Antipsychotics Flashcards
What investigations should be carried out before initialising treatment?
ECG Weight/height BP FBC U&Es LFT Prolactin Glucose/HbA1c Fasting lipids
What are typical antipsychotics?
Dopamine receptor 2 (D2) antagonism Chlorpromazine Fluphenazine Flupentixol Haloperidol Pipothiazine Sulpiride Trifluoperazine Zuclopenthixol
What are the side effects fo typical antipsychotics?
Neurological: Neuroleptic malignant syndrome Seizure threshold lowered -> fits Sedation Extrapyramidal side-effects Psychiatric: Apathy Confusion Depression Autonomic: Blood pressure Temperature Hypersensitivity: Liver Bone marrow Skin Endocrine: Raised Prolactin Peripheral autonomic: Muscarinic receptor blockade Alpha-1-adrenoceptor blockade Cardiac: Arrhythmia
What are extra pyramidal side effects?
Akathisia - subjective feelings of restlessness, often associated with objective signs (pacing, rocking, repeatedly crossing legs).
Parkinsonism - antipsychotic and idiopathic parkinsonism are clinically identical (tremor, rigidity and bradykinesia). Usually develops after several days to weeks.
Acute Dystonia - involuntary muscle spasms which produce briefly sustained abnormal postures. Usually occurs within 48hrs of initiation.
Tardive dyskinesia (TD) - abnormal involuntary hyperkinetic movements. TD is potentially irreversible. Abnormal movements include abnormal tongue movements (fly catching sign, bon-bon sign), pouting/smacking of lips, chewing, head nodding, grimacing, rocking movements.
What are the features of metabolic syndrome that can be caused by antipsychotics (olanzapine, clozapine)?
Central obesity Insulin resistance Impaired glucose regulation Hypertension Raised plasma triglycerides Raised LDL cholesterol level, and/or low HDL cholesterol level
What is neuroleptic malignant syndrome?
Hyperthermia Muscle rigidity Confusion Tachycardia Hyper/hypotension Tremor Raised Creatine Kinase (CK) Low pH – metabolic acidosis 5-20% mortality Usually on initiation of drug
Which antipsychotics are available to be given as depot injections?
Typicals: Haloperidol Flupentixol Zuclopenthixol Fluphenazine Atypicals: Risperidone Olanzapine Aripiprazole
What are atypical antipsychotics?
D2 antagonism +/- 5-HT receptor antagonism Aripiprazole Amisulpride Olanzapine Quetiapine Risperidone Clozapine
What are the side effects of aripiprazole?
Nausea Restlessness Insomnia may initial exacerbation of psychosis least weight gain minimal metabolic effect Partial dopamine agonist, long half life Dose- 5-30mg
What are the side effects of olanzapine?
Sedation +++ Weight gain ++++ Raised triglycerides Proglycaemic Dizziness Anticholinergic side-effects Can be used for rapid tranquillisation (i.m) Dose- 5-20mg
What are the side effects of quetiapine?
Sedation ++
Weight gain ++
Less metabolic disturbance than olanzapine
Possible QT prolongation
Requires titration
Effective in bipolar depression
Dose- 300-600mg (2 doses). Once daily extended release preparation also
What are the side effects fo risperidone?
Sedation + Weight gain ++ Hyperprolactinaemia Sexual dysfunction ++ EPSE ++ Dose- 4-6mg Depot available
What are the side effects of clozapine?
Sedation ++++ Weight gain ++++ Raised triglycerides Proglycaemic Hypersalivation Reduced seizure threshold Serious: Myocarditis/Cardiomyopathy Orthostatic hypotension Agranulocytosis (this requires regular blood monitoring with initially weekly Full Blood Count) D4 blockade in addition to other sites Careful dose titration
What needs to be checked before initiating carbamazepine?
Need to check liver and haematological function before and after starting treatment - risk of serious blood and hepatic disorders
Which atypical antipsychotic is the most effective?
Clozapine
