Module 1.5.2 (Management of Schizophrenia) Flashcards
What are 1st gen and 2nd gen antipsychotics
What are high potency 1st gen antipsychotics?
↑EPSE ↓ Sedation ↓ orthostatic hypotension ↓ anticholinergic side effects
Droperidol Flupentixol Haloperidol Trifluoperazine Zuclopenthixol
What are low potency 1st gen antipsychotics?
↓EPSE ↑sedation ↑ orthostatic hypotension ↑ anticholinergic side effects
Chlorpromazine and Pericyazine
What to do if EPSE occurs?
ideally reduce antipsychotic dose or switch to alternative antipsychotic
What treatment for the following EPSE?
A) Dystonias - stiffness, uncontrolled muscular spasms
B) Akathisia - inner restlessness, strong desire or compulsion to move
C) Parkinsonism - tremor and/or rigidity, mask- like face, shuffling gait, slow movements
D) Tardive Dyskinesia - involuntary abnormal movements of face, tongue, lips, hands or feet
A)
benzatropine (oral, inj), trihexyphenidyl (benzhexol)
B)
propranolol, clonazepam
C)
benzatropine, trihexyphenidyl
D)
Can be irreversible. Stop antipsychotic (preferred)
Treatment poor efficacy – tetrabenazine, Ginkgo biloba
anticholinergic MOA: Antagonizes acetylcholine and histamine receptors.it reduces the cholinergic effects significantly during Parkinson disease which becomes more pronounced in the nigrostriatal tract because of reduced dopamine concentrations.
What is first line treatment in schizophrenia?
2nd Generation Antipsychotics (SGAs)
- More metabolic adverse effects
- More expensive
How does cloazapine differ from other side effects of SGAs?
Increased sedation, weight gain and anticholinergic effects
Pharmacalogy of aripiprazole? What is it used to agument?
Is a dopamine system stabiliser (increased dopamine output when conc are low and decreased dopamine output when conc. are high)
- Less sedation, weight gain and prolactin elevation
- Good 1st choice antipsychotic
- Doesn’t provide sedation if patient acutely unwell
- May cause insomnia, akathisia and/or activation
> Often used to augment other antipsychotics
To reduce weight gain – e.g. clozapine, olanzapine
To reduce prolactin – e.g. risperidone
Pharmacology of brexpiprazole
Indicated only in schizophrenia
May have positive effects on mood
Well tolerated – little weight gain, prolactin elevation, akathisia
> best evidence of no EPSE side effects
Pharmaclogy of lurasidone
Take with food to increase absorption
Low incidence weight gain, small rise in prolactin
Theorised to improve mood & be useful in bipolar
Reports of increased irritability/rage
Pharmacology of olanzapine
Sedating – may be beneficial in acute psychosis
WEIGHT GAIN +++
- Metabolic syndrome major concern. For this reason falling out of favour as long term treatment
Pharmacology of paliperidone
- 9-hydroxyrisperidone
- Active metabolite of risperidone
- Similar adverse effects to risperidone
Swallow tablets whole –> Cannot be halved, crushed –> Empty tablet may appear in stools
- always with food, or always on an empty stomach
- Oral not commonly used, but depot very common
Pharmacology of Quietiapine
Commonly used antipsychotic
- Prone to abuse – watch for doctor shopping and picking up supply earlyn
- More sedating at lower doses
- To get antipsychotic effect, some patients require higher dose
Pharmacology of risperidone
Adverse effects:
- Prolactin elevation – can be severe and problematic
- EPSE – dose related
cheaper than most SGAs
Pharmacology of Amisulpride? How does its MOA change from low to higher doses?
Indicated for treatment of schizophrenia
- At low doses (50-300mg) it is more effective for negative symptoms
- At higher doses (400-800mg) it is more effective for positive symptoms
- Not metabolised in the liver; reduce dose in renal impairment
- Dose-related EPSE & hyperprolactinemia
Pharmacology of Asenapine
Rarely used
Sublingual wafer –> do not eat or drink for 10 minutes after taking –> take after all other medications –> poor absorption if swallowed
- Tastes awful!! Makes mouth numb/tingly up to 1 hour after taking
Pharmacology of Ziprasidone
Can cause QT prolongation, increase risk of arrythmia – monitor ECG
Little weight gain, prolactin elevation & sedation