CNS psychosis and schizophrenia Flashcards
PSYCHOSIS+SCHIZOPHRENIA
POSITIVE SYMPTOMS?
Delusions
Hallucinations
Disorganisation
symptoms added onto normal behaviour
PSYCHOSIS+SCHIZOPHRENIA
NEGATIVE SYMPTOMS?
Social withdrawal
Neglect
Poor hygiene
symptoms lost from normal behaviour
initial aim of tx?
reduce acute phase (positive) symptoms and return the patient to their baseline level of functioning
TYPICAL FIRST GENERATION ANTIPSYCHOTICS- there are 3 groups of phenothiazines.
which 3 drugs are in group 1 and cause most sedation, moderate antimuscarinic and EPSEs?
chlorpromazine
levopromazine
promazine
(pros are always first - group 1)
which antipsychotic drug is in group 2 phenothiazines?
mod sedation and least EPSEs
pericyazine
which drugs in group 3 phenothiazines?
mod sedation and high EPSEs
fluphenazine
prochlorperazine
trifluoperazine
The first-generation antipsychotic drugs (also known as typical or conventional) act predominantly by blocking which receptors in brain
dopamine D2
OTHER first gen antipsychotics
Butyrophenones?
Thioxanthenes?
Others?
Butyrophenones- haloperidol
mod sedation, high EPSEs exact same as group 2 phenothiazines
Thioxanthenes- zuclopenthixol
mod sedation, antimuscarinic effects and EPSEs
Diphenbutypiperidines- pimozide
Substituded benzamides- sulpirie
reduced sedation, antimusc epses
second-generation antipsychotic drugs (atypical) act on a range of receptors and are generally associated with a lower risk for acute extrapyramidal symptoms and tardive dyskinesia
give example drugs
amisulpride
aripiprazole
clozapine
olanzapine
quetiapine
risperidone
TYPICAL FIRST-GEN ANTIPSYCHOTICS SIDE-EFFECTS?
Block dopamine d2-receptors in the brain
Extrapyramidal symptoms
Hyperprolactinaemia
PHENOTHIAZINE 3 GROUPS?
GROUP 1?
GROUP 2?
GROUP 3?
GROUP 1? chlorpromazine, levomepromazine
Most sedation
GROUP 2? pericyazine
Least EPSEs
GROUP 3? fluphenazine, prochlorperazine
High EPSEs
ANTIPSYCHOTIC SIDE-EFFECTS
EXTRAPYRAMIDAL SEs most in which group?
MOST in Group 3 Phenothiazine+Butyrophenones (fluphenazine/haloperidol)
ANTIPSYCHOTIC SIDE-EFFECTS
HYPERPROLACTINAEMIA is least in which drug?
Aripiprazole
ANTIPSYCHOTIC SIDE-EFFECTS
SEXUAL DYSFUNCTION associated with which drugs?
ALL antipsychotics
ANTIPSYCHOTIC SIDE-EFFECTS
CARDIOVASCULAR SE?
QT prolongation, MOST common w/ pimozide+haloperidol (PH)
ANTIPSYCHOTIC SIDE-EFFECTS?
HYPOTENSION associated with which? CQ
Clozapine/Quetiapine
ANTIPSYCHOTIC SIDE-EFFECTS?
HYPERGLYCAEMIA? CiROQ
Clozapine
Risperidone
Olanzapine
Quetiapine
ANTIPSYCHOTIC SIDE-EFFECTS?
WEIGHT GAIN? COw
Clozapine
Olanzapine
ANTIPSYCHOTIC SIDE-EFFECTS?
NEUROLEPTIC MALIGNANT SYNDROME?
how to treat
STOP->TREAT W/ BROMOCRIPTINE->SHOULD RESOLVE IN 5-7 DAYS
ANTIPSYCHOTICS- MONITORING
what to monitor
weight
fasting blood gluc, hba1c, blood lipids
ecg
bp
fbc, u+es, lft
ANTIPSYCHOTICS- MONITORING?
how often WEIGHT?
Start, weekly 1st 6 weeks, 12 weeks, 1 year, then /year.
ANTIPSYCHOTICS- MONITORING?
how often FBG/HBA1c/LIPIDS/BLOOD PRESSURE?
Start, 12 weeks, 1 year, then /year
ANTIPSYCHOTICS- MONITORING?
how often ECG?
before initiation
CLOZAPINE- HIGH-RISK DRUG
USED IN? WHEN?
Resistant schizophrenia when…
2+ antipsychotics including a 2nd gen has been used for 6-8weeks each
ANTIPSYCHOTICS- MONITORING?
how often FBC/U&Es/LFTs?
Start, then /yearly
ANTIPSYCHOTICS- MONITORING?
how often PROLACTIN?
Start, then /6months then /year
CLOZAPINE- HIGH-RISK DRUG
what to do if MISSED MORE THAN 2 DOSES?
Specialist reinitiation
CLOZAPINE- HIGH-RISK DRUG
MONITOR X? WHEN?
Leucocytes+differential Blood Count
Weekly for 18 weeks
Fortnightly till 1 year
Monthly
CLOZAPINE- SIDE-EFFECTS?
MAG
Myocarditis+Cardiomyopathy- report+stop on tachycardia
Agranulocytosis+Neutropenia- monitor leucoyes+diff. BC (report infection symptoms)
GI Disturbances: report+stop on constipation->intestinal block
