Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BNF > Psychoses, Schizophrenia > Flashcards

Psychoses, Schizophrenia Flashcards

1
Q

what are positive symptoms of schizophrenia?

A 
thought disorders (disorganised thoughts and speech)
hallucinations
delusions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what causes +ve symp in schizophrenia

A

the OVERactvitity in mesolimbic pathway in the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are -ve symptoms of schizophrenia?

A

social w/d
poor hygiene
apathy
catatonia (immobility)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what causes -ve symp in schizophrenia

A

UNDERactivity in the mesocortical pathway in the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what class of drugs are antipsychotic drugs?

A

DOPAMINE-Receptor 2 -ANTAGONIST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

in what way are the second gen. of antipsychotic drugs are better than the first gen.

A

2nd gen. more effective than 1st gen. in treating negative symps. not just antagonising DA to suppress the OVERactivity of mesolimbic D-pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are extrapyramidal symptoms

A

movement symptoms: tremours, akathisia (inner restlessness), dystonia, dyskinesia, parkinsonism, tardive dsykinesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how does antipsychotic drugs cause extrapsyramidal symptoms

A

they are D2 anatagonist. they also inhibit D2 receptors in NIGROSTRAITAL (regulates movement) pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the other pathway that antipsyhotic drugs can effect and cause ADRs?

A

D2 antagnoists can also act on tuberofundibular pathway and cause hyperprolactineamia by promoting prolactin release from pituitary gland (DA acts as a prolactin inhibitor) symps: breast enlargement, sexual dysfunction, menstrual disturbances, galatorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how should antipsyhotics be stopped after taking long term (1-2 years) and why

A

gradually to avoid risk of actue withdrawal syndromes and rapid relapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how long should pt be monitored for after withdrawing antipsychotics

A

2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the 7 advice of Royal College of Psychiatrists on doses of antipsychotics

A
  1. consider alternatives (eg adjvants, newer or 2nd gen - clozapine)
  2. consider risk factors (obesity, elderly>70)
  3. consider drug interactions
  4. ECG to exclude QT prolongation, repeat and reduce dose if heart affected
  5. increase dose slowly and once weekly
  6. regular pulse, BP, temp check
  7. high dose only for short period and review.
    STOP if NO improvement after 3 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what form admin of antipsyhotics is required during an emergency psychotic episode and should the dose be adjusted from regular PO dose, why and how often review

A

IM ROUTE
IM dose is LOWER than PO dose as avoids 1st pass effect in liver, more drug in the circ.
dose reviewed daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the risks of using antipsychotics in elderlies?

A

postural hypotension
hyper/hypothermia
if dementia, increased risk of death, stroke, TIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the 3 rules to follow when rx antipsych in elderly

A
  1. not recommended to treat mild-mod psychotic symps
  2. initial dose is HALF adult dose
  3. review regularly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

for how long should a person try antipsychotic before determining its effectiveness

A

4-6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the risks of antipsychotics

A

EPSE, QT prologation (predipose to ventricular tachycardia, lead to ventricular defibrillation and sudden cardiac death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

antipsyhotics drugs are also known as … what are its long term and short term indication

A

neuroleptics - long term to treat schizophrenia, short term as tranquiliser to clam disturbed pts, regardless of underlying causes eg severe agitating depression, anxiety, brain damage etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are the major types of antipsychotics

A

2 distinct types - 1 and 2nd generation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the first line trt for schizophrenia

A

no 1st line opetion suitable for all pts, choice based on individual pt factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

describe the predominant MOA of 1st gen antipsychotics

A

UN-SELECTIVELY block D2 receptors in the brain, affecting all 4 dopamine pathways -mesolimbic, mesocorticol, nigrostriatal, tuberofundibular

22
Q

base on the characteristics of 1st and 2nd gen antipsychs, what factors can be used to determine treatment choice for pt

A
  1. 1st gen cause EPSE and HYPERprolactineamia –> avoid in parkinson pt
  2. 2nd gen cause more METABOLIC s/e –> avoid in overweight, diabetic pt
  3. other factors inc, sedation level, QT proplongation
23
Q

three class of 1st gen antipsychs

A
  1. phenothiazines (divided into 3 gps)
  2. butyrophenones
  3. thioxanthenes
  4. others: pimozide (QT-P), sulpiride, loxapine (bronchospasm)
24
Q

what are the 3 groups of phenothiazines?

A

group1: ‘promazine’ eg CHLORpromazine, LEVOpromazine, Promazine (used as sedative OTC)
group2: ‘cyazine’ eg PERIcyazine
group3: ‘phenazine/perazine’ eg FLUphenazine, PERphenazine, PROCHLORperzine, TRIFLUOperavzine

25
Q

describe the level of EPSE, SEDATION, ANTIMUSCARINIC effect of 3 groups of phenothiazine

A

group1: MOD EPSE, antimuscarinic, MOST sedative
group2: LEAST EPSE, MOD sedative
group3: MOST EPSE, LEAST antimuscarinic, sedative

26
Q

Butyrophenones are similar to gp3 of phenothiazine. name one butyrophenone

A

haloperidol (MOST EPSE, can cause QT-P)

27
Q

name 2 thioxanthenes

A
  1. FLUpentixol - do NOT take in evening as has altering sedative and stimulating effect
  2. ZUCLOpenthixol - depot used in aggitated/aggresive pt, more effective in preventing relapse
28
Q

2nd generation antipsychotics are also known as…

A

Atypical antipsychotics

29
Q

MOA of 2nd gen antipsychotics

A

block post-synaptic D1-D4 receptors and a wide range of other receptors –> many SE

30
Q

what are the two features of 2nd gen antipsychotics (SE, indication)

A

more metabolic SE eg weight gain, diabetes,
less EPSE
more effective at treating negative symptoms

31
Q

name a few 2nd gen antipsychotics

A

amisulpride (most hyperprolactin)
aripriprazole (does not cause hyperprolactin)
clozapine (adranulocytosis, myocarditis, GI obstruction, MOST weight gain and diabetes)
lurasidone
olanzapine (MOST weight gain and diabetes)
quetiapine
risperisone (MOST hyperprolactin)

32
Q

clozapine is the most effective atypical antipsychotic with numerous SE therefore licensed only for…

A

resistant schizophrenia, where unresponsive to 2 or more drugs (inc. 2nd gen) for 6-8 weeks each

33
Q

what are the requirements for dose change for clozapine what happened if missed dose?

A

measure plasma clozapine level before change or adding a 2nd antipsychotic
if miss 2 or more doses then need to re-initiate by specialist

34
Q

who should avoid taking clozapine and why

A

clozapine increases the risk of agranulocytosis, avoid concomitant with bone marrow suppressant eg amoinosalicylates (sulfasalazine), immunosuppressants (MTX, cytotoxics)

35
Q

what are the main SE of clozapine MAG

A

Myocarditis, cardiomyopathy (esp 1st 2 months of trt) –> STOP e.g. tachycardia, med Hx of heart disease
Agranulocytosis, neutropenia (FBC,WBC every week for 18/52, then 2 weekly for 52/52 then monthly) REPORT SIGNS OF INF
Gastro intestinaal obstruction (concomitant drug eg hyoscine -antimusc) REPORT CONSTIPATION

36
Q

what is agranulocytosis

A

an acute condition involving a severe and dangerous leukopenia (lowered white blood cell count), most commonly of neutrophils –> look for signs of infection/flu
fever, sore throat, mouth ulcer, rapid HR and BR, LOW BP

37
Q

what is depot preparations (typically end in decanoate)

A

long acting, sustained release antipsychotics by IM injection every 1-4 weeks to aid compliance

38
Q

how to initiate depot and switch from PO to depot

A

initiate - test dose as SE are prolonged (a month or longer)

switch - give PO whilest stablising on depot

39
Q

antipsychotic drug side effects and monitoring in detail:

EPS

A

esp with group 3 phenothiazine “perazine”, haloperidol and 1st gen depot preparations. e.g parkinsonian (old), dystonia (children, abnormal move of face and body), akathisia, tardive dyskinesia (rhythmic involuntary move of tongue, face, jaw. MOST SERIOUS can be IRREVERSIBLE –> STOP at FIRST SIGN
physical health monitoring yearly

40
Q

what is the first sign of tardive dyskinesia

A

fine vermicular movement of tongue

41
Q

HYPERLACTINEAMIA (which drug, symp, monitor)

A

esp with risperidone, amisulpride, 1st gen Antipsychotics
breast enlargement, galactorrhoea, menstrual irregularities, sexual dysfunction, reduced bone mineral density
monitor prolactin level, endocrine function in children eg weight height sexual maturation

42
Q

which antipsychotic drug does not increase prolactin level and why

A

aripripazole as it is a partial D2 receptor antagonist

43
Q

METABOLIC SE (which drug, symp, monitor)

A 
more common with 2nd gen 
hyperglycaemia (sometimes diabetes) most with CROQ clozapine, risperidone, olazapine, quetiapine
weight gain (most with COW clozapine, olazapine)
lipid changes (dyslipidemia) 
sexual dysfunction (most with haloperidol, risperidone)
44
Q

CV S/E (which drug, symp, monitor)

A

tachycardia, arrhythmias, postural hypotension (dose related, avoid in elderly who at risk of falls, most with clozapine, chlorprmazine, lurasidone, quetiapine) , QT prolongation (most with pimozide, haloperdol) annual CV risk assess and ECG

45
Q

which drug has negligible effect on QT-P

A

aripripazole

46
Q

symptoms for neuroleptic malignant syndrome

A

muscle rigidity, fluctuating consciousness and BP, hyperthermia, sweating, tachycardia, loss of blood from skin- pallor (pale), urinary incontinence

47
Q

neuroleptic malignant syndrome is rare but potentially fetal, how long does it lasts once discontinued?

A

5-7 days longer with depot

48
Q

which drug can treat neuroleptic malignant syndrome

A

bromocriptine, dantrolene (DAagonist)

49
Q

which drug is known to cause QT-P? monitoring requirement and DDI

A

pimozide, ECG BEFORE trt and yearly, STOP or reduce dose if prolonged. No concomitant QT drug/electrolyte imbalance drug

50
Q

S/E profile of antipsychotics

A
  1. EPSE
  2. HYPERPROLACTINAEMIA
  3. WEIGHT GAIN, BGL, diabetes
  4. SEXUAL DYSFUNCTION
  5. CV RISK - QT-P, HYPOTENSION
  6. NEUROLEPTIC MALIGNANT SYDNMORE (FATAL)
  7. ANTIMUSCARINIC
  8. AGRANULOCYTOSIS, BLOOD DYSCRASIAS
  9. PHOTOSENSITIVITY
  10. LIVER TOXICITY (JAUNDICE)
  11. chlorpromazine - contact sensitisation
  12. pimozide - QT-P
51
Q

antipsychotic drug monitoring

A
  1. FBC, UE, LFT (esp with phenothiazine)
  2. Lipid and weight at baseline, 3M then yearly
  3. Fasting blood glucose at baseline, 3M, yearly
  4. ECG at start (esp if CV risk factor or Hx of CVD)
  5. BP before starting upon dose change
52
Q

Common DDI with antipsychotics

A
  1. risk of QT-P: amiodarone, quinolones, quinine, SSRI, macrolides (ACE)
  2. risk of EPSE (parkinsons, metoclopramide D2 agnoist)
  3. risk of sedation: hypnotics Zs, benzos, alcohol, opioid, antiepileptics
  4. risk of HYPOtension: antihypertensives, diuretics, nitrates
  5. risk of antimuscarnic SE: TCA, antihistamines, antimuscarnicis (hyoscine)

BNF (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions