Atypical Antipyschotics Flashcards
What do atypical antipsychotics cause ?
They cause distressing side effects and did not have much impact on negative symptoms.
Why was clozapine ewithdrawn from the market ?
8 fatal cases of agranulocytosis in Finland .
Which antipsychotic was More costly
Atypical however they may be more cost effective if they reduce admission and improve treatment outcomes.
What is the first line of treatment for schizophrenia
Atypical antipsychotics
How does atypical differ from typical antipsychotics
Causes fewer extrapyramidal side effects including tardive dyskinesia as they selectively block dopamine receptors in the mesolimbic area.
However can cause more metabolic syndrome for example weight gain,diabetes ,raised lipid levels etc.
atypical works on positive and negative.
Which antipsychotic is both dopamine and serotonin antagonists
More atypicals than typical
Mode of action
Atypicals block dopamine receptors in the mesolimbic area of the brain which reduces positive symptoms .
Where are atypical serotonin antagonists?
In the nigostriatal pathway this can increase dopamine levels which leads to less side effects and the mesocortical pathway results in improved negative symptoms
Atypical Side Effects
Weight gain
Dizziness
Sedation
Seizures
Postural hypotension
Myocarditis
Hyper salivation
Atypicals & pregnancy
Extrapyramidal side effects and withdrawal symptoms have been reported in neonates when antipsychotics are taken in the third trimester and they should only be taken in the third trimester .
What fatal blood disorder does clozapine cause ?
Agranulocytosis proceeded by neutropenia
What blood disorder is the absence of white blood cells
Agranulocytosis
What percentage of people get neutropenia
3-4% they might then need to stop clozapine .
When is clozapine tried as treatment ?
When two other antipsychotics have been tried first
What causes of cardiovascular instability is due to clozapine ?
Drop in bp,tachycardia,palpitations ,myocarditis and cardiomyopathy
If this occurs clozapine must be stopped and the person referred to a cardiologist
What is carried out before commencement of clozapine
Physical history emphasis on cardiac looking at arrhythmias
Why would the dosage be adjusted
Is the person starts or stops smoking during treatment or switches to an e cigarette.
How long does clozapine need to be stopped for in order for the dose to change
48 hours
What’s essential when on clozapine
Blood monitoring
In patients who are not monitored what is the mortality rate for induced agranulocytosis?
0.3%
In those monitored what is the mortality rate for clozapine induced agranulocytosis
0.01%
How often must bloods be taken for those on clozapine
Weekly for first 18 weeks ,then fortnightly up to a year and monthly thereafter
What does it mean when bloods have an amber light
The WBC levels are borderline
What does it mean when bloods have a green light
The white blood cell count is adequate
What does it mean when bloods come back with a red light
The white blood cell count levels are too low to admister clozapine
How long after clozapine should bloods be carried out for ?
For 4 weeks
Clinical features of agranulocytosis
Sore throat
Lethargy
Weakness
Fever
Flu like symptoms
What is the treatment of agranulocytosis which is symptomatic
Person may need to be barrier nursed ,antibiotic treatment if infection is present ,fatalities usually result from infections due to a compromised immune system .
Atypical antipsychotics
Clozapine - clozaril
Quetiapine - seroquel
Risperidone - risperidal
Depot injection
Risperidone consta ( takes two weeks to work )
Olanzopine embonate - zyadhera
Paliperidome - xeplion
True or false do atypicals work more on serotonin then typicals
True
What new medication was released in September 2024
Cobenfy
What is cobenfy
A muscarinic agonist which dampens the release of dopamine
It improves positive symptoms
Avoids many of the antipsychotic side effects such as weight gain ,sedation
Not recommended for people with liver damage
