CNS 5 Flashcards
State when antipsychotics are used?
Used short term to calm disturbed pt who may be suffering from schizophrenia, brain damage, mania, toxic delirium or agitated depression
Positive symptoms of schizophrenia
Hallucinations and delusion
Negative symptoms of schizophrenia
Social withdrawal
Apathy/ lack of interest, enthusiasm/ withdrawn
Antisychotics are used to relieve what symptoms of schizophrenia
Positive symptoms
And less effective for negative symptoms
The 2nd generation of antipsychotics are better at treating ….
Negative symptoms of schizophrenia
Which generation of antipsychotics has more Extrapyramidal side effects
First generation
Second generation of antipsychotics (atypical)
Amisulpride
Aripiprazole
Clozapine
Lurasidone
Olanzapine
Paliperidone
Quetiapine
Risperidone
Memory trick for Ist generation
AZine or ol
Memory trick for 2nd generation Antipsychotics
One or pines
Facts about first generation Antipsychotics
Acts predominantly by blocking D2 receptors in the brain
Non selective for any of the dopamine pathways in the brain hence can cause a range of Side effects especially EPSE and elevated prolactin
Facts about 2nd generation Antipsychotics
More selective on a specific D receptor, hence less side effect
Better at tx negative symptoms of schizophrenia
Facts about Clozapine
It is a D1, D2, 5HT2A , Alpha I adrenoceptor and Muscarinic receptor Antagonist
What’s the indication for clozapine
It is licensed for tx of schizophrenia in pts who are unresponsive or intolerant to other antipsychotic
Psychosis in Parkinson disease
MHRA/CSM warning for clozapine
Potentially fatal risk of intestinal obstruction, faecal impaction and paralytic ileus
Pt should seek medical advice before taking the next dose of clozapine if constipation develops
2. Monitor blood concentrations for toxicity in certain clinical situations eg stop smoking, switching to e cigarette, pneumonia or serious infections, concomitant meds which may increase clozapine levels
Blood monitoring should be carried out to manage the risk of Agranulocytosis
Contraindications of clozapine
Bone marrow disorders, hx of Agranulocytosis, drug intoxication, hx of neutropenia, paralytic ileus, severe cardiac disorders, uncontrolled epilepsy and CNS depression
Mnemonic for clozapine
CLOSE DA bloody door
DA- Dopamine and Alpha 1 receptors
Close door, last option
Bloody- Agranulocytosis/ blood disorder
Monitoring clozapine
Monitor prolactin( for signs of Hyperprolactineamia eg breast enlargement and Galactorrhea)
2. Monitor physical health and CVD risk assessment for at least once a year
3. Monitor leukocyte and blood count
4. Monitor blood clozapine conc in certain clinical conditions
5. Close supervision during initiation (risk of collapse due to HTN and convulsion)
6.monitor blood lipids and fasting glucose
Patient and carer advice Clozapine
Photosensitization at higher doses( avoid direct sunlight)
Driving and skilled task- drowsiness enhanced by etoH
Advise on how to administer clozapine oral suspension and orodispersible tablet
Suspension: shake well for 90s when dispensing or if visibly settled and stand for 24hrs before use. Otherwise shake well for 10sec before use. May be diluted with water
Orodispersibel tablet: place on tongue ,allow to dissolve and swallow
Facts about Antisychotics depot injection
Long acting used for maintenance therapy for pts who can’t comply with oral tx
They have more EPSE than oral tx
