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JUNE 24 > Antipsychotics June 24 > Flashcards

Antipsychotics June 24 Flashcards

1
Q

281. What are the main uses of antipsychotics?

A

Used short term to calm disturbed patients who may be suffering from schizophrenia, brain damage, mania, toxic delirium, or agitated depression. Used to alleviate severe anxiety but only used short term.

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2
Q
  1. What are the 2 main aims of treating psychosis?
A
  • To alleviate suffering of the patient and carer. - Improve social & cognitive functioning.
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3
Q
  1. If antipsychotics are used for anxiety, how long are they used for?
A
  • Use in severe or difficult-to-treat anxiety. - Short term.
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4
Q
  1. What are the positive and negative symptoms of schizophrenia?
A

Positive: Hallucinations, Thought disorder, Delusions. Negative: Apathy, Social withdrawal.

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5
Q
  1. Give examples of 1st and 2nd generation antipsychotics and what is the difference?
A
  • 1st generation end in ‘” azine “ or “ol”. - 2nd generation always end in “apine” or “one”. - Key difference is that 1st gen have more EP side effects compared to 2nd gen. 2nd gen are better at treating negative symptoms.
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6
Q
  1. Which phenothiazine antipsychotics are group 1, 2, and 3, and what’s the difference between each?
A

(Table to be added)

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7
Q
  1. If prescribing antipsychotics for the elderly, what must be considered?
A
  • Balance benefits to risk. - Antipsychotics are related to small cases of stroke, TIA, and mortality in elderly patients with dementia. - Susceptible to postural hypotension and hypo or hyperthermia in hot or cold weather. - Not to be used in the elderly to treat mild-moderate psychotic symptoms. - Reduce initial doses in the elderly and review treatment regularly.
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8
Q
  1. What are EP side effects?
A
  • Parkinsonian symptoms (tremor), Acute dystonia, Akathisia, Tardive dyskinesia, Increased prolactin concentration & hyperprolactinaemia. (Pneumonic: ADAPPT)
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9
Q
  1. What group of drugs are patients more likely to expect EP side effects with?
A

1st generation.

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10
Q
  1. What needs to be monitored when taking antipsychotics and how often?
A
  • FBC, urea, electrolytes, liver function at the start with antipsychotics and then annually. - Blood lipids, weight, fasting blood glucose, ECG. - BP, prolactin concentrations, physical health monitoring (including CVD risk) at least once a year.
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11
Q
  1. Create a table explaining which antipsychotic to take to avoid certain side effects (slide 214)?
A

(Screenshot from files q291 a+b to be added)

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12
Q
  1. What’s the main patient and carer advice given to patients on antipsychotics?
A
  • Photosensitization: this may occur at high doses, avoid direct sunlight. - Driving: drowsiness may affect performance of skilled tasks, especially at the start of treatment.
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13
Q
  1. Which antipsychotic is given last line when all others have failed?
A

Clozapine.

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14
Q
  1. What’s the MHRA warning around clozapine?
A
  • Potentially fatal risk of intestinal obstruction, fecal impaction, and paralytic ileus. Seek medical advice before taking the next dose of clozapine if constipation develops (Oct 2017). - Clozapine and other antipsychotics: monitor blood concentrations for toxicity (Aug 2020). - Blood monitoring required to manage the risk of agranulocytosis. Monitor blood conc for toxicity in certain clinical situations, e.g., stop smoking, switching to e-cigarettes.
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15
Q
  1. What are the contraindications for clozapine?
A
  • Bone marrow disorders - History of agranulocytosis - History of neutropenia - Drug intoxication - Paralytic ileus - Severe cardiac disorder (myocarditis) - Uncontrolled epilepsy - Severe CNS depression
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16
Q
  1. What are the monitoring requirements of clozapine?
A
  • Prolactin - Patients with schizophrenia should have physical health monitoring & CVD risk assessment at least once a year. - Monitor leukocytes and blood count - Monitor blood clozapine concentration in certain clinical conditions. - Close supervision during initiation due to the risk of collapse due to hypotension & convulsions. - Monitor blood lipids and fasting glucose.
17
Q
  1. What’s the main patient and carer advice given to patients on clozapine?
A
  • Photosensitization at higher doses (avoid direct sunlight). - Driving & skilled tasks: drowsiness may affect work, especially at the start of treatment, effects of alcohol enhanced. - Advice to be given on how to administer clozapine oral suspension or orodispersible tablets: Shake well for 90 seconds when dispensing or if visibly settled & stand for 24 hours before use; otherwise, shake well for 10 seconds before use. - May be diluted with water. - Orodispersible tablets: place on the tongue, allow to dissolve and swallow.
18
Q
  1. Why are antipsychotics given as depot injections sometimes, and what’s the main problem with depot injections?
A
  • Used for maintenance therapy for patients who can’t comply with oral treatment. - They have more EPSE than oral prep.
19
Q
  1. What is neuroleptic malignancy syndrome?
A
  • It is a rare but potentially fatal adverse effect of all antipsychotics. - Signs and symptoms include fever, increased sweating, rigidity, confusion, fluctuating consciousness, fluctuating blood pressure, tachycardia, raised creatine kinase, leukocytosis, and raised liver function tests.
20
Q
  1. What is motor neurone disease, and what are the main aims of treating?
A
  • A neurodegenerative disease condition that affects the brain and spinal cord. - Aim: to maintain functional ability and manage symptoms. - There’s no cure.
21
Q
  1. What drugs are used for the muscular symptoms associated with motor neurone disease?
A
  • Quinine (unlicensed) 1st line treatment for muscle cramps. - Baclofen: 2nd line treatment. - Other options include tizanidine, dantrolene sodium, gabapentin (all unlicensed).
22
Q
  1. What drugs are used for saliva issues associated with motor neurone disease?
A
  • Antimuscarinic drugs (unlicensed). - Glycopyrronium bromide for patients with cognitive impairment. - If ineffective, specialist referral for botulinum toxin type A.
23
Q
  1. What drugs are used for the respiratory symptoms associated with motor neurone disease?
A
  • Opioids (unlicensed) for breathlessness. - Benzodiazepines (unlicensed) if symptoms are exacerbated by anxiety.
24
Q
  1. What drugs are used for saliva associated with motor neurone disease?
A
  • Humidification (moisture), nebulizers, and carbocisteine.
25
Q
  1. What drugs are used for amyotrophic lateral sclerosis?
A

Riluzole: used as a treatment to extend life.

JUNE 24 (4 decks)

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