Drug Therapies - Anti-psychotics Flashcards
What are anti-psychotics for?
Schizophrenia
Schizoaffective
Bipolar
Psychotic Depression
Augmentation for resistant anxiety disorders
What are the major types of anti-psychotic?
Split into Typical (older) and Atypical (more modern)
What are the types of Typical anti-psychotics?
High potency D2 receptor antagonists e.g. haloperidol
Low potency D2 receptor antagonists e.g. Chlorpromazine
Major side effects of typical anti-psychotics?
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
What are the major EPS?
Acute dystonia
Parkinsonism (incl tremor, bradykinesia)
Akathisia
Tardive Dyskinesia
List some Atypical Anti-psychotics
Risperidone
Quetiapine
Aripoprazole
Clozapine
What’s the big problem with Atypical ones?
They cause metabolic syndrome i.e.:
- Dyslipidaemia
- Elevated blood sugars
- Weight Gain
- DM
As well as abnormal LFTs
What do you need to test before starting an atypical anti-psychotic?
Fasting Lipid Profile
Fasting Blood Sugar
LFTs
FBC
When do we use clozapine?
Only in treatment resistant patients because the side effect profile is so bad
What are the side effects of clozapine?
- Weight gain, sedation & abnormal LFTs
- Seizures
- Hypertriglycidaemia
- Hypercholesterolaemia
- Hyperglycaemia
- Non-ketotic Hyperosmolar coma
And Agranulocytosis
Agranulocytosis is the most dangerous side effect of clozapine, how do we keep the risk down?
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
How do we treat EPS of anti-psychotics? (mainly high potency typical ones)
Anticholinergics
Dopamine facilitators e.g. amantadine
B-blockers e.g. propranolol
