Antipsychotics Flashcards
What should you do before starting an antipsychotic?
ask about personal/
family history of diabetes, hypertension, and cardiovascular disease.
Give advice
on diet, weight control and exercise.
Perform BP, weight, fasting blood glucose, lipid profile, FBC, ECG if on clozapine or zotepine.
Monitoring when on antipsychotics?
6-monthly
monitoring of LFT, U&E, prolactin, weight, HbA1c is recommended
How do typical antipsychotics and atypical antipsychotics exert there effect?
typical - D2 antagonism
atypical - interact with several receptors (e.g., D2, D3, D4, 5-HT)
Are extrapyramidal symptoms associated with typical or atypical antipsychotics?
typical
What side effects are associated with atypical antipsychotics?
metabolic disturbances - weight gain, insulin resistance
What is a potentially life-threatening side effect of both first-generation and second-generation antipsychotics? What are the signs and symptoms of this?
neuroleptic malignant syndrome - fever, muscle rigidity, autonomic instability, and mental status changes
Examples of typical antipsychotics?
chlorpromazine, haloperidol
Extrapyramidal symptoms?
bradykinesia, dystonia, rigidity, athetosis, akathisia, ballimus, chorea, tics and tremors
high potency typical antipsychotic SEs?
hyperprolactinaemia,
extrapyramidal symptoms (esp. in high-potency typicals eg. haloperidol, fluphenazine, perphenazine, trifluoperazine, pimozide)
prolonged QT syndrome
neuroleptic malignant syndrome
low-potency typical antipsychotic SEs?
anticholinergic effects, sympatholytic effects (orthostatic hypotension - due to alpha 1 blockade), metabolic effects, sedation
why do typical antipsychotics cause hyperprolactinaemia?
Dopamine inhibits the release of prolactin via the D2 receptor in the tuberoinfundibular pathway. Therefore, dopamine antagonists increase the effects of prolactin.
Hyperprolactinaemia symptoms?
galactorrhea in women, gynecomastia in men, and symptoms of hypogonadotropic hypogonadism (due to ↓ FSH and LH secretion) in both sexes.
atypical antipsychotic examples?
Clozapine
Olanzapine
Risperidone
atypical antipsychotics SEs?
Metabolic effects (usually weight gain, hyperglycemia, dyslipidemia) most prominent
sedation, prolonged QT, hyperprolactinaemia (less pronounced than typical), neuroleptic malignant syndrome
clozapine can cause agranulocytosis
Clozapine specific SE?
agranulocytosis
Neutropenia
symptoms of hypogonadotropic hypogonadism?
women: amenorrhea, reduced libido, infertility
Men: erectile dysfunction, reduced libido, infertility
Anticholinergic symptoms?
Can’t spit can’t shit can’t see can’t pee
Dry mouth, blurred vision, mydriasis, constipation, urinary retention, and tachycardia
neuroleptic malignant syndrome symptoms? Dx? Tx?
FALTER - Fever, Autonomic instability, Leukocytosis, Tremor, Elevated enzymes (creatine kinase, transaminases), Rigor
Muscle rigidity, akinesia, tremor
Hyperthermia
Autonomic instability (tachycardia, labile blood pressure, tachypnea, diaphoresis, dysrhythmias)
Mental status change: confusion, delirium, reduced vigilance, stupor
sign raised creatine kinase and leukocytosis
discontinue drug. Supportive care - ICU
Dantrolene (ryanodine receptor antagonist) - prevents calcium release from sarcoplasmic reticulum of striated muscle.
1st and 2nd line for acute psychosis?
1st: atypical
2nd: typical
1st and 2nd line for bipolar affective disorder or acute mania?
1st: atypical
2nd: typical
antipsychotic for delirium?
typical
Antipsychotic for Psychotic symptoms caused by medication for Parkinson disease (dopamine agonists)
Clozapine
Antipsychotic for psychosis during pregnancy?
typical (eg. haloperidol)
antipsychotic for postpartum psychosis?
atypical(e.g., quetiapine, risperidone, olanzapine)
Which class of antipsychotics should be used in elderly to avoid anticholinergic SEs?
high-potency substances (e.g., haloperidol, risperidone) or melperone are preferred
Define akathisia
refers to a feeling of inner restlessness that is reduced or relieved by movement. When sitting, a person may caress their scalp, cross and uncross their legs, rock or squirm in their chair, get out of the chair often and pace back and forth and even make noises such as moaning. When standing, a person with akathisia may involuntarily march in place.
Akinesia vs bradykinesia vs hypokinesia
Akinesia means absence of movement. Bradykinesia means slowness of movement. Hypokinesia means decreased amplitude or range of movement. These three terms are commonly grouped together and referred to as bradykinesia.
Define athetosis
Athetosis means slow, writhing, continuous, involuntary movements. Athetosis sometimes resembles slow dance-like movements, changing randomly in a flowing pattern. It is a term often used to describe the movements of someone with cerebral palsy (CP).
Define chorea
Chorea refers to involuntary, irregular, purposeless, non-rhythmic, abrupt, rapid or unsustained movements that seem to flow from one body part to another. A characteristic feature of chorea is that the movements are unpredictable in timing, direction and body parts affected
Define dyskinesia and tardive dyskinesia
Dyskinesia is a general term for any abnormal involuntary movement. “Tardive dyskinesia” is a term used for abnormal involuntary movements that begin after taking certain medications used to treat nausea or emotional problems. Tardive dyskinesia sometimes resembles chorea, dystonia, myoclonus, tics or tremor
How should you describe dyskinesias?
it is important that dyskinesias are very precisely described by the examiner in terms of rhythm, speed, duration and pattern.
It is very important for the individual to tell the examiner what brings on or helps control the dyskinesia and when during the day the dyskinesia is easier or more difficult to control
