Psychopharmacology Flashcards
Give 4 conditions that are treated with antipsychotics
- schizophrenia
- delirium in dementia
- mania
- psychosis
What is the mechanism of action of typical antipsychotics
antagonise Dopamine 2 receptors involved in:
* mesolimbic and mesocortical regions - antipsychotic effects
* nigrostriatal regions - motor side effects
Give 4 extrapyramidal side effects of typical antipsychotics
- Parkinsonism - tremor, rigidity, bradykinesia
- acute dystonia - bizarre and involuntary muscle contractions - neck/jaw/eyes
- akathisia - restlessness
- Tardive dyskinesia - abnormal movements, particularly affecting the face
What causes extrapyramidal effects from typical antipsychotics
these result if the blockade of dopamine receptors in the nigrostriatal pathways exceed 80%
Give 3 examples of typical antipsychotics
- haloperidol
- chlorpromazine
- Prochlorperazine
What is the mechanism of action of atypical antipsychotics
antagonist to:
* D1 and/or 2 receptors
* 5HT2 receptor - prevent reuptake of serotonin
* histamine 1 receptor
* alpha 1 adrenoreceptor
Give 3 examples of atypical antipsychotics
- risperidone
- olanzapine
- quetiapine
- aripiprazole
- clozapine
Give 6 side effects of antipsychotics
- antimuscarinic effects
- weight gain (atypical)
- drowsiness and cognitive impairment
- raised prolactin (typical)
- diabetes
- reduced seizure threshold (atypical)
- prolonged QT interval
Give 4 antimuscarinic side effects of antipsychotics
- dry mouth
- constipation
- urinary retention
- blurred vision
Give 2 potential risks of antipsychotic medications in elderly patients?
- increased risk of stroke
- increased risk of venous thromboembolism
Which antipsychotic should be considered in patients struggling with symptoms of raised prolactin
aripiprazole
When is clozapine most commonly used
treatment resistant schizophrenia - when 2 or more antipsychotics have not worked after 6-8w each
Why is clozapine not first line with other atypical antipsychotics and how is it monitored
- lots of adverse effects so requires close monitoring
- Clozapine monitoring system - advice on drug dosage depending on blood results
- only consultant psychiatrists can prescribe
Give 5 complications of clozapine
- Myocarditis
- Agranulocytosis / neutropenia
- Reduced seizure threshold
- Constipation
- Hypersalivation
What is neuroleptic malignant syndrome
- rare, potentially life threatening complication of antipsychotics treatment that
- occurs with a certain genetic variant of the D receptor, and results in abnormal blockade of D2 in the striatum and hypothalamus.
Give 4 key features of neuroleptic malignant syndrome
- Rigidity
- Delirium/ altered consciousness
- Fluctuating bp and tachycardia
- hyperthermia
Give 2 key blood test findings of neuroleptic malignant syndrome
- Raised creatine kinase
- leucocytosis
How is neuroleptic malignant syndrome managed
- stopping the causative medication
- dopamine agonist (bromocriptine)
- benzodiazepines for agitation
Give 5 examples of selective serotonin reuptake inhibitors (SSRIs)
- sertraline
- citalopram
- escitalopram
- fluoxetine
- paroxetine
Give 4 conditions that are treated with SSRIs
- depression
- anxiety
- OCD
- bulimia
Describe the mechanism of action for SSRIs
inhibit the reuptake of serotonin from presynaptic serotonin pumps
What is the first line SSRI in under 18s
fluoxetine
Which 2 SSRIs are most likely to lead to QT prolongation
- citalopram
- escitalopram
Give 5 side effects of SSRIs
- GI symptoms - N+V
- hyponatraemia
- increased suicidality
- sexual dysfunction
- anxiety/ agitation
What type of drug increases GI bleeding risk when taken with SSRIs? How should be co-prescribed
- NSAIDs
- co-prescribe PPi
What 3 drugs should be avoided when taking SSRIs due to the increased risk of serotonin syndrome
- triptans
- monoamine oxidase inhibitors
- tramadol