Psych - Antipsychotics Flashcards
Describe the general treatment algorithm for choosing an antipsychotic
2nd generation
1st or 2nd generation
Check diagnosis, compliance etc.
Consider clozapine, higher dose, combination
State some 1st generation anti-psychotics
-zine, -ixol
chlorpromazine
haloperidol
zuclopenthixol
State some 2nd generation anti-psychotics
-apine & -idone
clozapine
olanzapine
risperidone
Generally, how do anti-psychotics work?
Effect on dopamine pathways in the brain
State the 3 types of extra pyramidal SEs that can be caused by anti-psychotics
acute dystonic reaction
Parkinsonism
tardive dyskinesia
State 3 non EPSEs that can be caused by anti-psychotics
neuroleptic malignant syndrome
hyperprolactinaemia
akathisia/restless legs
State the symptoms of acute dystonia
- onset minutes
- increasing muscle tone
- energetic
- torticolis (neck muscle spasm, head to one side)
- oculogyric crisis (spasmodic eye movements)
- tongue protrusion
State the symptoms of Parkinsonism
- bradykinesia
- cogwheel rigidity
- resting tremor
- shuffling gait
- dead-pan facial expression
State the symptoms of tardive dyskinesia
- longterm, often permanent
- involuntary repetitive oro-facial movements
- blinking, grimacing, pouting, lip-smacking common
- may involve limbs/trunk
State how to treat EPSEs
Anticholinergics (procyclidine, trihexyphenidyl, orphenadrine) & change anti-psychotic
State the investigation for NMS
CK
State the symptoms of NMS
increasing muscle tone, pyrexia, changing pulse/BP, rhabdomyolysis, coma/death
State treatment of NMS
EMERGENCY
stop anti-psychotic
rapid cooling & renal support
skeletal muscle relaxants (dantroline)
dopamine agonists (bromocriptine - to knock them off receptors)
State why patients on anti-psychotics may develop hyperprolactinemia
prolactin release inhibited by dopamine
Describe the symptoms of akathisia
- day-weeks of treatment
- pacing, rocking, unable to sit or stand still
- poor sleep
