Psychopharmacology 3 Flashcards
What should be considered in prophylaxis for psychotic diseases
Life long Complaince issues Lack of insight Consider long acting IM injection May need to use mental health act
Relapses reduces functionality and IQ. Don’t want to relapse
What are the adverse effects of antipsychotics
Tardive dyskinesia- involuntary muscle movements that may not resolve with drug discontinuation.
Neuroleptic malignant syndrome- only psychiatric emergency, svere muscle rigidity, fever, altered mental state, autonomic instability, elevated WBC, CPK and LFT’s. potetnially fatal
Extrapyramidla side effects- Acute dystonia, parkinson syndrome, akathisia
What should be started to reduce the chance of extrapyramidla side effects?
Anticholinergics such as benztropine, thexyphendyl, diphenhydramine
Dopamine facilitators such as amantandine
Beta-blockers such as propanolol
Need to watch for anticholinergic SE, particularly if taken with other meds with anticholienbrgic actions e.g. triycylics
What bloods would you do before starting someone on an antipsychotic?
Fasting liid profile
Fasting blood sugar
LFT’s
CBC
What is akathisia?
Restlessness, can’t sit still patients describe it as feeling uncomfortable in their skin
Associated with higher risk of suicide. Treat it with anxiolytic or propranolol
What are anxiolytics
Used to treat panic disorder, generalised anxiety disorder, substance related disorder and their withdrawal,
In anxiety disorders use aniolytics and SSRI’s or SNRI’s
What is buspirone?
Anioxyltic
pros- good augmentatiopn strategy
No sedation
CONS- mtakes about 2 weeks to work, no sedation to take the edge off as in benzo’s
What are benzodiazepines?
Used to treat insomnia, parasomnias and anxiety disorders
Often used for CNS depressant withdrawl protocols e.g. ethanol withdrawl
What are the side effects of benzodiazepines
Somnolence Cognitive deficits Amnesia Disinhibiton Tolerance Dependence
Should you use benzodiazepines to treat anxiety?
No treat it with SSRI’s
What are the take home points?
Be clear on the diagnosis and any co-morbid diagnoses
Try to treat 2 birds with one stone
Select on side effect profile
Monitor efficacy and tolerance
What anti psychotic drug would you use to treat schizophrenia with high cholesterol
Risperidone