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M4 PSYCH > Antipsychotics (PSYCH DRUGS) > Flashcards

Antipsychotics (PSYCH DRUGS) Flashcards

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1
Q

Oral First gen/typical antipsychotics

A

x3
1. Chlorpromazine (100-600mg/day)
2. Haloperidol (5-20mg/day)
3. Trifluoperazine (5-10mg/day)

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2
Q

Oral 2nd gen/atypical antipsychotics AND dose

A

X7
1. Risperidone (0.5-1mg, max 6mg/day)
2. Paliperidone (6mg, max 12 mg/day
3. Aripiprazole (15 mg ON, max 30mg/day)
4. Olanzapine (5-10 mg, max 20 mg/day)
5. Clozapine (25mg ON, max 900mg)
6. Quetiapine (50mg BD, max 800mg/day)
7. Amisulpride (200mg, max 1200mg/day)

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3
Q

MOA typical/1st gen antipsychotics

A

D2 receptor blockade (Dopamine receptor antagonist)

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4
Q

Side effects of first gen/typical antipsychotics

A

X7
1. Extrapyramidal side effects
2. Hyperprolactinemia
3. Sedation
4. Hypotension
5. Weight gain
6. Anticholinergic
7. Sexual side effects

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5
Q

Extrapyramidal side effects =?

A

x4
1. Acute dystonia
2. Pseudoparkinsonism
3. Akathisia
4. Tardive dyskinesia (chronic use of antipsychotics)

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6
Q

Acute dystonia symptoms

A

Involuntary movement/contraction of major muscle groups:
1. Oculogyric crisis (fixed upward or lateral gaze)
2. Torsion dystonia
3. Torticollis
4. Spasm of lip, face, throat muscles
5. Grimacing
6. Exaggerated posturing
7. Trismus (jaw muscle)

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7
Q

Mx of acute dystonia

A

IM benztropine (congentin)
+switch to atypical/2nd gen antipsychotic

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8
Q

Akathisia symptoms

A
  1. Restlessness
  2. Irritability
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9
Q

Mx of Akathisia

A

Best: propranolol
Acute akathisia: Anticholinergic eg. Benztropine
Chronic akathisia: BZD

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10
Q

Pseudoparkinsonism symptoms

A

more common
1. Resting Tremors
2. Stiffness of muscle, rigidity
3. Akinesia*, mask like facies, psychomotor retardation (bradykinesia)
4. Postural instability
5. Shuffling gait

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11
Q

Mx of Pseudoparkinsonism

A
  1. Gradual dose reduction
  2. Switch to 2nd gen/atypical antipsychotic
  3. Anticholinergic (eg. benzhexol)
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12
Q

Tardive dyskinesia Symptoms

A
  1. Oro-bucco-lingual and facial dyskinesia eg. Fly catching tongue protrusion
  2. Athetosis
  3. Choreiform pill rolling hand movements
  4. Hip thrusting
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13
Q

Mx of Tardive dyskinesia

A
  1. Switch to 2nd gen/atypical antipsychotic
  2. Maintain pt on lowest effective dose of antipsychotic
  3. Vitamin E may help alleviate symptoms
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14
Q

Onset of individual EPS symptom

A
  1. Acute dystonia: few hrs
  2. Akathisia: most common after 5 days of initiation
  3. Pseudoparkinsonism: gradual
  4. Tardive dyskinesia: at least 6 months, usu after many years
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15
Q

Neuroleptic Malignant Syndrome dx criteria

A

Associated with use of neuroleptic meds 1. Severe muscle rigidity 2. Elevated temperature 3. 2 or more of the following:
1) diaphoresis
2) dysphagia
3) tremor
4) incontinence
5) changes in level of consciousness ranging from confusion to coma
6) mutism
7) tachycardia
8) elevated or labile BP
9) leukocytosis
10) laboratory evidence of muscle injury (eg. Raised CK)

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16
Q

Mx of Neuroleptic Malignant Syndrome

A
  1. Stop antipsychotics
  2. Supportive measures (for heat): IV hydration, cooling measures, transfer to ICU
  3. Pharmacological: bromocriptine (to reverse dopamine blockade), dantrolene/lorazepam to reduce rigidity
  4. After stabilisation, change to a different antipsychotic (less potent eg. Quetiapine)
17
Q

Hyperprolactinemia manifestations

A

x4 (reversible)
1. Galactorrhea/gynaecomastia
2. Sexual dysfunction
3. Amenorrhea
4. Hypoestrogenism

18
Q

Which antipsychotics have hyperprolactinemia as SE?

A
  1. All first gen/typical antipsychotics
  2. Risperidone (the only 2nd gen/atypical antipsychotic)
19
Q

Special features of Chlorpromazine

A

More sedating among first gen antipsychotics

20
Q

Special features of haloperidol

A

High potency but more EPS among first gen antipsychotics

21
Q

Depot First gen/typical antipsychotics + Dose

A
  1. Flupenthixol (Fluanxol) - 20-60 mg every month
  2. Zuclopenthixol - 200-600mg every month
22
Q

Depot 2nd gen/typical antipsychotics

A
  1. Risperidone (Consta) - 2-weekly IM, unpopular
  2. Paliperidone (Sutenna) - monthly
23
Q

Side effect of 2nd gen/atypical antipsychotics

A
  1. X7 of first gen antipsychotics (less of EPSE)
  2. Weight gain
  3. Prolonged QTc
  4. Neuroleptic malignant syndrome

<Aripiprazole least/minimal SE>

24
Q

Indication for 2nd gen/atypical antipsychotics

A
  1. Schizophrenia (positive and negative symptoms)
  2. Bipolar disease (with or without psychotic features)
  3. Major depression with psychotic features
  4. Agitation
  5. Delirium
25
Q

MOA of 2nd gen/atypical antipsychotics

A
  1. Blocks D2
  2. Blocks 5HT2A *reduced EPSE and also targets negative symptoms in schozophrenia
  3. Blocks alpha adrenergic
26
Q

Drug for treatment resistant schizophrenia

A

Clozapine (2nd gen/atypical antipsychotic)

27
Q

Potential life threatening SE of clozapine

A

Fatal Agranulocytosis / blood dyscrasia
+ fatal myocarditis or cardiomyopathy
+ fatal pulmonary embolism
+ seizures

28
Q

Before starting and during prescription of clozapine, what must be done?

A

Frequent RBC monitoring (weekly for first 18 weeks then fortnightly or monthly thereafter until a year)

29
Q

MOA of clozapine (and thus good for treatment resistant schizophrenia)

A
  1. Dopamine (D1, D3, D4)
  2. Alpha adrenergic (alpha 1&2)
  3. Histaminergic (H1)
  4. Muscarinic anticholinergic (M1)
  5. Serotonergic (5HT1A, 2C, 6&7)
30
Q

2nd gen/atypical antipsychotics good for negative symptoms of schizophrenia

A

COCA
1. Clozapine
2. Olanzapine
3. Cariprazine
4. Amisulpride

31
Q

Side effect concern: QTc prolongation
1. Antipsychotic to avoid
2. Antipsychotic to use

A
  1. Avoid: first gen/typical antipsychotic (haloperidol, chlorpromazine)
  2. Use: aripiprazole (or lurasidone, brexpiprazole)
32
Q

Side effect concern: EPSE
1. Antipsychotic to avoid
2. Antipsychotic to use

A
  1. Avoid: Haloperidol
  2. Use: 2nd gen (Aripiprazole, Olanzapine, Risperidone, Quetiapine, Clozapine)
33
Q

Side effect concern: Weight gain
1. Antipsychotic to avoid
2. Antipsychotic to use

A
  1. Avoid: olanzapine, clozapine
  2. Use: Aripiprazole, Haloperidol, Trifluoperazine
34
Q

Side effect concern: Sedation
1. Antipsychotic to avoid
2. Antipsychotic to use

A
  1. Avoid: Quetiapine, Olanzapine, Clozapine
  2. Use: Aripiprazole
35
Q

Side effect concern: Seizure
1. Antipsychotic to avoid
2. Antipsychotic to use

A
  1. Avoid: Chlopromazine, clozapine
  2. Use: Haloperidol, Sulpride, Risperidone, Aripiprazole
36
Q

Highest risk of metabolic syndrome among 2nd gen/atypical antipsychotics

A

Clozapine

37
Q

Antipsychotic in ACUTE mx

A
  1. Oral or depot antipsychotics for rapid tranquilisation
    - oral rapidly dissolvable tablets: PO olanzapine 10 mg STAT or PO risperidone quicklet 2 mg STAT or
    - IM haloperidol 5 mg STAT
  2. Alternatives:
    1) IM lorazepam 2mg STAT
    2) Antihistamine
38
Q

Ix before and after starting antipsychotics

A
  1. PE - weight (metabolic syn), BP, EPSE
  2. ECG - QTc (when initiating rx)
  3. labs - fasting blood glucose, fasting lipid (triglycerides, cholesterol) *baseline and at least every 12 months

M4 PSYCH (5 decks)

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