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Stage 2: Mental Health > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

What are the two types of antipsychotics?

A

1) First generation (FGA) / typical

2) Second generation (SGA) / atypical

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2
Q

What are three examples of FGA?

A

1) Haloperidol
2) Chlorpromazine
3) Flupentixol

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3
Q

What are 7 examples of SGA?

A

1) Olanzapine
2) Quetiapine
3) Risperidone
4) Aripiprazole
5) Lurasidone
6) Amisulpiride
7) Clozapine

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4
Q

How do antipsychotics work?

A

Dopamine (D2) antagonists

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5
Q

What brain activity is schizophrenia associated with?

A

Increased activity in the dopaminergic mesolimbic and mesocortical pathways

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6
Q

What are side effects of antipsychotics?

A

1) QTc prolongation
2) Metabolic syndrome (central obesity, diabetogenic, dyslipidaemia)
3) Hyperprolactinaemia
4) Some have sedative effect (due to action on histamine and serotonin receptors)
5) Extrapyramidal side effects (EPSEs)

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7
Q

Which side effect of antipsychotics is notoriously difficult to treat?

A

EPSEs

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8
Q

What investigations do you need to do in someone before starting on antipsychotics?

A
  • ECG (before initiation and monitor)
  • Prolactin levels
  • Blood glucose
  • Lipid levels
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9
Q

What can prolonged QT syndrome/QTc prolongation lead to?

A

Heart block/arrhythmias

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10
Q

What are symptoms of hyperprolactinaemia?

A
  • Galactorrhoea
  • Infertility
  • Amenorrhoea
  • Oligomenorrhoea
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11
Q

What are EPSE symptoms?

A

1) Acute dystonia
2) Parkinsonism
3) Akathisia
4) Neuroleptic malignant syndrome
5) Tardive dyskinesia

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12
Q

What is acute dystonia?

A
  • Uncontrolled muscle spams mostly over face, tongue, neck

- Occurs 1-5 days after drug initiation

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13
Q

What is akathesia?

A
  • Restlessness, irresistible desire to move around

- Occurs 5-60 days after drug initation

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14
Q

What is neuroleptic malignant syndrome?

A
  • Muscle rigidity, fever, unstable BP, myoglobinaemia (dark urine) - medical emergency
  • Occurs weeks to months after drug initiation
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15
Q

What is tardive dyskinesia?

A
  • Involuntary painless movements of face and upper limbs
  • Occurs months to years after drug initiation
  • Doesn’t go away even if stop antipsychotic
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16
Q

How do you treat neuroleptic malignant syndrome?

A

Stop antipsychotic

17
Q

What is first-line treatment for schizophrenia and other psychotic disorders?

A

SGA - often olanzapine

18
Q

Give 3 reasons why SGAs are now first line over FGAs?

A

1) Less side effects esp. EPSES
2) Less likely to cause hyperprolactinaemia
3) More effective for the negative symptoms of schizophrenia

19
Q

How can you treat EPSEs?

A

1) Switch the drug/reduce the dose

2) Give procyclidine

20
Q

What receptors to SGAs act on?

A

Dopamine and 5-HT receptors

21
Q

When is olanzapine good and why?

A

Acute setting bc has rapid onset

22
Q

What is there a higher risk of with olanzapine?

A

Weight gain and sedation

23
Q

What monitoring needs to be done in people on antipsychotics?

A
  • Prolactin
  • BMI
  • Blood glucose
  • Lipids
  • Regular physical health checks incl. CV risk
24
Q

When and how would you use procyclidine?

A
  • To treat drug-induced Parkinsonism and akathisia

- Would be on it long term alongside antipsychotics

25
Q

For what symptoms of schizophrenia do antipsychotics generally work better for?

A

Positive symptoms

26
Q

When is clozapine used?

A

1) Treatment-resistant schizophrenia (floridly psychotic)

2) If patient gets EPSEs

27
Q

Why does clozapine need close monitoring upon initiation?

A

Risk of hypotension and convulsions

28
Q

What is the main risk/side effect of clozapine?

A

Agranulocytosis - high risk of infection

29
Q

What do you have to do when a patient is on clozapine due to the risk of agranulocytosis?

A

Regular bloods

  • Measure WBC weekly for the first 18 weeks, then fortnightly for the first year, then monthly
  • Other parameters also need more frequent monitoring compared to other antipsychotics
30
Q

What do you need to have done to prescribe clozapine?

A

Tried at least 2 SGAs

31
Q

Why are people often first prescribed olanzapine?

A
  • First presentation of psychosis in acute setting bc acts v quickly
  • Then will be changed to another one long term that is better for them
32
Q

How are antipsychotics given?

A

Either orally or monthly IM injection (adherence)

33
Q

How do you treat psychotic depression?

A

Olanzapine short term but long term treat depression

Stage 2: Mental Health (4 decks)

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