Chapter 18 Psychotropic Drugs Flashcards
Positive symptoms of schizophrenia
Hallucinations (hearing voices)
Delusions (bizarre grandiose)
Disorganised thinking and speech
Negative symptoms of schizophrenia
Lack of motivation
Poor self care
Reduced speech output
social withdrawal
Cognitive symptoms of schizophrenia
Impaired planning
Impaired memory
Reduced mental flexibility
Symptoms associated with mood in schizophrenia
Depression
Anxiety
Typical antipsychotics
controls positive or negative symptoms?
What does it worsen?
Chlorpromazine
haloperidol
zuclopenthixol
Controls positive symptoms
Worsens cognition
Indications for antipsychotics
Acute and chronic psychoses (schizophrenia)
Bipolar disorder
Adverse effects
Sedation (Chlorpromazine and Clozapine), [Olanzapine and Quetiapine]
Anxiety
Agitation
Tachycardia
Blurred vision
Nausea
Dry mouth
Orthostatic hypotension (Chlorpromazine, Clozapine) [PQR] - Paliperidone, Quetiapine, Risperidone
Weight gain & Hyperglycaemia (Olanzapine, clozapine) [chlorpromazine, PQR]
Other specific adverse effects of antipsychotics
Movement disturbance (Haloperidol, risperidone >6mg d, chlorpromazine and paliperidone dose dependent)
Anticholinergic effects (Chlorpromazine and Clozapine) [Olanzapine]
Prolactin Release + sexual/ejaculatory problems excp. amisulpride (Amisulpride, Paliperidone, risperidone) [haloperidol, chlorpromazine]
Prolonged QT interval (Amisulpride, haloperidol, ziprasidone)
Extrapyrimidal side effects
incidence
Which antipsychotics cause them?
Which are less likely?
What are they?
Incidence = dose related
Highest with haloperidol and trifluoperazine
Lowest with chlorpromazine and periciazine
Dystonias
Akathesia
Parkinsonism
Tardive Dyskinesia
Dystonias
Definition
Incidence? When does it start?
How do we treat?
Involuntary muscle contractions that cause repetitive or twisting movements.
Likely with higher doses.
More likely in children and young adults.
Often occur within 24-48 hours of starting treatment or increasing dose.
Responds rapidly to benzatropine
Akathesia
Definition
Incidence
Differentiate between akathesia and …?
A feeling of motor restlessness
Occurs 2-3 days (up to several weeks) after starting treatment and may subside spontaneously
Differentiate between agitation and akathesia
Akathesia tends to improve with dose reduction and deteriorate when the dose is increased
Parkinsonism
Definition
Incidence
treatment
Tremor, rigidity, bradykinesia
Usually develops after weeks or months
Usually reversible, but somtimes short term treatment is required.
Short term use of anticholinergic (benzatropine or benzhexol) will help.
Tardive Dyskinesia
Involuntary movements of the face, mouth or tongue.
Can appear after medium-long term treatment and after stopping treatment. Usually when tx is stopped abruptly.
Increased risk: elderly (esp. females), smokers, diabetics and affective disorders.
NMS ( Neuroleptic Malignant Syndrome)
Potentially fatal condition
Fever, muscle rigidity, altered conscioussness and autonomic instability.
Progresses rapidly over 24-72 hours.
Doesn’t have to start immediately. Can be seen months or years after starting therapy.
Therapy: Need to cease antipsychotic.
Anticholinergics or benzos can help muscle rigidity.
Metabolic effects
COQ ( Clozapine, Olanzapine and Quetiapine) - Weight gain, dyslipidaemia and increased blood glucose.
Counselling
L9 - Associated with high risk of relapse and suicide
- to prevent an episode rather than taking it after symptoms occur.
Best to avoid illicit substances:
- Decreases control of psychotic symptoms
- regular use of illicit drugs increases risk of relapse
Make sure you understand
- EPSE side effects and what you can do
- The risk of tardive dyskinesia with long term antipsychotic treatment.
L1- Drowsiness, Increase alcohol, cannabis or sleeping tablet effects. Don’t drive or operate machinery.
L16: Dizzy upon standing. Get up gradually from sitting or lying position
Monitor
- Clinical improvement
- Consider : poor compliance, substance misuse, drug interactions, inadequate dose
Increased risk of pneumonia
Weight, BMI, waist circumference, blood glucose, lipids, BP, (EEG,ECG, prolactin)
full blood count and liver function test
Amisulpride solian
Prolonged QT interval.
Prolactin increase,
Insomnia
Hypersalivation
200mg= 400mg daily. Max 1200mg
Maintenance dose for negative symptoms >50mg
Aripiprazole ( Abilify)
Preacution : Unstable heart disease or recent MI
Hepatic
Insomnia
Light headedness
Akathesia
Headache
Schizophrenia = 10-15mg daily
Steady state - 2 weeks
Bipolar - 15mg-30mg daily
Asenapine (Saphris)
Preacution : Hepatic
Insomnia, Hypersalivation, Akathesia and oral hypoesthesia ( for about 1 hour after taking) numbness
Schizophrenia = 5-10mg BD Bipolar = 5-10mg BD
Allow wafer to dissolve on tongue. Take last after other medications. Do not eat or drink for 10 minutes after taking.
Inside of mouth may be numb or tingly after taking.
