Drugz Flashcards
Adverse effects of benzos
eg dependence, cognitive impairment, psychomotor effects including the risk of falls in older patients, somatic symptoms
Common side effects of antipsychotics
- Weight gain and metabolic syndrome
- Orthostatic hypotension
- Anticholinergic
- Extrapyramidal side effects
- Tardive dyskinesia
- Drug interactions / allergy
- Avoid polypharmacy and oversedation
- Sexual side effects
- NMS neuroleptic malignant syndrome
Which antipsychotics put patients at increased risk of long QT?
- amisulpride
- ziprasidone
- haloperidol
- droperidol
- thioridazine
List some SEs of anticholinergics
Dry mouth, blurred vision, constipation, urinary hesitancy, raised intraocular pressure
Delirium- enlarged pupils, hot, dry flushed skin, tachycardia (Elderly particularly susceptible)
SWITCH TO amisulpride, aripiprazole, paliperidone, risperidone and ziprasidone
Which drugs most commonly cause orthostatic hypotension
Risperidone, Quetiapine, ziprasidone most
Usually subsides after first few days
Older patients at risk of falls = check BP sitting and upright for postural shift if hx of dizziness after sitting for long, after meals, on exercise or with transient illness
If severe and persistent change medication
Clozapine- if you miss 3 consecutive days need to retitrate from low dose (you quickly lose tolerance)
RISPERIDONE - advantages and disadvantages
ADVANTAGES
- Lower incidence of EPS than typical antipsychotics at lower doses
- (<8 mg)
- Associated with less weight gain compared to clozapine and olanzapine
DISADVANTAGES
- SE: insomnia, agitation, EPS, H/A, anxiety, prolactin, postural hypotension, constipation, dizziness, weight gain
Highest risk of EPS among atypicals (still lower than high-potency typicals)
OLANZAPINE - advantages and disadvantages
ADVANTAGES
- Better overall efficacy compared to haloperidol Well tolerated
- Low incidence of EPS and TD
DISADVANTAGES
- SE: mild sedation, insomnia, dizziness, minimal anticholinergic, early AST and ALT elevation, restlessness
- High risk of metabolic effects (weight gain, DM, hyperlipidemia)
QUETIAPINE - advantages and disadvantages
ADVANTAGES
- Associated with less weight gain compared to clozapine and olanzapine
- Mood stabilizing
DISADVANTAGES
- SE: H/A, sedation, dizziness, constipation
- Most sedating of first line atypicals
CLOZAPINE - advantages and disadvantages
ADVANTAGES
- Most effective for treatment- resistant schizophrenia
- Does not worsen tardive symptoms; may treat them
- Approximately 50% of patients benefit, especially paranoid patients and those with onset after 20 yr
DISADVANTAGES
- SE: drowsiness/sedation, hypersalivation, tachycardia, myocarditis, cardiomyopathy, dizziness, EPS, NMS
- 1% agranulocytosis
ARIPIPRAZOLE - advantages and disadvantages
ADVANTAGES
- Less weight gain and risk of metabolic syndrome compared to olanzapine and a lower incidence of EPS compared to haloperidol
DISADVANTAGES
- SE: H/A, agitation, anxiety, insomnia, weight gain, decreased serum prolactin levels
Comparison of atypical antipsychotics
How to assess someone with EPSEs?
ASENAPINE - advantages + disadvantages
ZIPRASIDONE - advantages + disadvantages
AMISULPRIDE - advantages + disadvantages
Dopamine pathways in the brain + their side effects
- NIGROSTRIATAL- From the substantia nigra to the caudate nucleus-putamen (neostriatum) and is concerned with sensory stimuli and movement. EPSE
- MESOLIMBIC- projects from the ventral tegmentum to the mesolimbic forebrain and is thought to be associated with cognitive, reward and emotional behaviour. POSITIVE SX
- TUBEROINFUNDIBULAR is concerned with neuronal control of the hypothalmic-pituatory endocrine system. PROLACTIN
- MESOCORTICAL Thought to be important for frontal functions. NEGATIVE/ COGNITIVE
MOA for benzos
Benzodiazepines potentiate the inhibitory effects of GABA throughout the CNS, resulting in anxiolytic, sedative, hypnotic, muscle relaxant and antiepileptic effects.
Indications for benzos
- Short-term management of anxiety, agitation
- Acute alcohol withdrawal
- Muscle spasm
- Premedication
- Conscious sedation
- Status epilepticus
Common SEs for benzos
drowsiness, oversedation, light-headedness, memory loss, hypersalivation, ataxia, slurred speech, dependence, effects on vision, eg blurred vision, impaired tracking
List some benzos. Which are long/short acting?
Shorter-acting agents (particularly those with rapid onset of action) are more likely to lead to acute withdrawal symptoms. Diazepam’s rapid onset of action and long half-life mean it is associated with less withdrawal.
Long-acting agents, eg diazepam, clonazepam, are preferred when using benzodiazepines as prophylaxis against withdrawal from alcohol, barbiturates or other benzodiazepines.
Counselling information for benzos
- You may feel drowsy
- drowsiness may persist the following day
- avoid driving/operating heavy equipment until you know how you react
- Avoid alcohol
- If you take this medicine regularly for more than 2–4 weeks your body may become used to it and in time, you may need a higher dose for it to continue to work
- If you stop the medicine suddenly, you may have unpleasant effects (eg feeling anxious, difficulty sleeping). Discuss how to stop the medicine with your doctor first.
Symptoms of benzodiazepine withdrawal
suddenly stopping treatment (or reducing or tapering the dose too quickly) in dependent people may produce withdrawal symptoms:
- anxiety, dysphoria, irritability, insomnia, nightmares, sweating, memory impairment, hallucinations, hypertension, tachycardia, psychosis, tremors and seizures
