

More selective blockade of certain D2 receptors

Also block 5-HT receptors

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5
Q

Which type of antipsychotics are more likely to cause extra-pyramidal side effects?

A

Typical/first generation

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6
Q

What are the extra-pyramidal side effects?

A

Parkinsonism
Tardive dyskinesia
Akathisia
Acute dystonia

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7
Q

What is tardive dyskinesia?

A 
Lip smacking
Rocking
Rotating ankles
Marching in place
Repetitive sounds
--> happens with chronic use
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8
Q

How is tardive dyskinesia treated?

A

Tetrabenazine (monoamine uptake inhibitor)

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9
Q

What is akathisia?

A

Inner state of restlessness

- carries an increased risk of suicide

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10
Q

What is acute dystonia?

A

Painful, sustained muscle spasm

- especially of neck (torticollis), jaw or eyes

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11
Q

How can acute dystonia be treated?

A

Procyclidine, Benztropine or Prochlorperazine

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12
Q

Which type of antipsychotic is thought to have the greatest risk of metabolic syndrome?

A

Atypical (second generation)

- especially clozapine and olanzapine

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13
Q

What other side effects are seen with antipsychotic drugs?

A 
Raised prolactin
Sedation + apathy
Metabolic syndrome - weight gain and T2DM
Stroke and VTE risk in elderly
Sexual dysfunction
Long QT
Neuroleptic malignant syndrome
Postural hypotension
Photosensitivity (chlorpromazine)
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14
Q

Why do antipsychotics increase prolactin?

A

Dopamine usually inhibits it’s release

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15
Q

Which atypical antipsychotic has a potentially better side effect profile?

A

Aripiprazole

  • lower risk of sedation and metabolic syndrome
  • LOWERS prolactin
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16
Q

Which antipsychotic can be considered most effective, but the ‘dirtiest’?

A

Clozapine –> lots of side effects

17
Q

What are the side effects of clozapine?

A 
Sedation
Metabolic syndrome
Hypotension
Constipation
Anti-cholinergic
Hypersalivation
Agranulocytosis --> FBC monitoring
18
Q

How is hypersalivatin associated with clozapine treated?

A

Hyoscine hydrobromide

19
Q

What might happen if a patient on clozapine stops smoking?

A

Levels may jump suddenly –> look out for side effects

20
Q

What are the features of neuroleptic malignant syndrome?

A

Develops within 2 weeks of starting drug

  • hyperthermia
  • altered mental status
  • muscle rigidity (raised CK)
  • dysautonomia: raised HR, labile BP, sweating
21
Q

What is the drug management for schizophrenia?

A

1st line: oral (ideally) or depot, 1st or 2nd generation antipsychotic
- if one fails, switch to another

2nd line: Clozapine if 2 different antipsychotics have been ineffective

22
Q

When are depot antipsychotic injections preferred?

A

If compliance is poor

23
Q

Which tests need to be done at baseline and annual check up?

A

FBC, U+E, LFTs
Metabolic/CV:
- fasting glucose, HbA1c, lipids, weight, waist circumference, BP, ECG
Prolactin

24
Q

What additional monitoring is required?

A 
Weight: weekly for first 6 weeks, then at 3 months
BP, HR, lipids and glucose at 3 months
Prolactin at 6 months
ECG for haloperidol
FBC for clozapine
25
Q

Which non-drug management should be offered for schizophrenia?

A 
Individual CBT alongside antipsychotic
Family intervention
Art therapy
Lifestyle advice
Social support
26
Q

How regularly does FBC need to be monitored in a patient taking clozapine?

A

Weekly for first 6 months
Fortnightly for the next 6 months
Then every 4 weeks
For one month after cessation of clozapine

27
Q

When should you be worried about agranulocytosis?

A

Sore throat in a patient on clozapine –> get a FBC

28
Q

Why is ECG monitoring required in patients taking clozapine?

A

Risk of myocarditis

29
Q

How should an acutely psychotic patient be managed if they are being difficult?

A 
Non drug approaches first:
- use of distraction
- seclusion
- try talking to them
Drug sedation
30
Q

What are the options for sedating an acutely psychotic patient?

A

Lorazepam 1-2mg
+/- Haloperidol 5mg

Try oral first, if unsuccessful –> lorazepam IM

Psychiatry (12 decks)

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