Antipsychotics - First generation Flashcards
What are examples of first generation antipsychotics?
- Haloperidol
- Chlorpromazine
- Prochlorperazine
What are indications for the use of first generation antipsychotics?
- Severe psychomotor agitation
- Schizophrenia
- Bipolar Disorder
- Nausea and vomiting
What is the mechanism of action of first generation antipsychotics?
Block post-synaptic D2 receptors. There are 3 doapminergic pathways:
- Mesolimbic/mesocortical pathway - runs between midbrain and limbic system/frontal cortex
- Nigrostriatal pathway - connects substantia nigra with corpus striatum of the basal ganglia.
- Tuberohypophyseal pathway - connects hypothalamus with pituitary gland.
D2 receptors are also found in the CTZ - blockade helps nausea and vomiting
What are side effects of first generation antipsychotics?
-
Extrapyramidal side effects
- Dystonia
- Akasthisia
- Neuroleptic malignant syndrome
- Tardive dyskinesia
- Drowsiness
- Hypotension
- QT-prolongation
- ED
- Hyperprolactinaemia
WHy does hyperprolactinaemia occur with first generation antipsychotics?
Due to tuberophyseal D2 blockade
Why do extrapyramidal side effects occur with first-generation antipsychotics?
D2 blockade in the nigrostriatal pathway
What side effect can occur with chronic first generation antipsychotic use?
Tardive dyskinesia
What monitoring would you perform on someone using first generation antipsychotics?
- Symptom review
- Signs of neurological, respiratory or CV depression
What are examples of high-potency first generation anti-psychotics?
Haloperidol
What are examples of extrapyramidal side effects seen with first generation antipsychotic use?
- Tardive dyskinesia
- Neuroleptic malignant syndrome
- Akasthisia
- Acute dystonia
What mnemonic can you use to remember the features of neuroleptic malignant syndrome?
FALTER:
- Fever
- Autonomic instability
- Leukocytosis
- Tremor
- Elevated enzymes (creatinine kinase, transaminases)
- Rigor
