Drug Therapies - Anti-psychotics Flashcards

1
Q

What are anti-psychotics for?

A
Schizophrenia
Schizoaffective
Bipolar 
Psychotic Depression
Augmentation for resistant anxiety disorders
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2
Q

What are the major types of anti-psychotic?

A

Split into Typical (older) and Atypical (more modern)

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3
Q

What are the types of Typical anti-psychotics?

A

High potency D2 receptor antagonists e.g. haloperidol

Low potency D2 receptor antagonists e.g. Chlorpromazine

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4
Q

Major side effects of typical anti-psychotics?

A

High potency ones have a high risk of Extrapyramidal side effects (EPS)
Low potency have a risk of cardiotoxic and anticholinergic effects e.g. sedation & hypotension

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5
Q

What are the major EPS?

A

Acute dystonia
Parkinsonism (incl tremor, bradykinesia)
Akathisia
Tardive Dyskinesia

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6
Q

List some Atypical Anti-psychotics

A

Risperidone
Quetiapine
Aripoprazole
Clozapine

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7
Q

What’s the big problem with Atypical ones?

A
They cause metabolic syndrome i.e.:
- Dyslipidaemia
- Elevated blood sugars
- Weight Gain
- DM
As well as abnormal LFTs
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8
Q

What do you need to test before starting an atypical anti-psychotic?

A

Fasting Lipid Profile
Fasting Blood Sugar
LFTs
FBC

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9
Q

When do we use clozapine?

A

Only in treatment resistant patients because the side effect profile is so bad

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10
Q

What are the side effects of clozapine?

A
  • Weight gain, sedation & abnormal LFTs
  • Seizures
  • Hypertriglycidaemia
  • Hypercholesterolaemia
  • Hyperglycaemia
  • Non-ketotic Hyperosmolar coma
    And Agranulocytosis
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11
Q

Agranulocytosis is the most dangerous side effect of clozapine, how do we keep the risk down?

A

Heavy monitoring in the first year, specifically:

  • bloods every week for a while
  • bloods every 2 wks up to a yr
  • then bloods every month after
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12
Q

How do we treat EPS of anti-psychotics? (mainly high potency typical ones)

A

Anticholinergics
Dopamine facilitators e.g. amantadine
B-blockers e.g. propranolol

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