Brainscape's Knowledge GenomeTM

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


See full index

BNF Chapter 4 - CNS > Psychosis and Schizophrenia > Flashcards

Psychosis and Schizophrenia Flashcards

1
Q

What type of psychotic symptoms do antipsychotic drugs relieve?

A

Positive psychotic symptoms such as thought disorder, hallucination, delusions, and prevent relapse.

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

What symptoms of psychosis may atypical antipsychotics be better for?

A

Negative symptoms such as apathy and withdrawal.

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

How can the hallucinations seen in psychosis be further categorised?

A

Sight, sound, touch, smell, taste.

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

Instead of exceeding BNF doses for antipsychotics, what course of action should be taken if a patient is not responding to antipsychotic treatment?

A

Consider adjuvant therapy and newer or second-generation antipsychotics such as clozapine. Consider potential for drug interactions.

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

What monitoring is required when patients are taking antipsychotics?

A

ECG to exclude abnormalities such as prolonged QT interval. Repeat periodically and reduce dose if QT interval prolongation seen or another cardiac abnormality develops. Regular pulse, BP and temperature check, and ensure the patient is drinking enough water.

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

How should doses of antipsychotic drugs be increased?

A

Slowly and not more often than one per week.

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

Occasionally, high dose antipsychotic therapy is considered for a limited period. When should this be discontinued if no improvement is seen?

A

After three months, reduce to normal dosage.

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

Emergency IM doses of antipsychotics are sometimes given. How should the dose given relate to that of the orally administered dose?

A

The IM dose should be lower to account for the lack of the first pass effect. The dose should be reviewed at least once daily.

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

What risks are there when an elderly patient with dementia takes antipsychotic drugs?

A

An increased risk of mortality and stroke or TIA. The elderly are also at an increased risk of postural hypotension and hyper- & hypothermia.

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

Should antipsychotics be prescribed for mild to moderate cases in the elderly?

A

No.

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

The initial dose for antipsychotics in the elderly should be less than that of an adult dose. How much different should they be?

A

Half the adult dose or less. Treatment should be reviewed regularly.

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

Which is the only atypical antipsychotic licensed for use in patients over the age of 65? For how long should it be used before review?

A

Risperidone. It should be used for 6 weeks then reviewed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What type of side effects are the typical antipsychotics usually associated with?

A

Extrapyramidal side effects.

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

What type of side effects are the atypical antipsychotics usually associated with?

A

Metabolic side effects.

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

Give some examples of typical antipsychotics.

A

Chlorpromazine, haloperidol, flupentixol, fluphenazine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Give some examples of atypical antipsychotics.

A

Amisulpride, aripiprazole, olanzapine, quetiapine, risperidone.

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

Give some extrapyramidal symptoms.

A

Acute pseudoparkinsonism, acute dystonia, acute akathisia, chronic tardive dyskinesia.

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

How is acute pseudoparkinsonism treated?

A

With antimuscarinics such as procyclidine.

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

What symptoms are associated with acute pseudoparkinsonism?

A

Tremor or rigidity.

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

What symptoms are associated with acute dystonia?

A

Abnormal face and body movements.

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

How is acute dystonia treated?

A

With antimuscarinics such as procyclidine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What symptoms are associated with acute akathesia?

A

Inner restlessness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is acute akathesia treated?

A

By either discontinuing antipsychotic treatment or switching to a different antipsychotic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is tardive dyskinesia?

A

Rhythmic, involuntary movements of the tongue, face and jaw. Usually develops on long-term therapy. May be irreversible upon drug withdrawal. Worth switching the patient to an atypical antipsychotic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the symptoms of hyperprolactinaemia?

A

Sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, galactorrhoea (excessive or inappropriate production of milk).

26
Q

How does hyperprolactinaemia develop?

A

Both first- and second-generation antipsychotics increase prolactin concentration because dopamine inhibits prolactin release. Less dopamine = more prolactin.

27
Q

With which antipsychotics is hyperprolactinaemia more prevalent?

A

Risperidone and amisulpride.

28
Q

What symptoms of sexual dysfunction are sometimes seen with antipsychotic use?

A

Decreased libido, disorders of arousal, erection/ejaculation problems in men.

29
Q

With which antipsychotics is sexual dysfunction more common?

A

Haloperidol and risperidone.

30
Q

When is QT interval prolongation more likely to be seen when using antipsychotics?

A

When exceeding the recommended maximum dose.

31
Q

What cardiovascular side effects are seen with antipsychotic use?

A

QT-interval prolongation, tachycardia, arrhythmias, hypotension. Cases of sudden death have been noted.

32
Q

Which antipsychotics come with a greater risk of hyperglycaemia, weight gain, and diabetes?

A

Clozapine, olanzapine, quetiapine, risperidone. Regular monitoring is necessary.

33
Q

Which antipsychotics come with a greater risk of postural hypotension and syncope?

A

Clozapine, chlorpromazine, quetiapine.

34
Q

When are FBC, U&Es and LFTs required when a patient is taking antipsychotic medication?

A

At the start of therapy and every year thereafter.

35
Q

When are blood lipids and weight required to be monitored when a patient is on antipsychotic medication?

A

At baseline, at 3 months, then yearly (patients taking clozapine or olanzapine require more frequent monitoring).

36
Q

When should fasting blood glucose be monitored in patients taking antipsychotic medication?

A

At baseline, at 4-6 months, then yearly (patients taking clozapine or olanzapine require more frequent monitoring).

37
Q

When should a patients BP be monitored when they are taking antipsychotic medication?

A

Before starting therapy and frequently during dose titration.

38
Q

When is ECG monitoring required when a patient is taking antipsychotic medication?

A

When patients present with CV risk factors or a personal history of CVD.

39
Q

When should serum prolactin concentration be monitored in patients taking antipsychotic medication?

A

At the start of therapy, at 6 months, then yearly thereafter.

40
Q

When should patients with schizophrenia have physical health monitoring?

A

At least once per year.

41
Q

Which antipsychotic drug comes with an increased risk of acute dystonic reactions, especially in young children and young women?

A

Chlorpromazine.

42
Q

What are the symptoms of the acute dystonic reactions associated with chlorpromazine use?

A

Facial and skeletal muscle spasms and oculogyric crisis.

43
Q

Healthcare staff should avoid direct contact with which antipsychotic medication?

A

Chlorpromazine (contact sensitization). Tablets should not be crushed and solutions should be handled with care.

44
Q

ECG monitoring is required before treatment and anually with which antipsychotic drug? Why?

A

Pimozide due to risk of sudden unexplained death. Should not be given with other antipsychotics, TCAs, or other drugs which prolong the QT interval.

45
Q

What should be done if the QT interval is prolonged when a patient is on pimozide?

A

Review treatment.

46
Q

There is an increased risk of fatal blood disorder/agranulocytosis with which antipsychotic drug?

A

Clozapine. Avoid use with other drugs which may exacerbate agranulocytosis/leukopenia.

47
Q

What specific monitoring should be done prior to clozapine usage?

A

Blood counts. Physical examination and full medical history. Specialist examination if cardiac abnormalities or history of heart disease found.

48
Q

When on clozapine, what symptoms should patients report immediately?

A

Symptoms of infection, especially flu-like symptoms.

49
Q

There is a risk of myocarditis and cardiomyopathy with which antipsychotic drug?

A

Clozapine.

50
Q

What course of action should be taken if a patient on clozapine develops persistent tachycardia, especially in the first two months of therapy?

A

Medical observation for other indicators of cardiomyopathy or myocarditis.

51
Q

If myocarditis or cardiomyopathy are suspected during clozapine use, what course of action should be taken?

A

Stop clozapine and patient evaluated urgently by cardiologist.

52
Q

If clozapine-induced myocarditis or cardiomyopathy occurs during clozapine treatment, what course of action should be taken?

A

Discontinue clozapine permanently.

53
Q

Which antipsychotic drug is associated with an increased risk of constipation, intestinal obstruction, faecal impaction and fatal paralytic ileus?

A

Clozapine.

54
Q

With regards to intestinal obstruction, which drugs should be avoided when a patient is taking clozapine?

A

Drugs that may cause constipation such as antimuscarinics or opioids.

55
Q

With regards to intestinal obstruction, which patients may not be suitable for treatment with clozapine?

A

Patients with a history of colonic disease or lower abdominal surgery.

56
Q

How can the hypersalivation associated with clozapine use be treated? When must extra caution be taken?

A

Hyoscine butylbromide as long as the patient is not at risk from the additive anti-muscarinic side-effects of hyoscine and clozapine.

57
Q

With which antipsychotic is there an increased risk of CNS and respiratory depression?

A

Olanzapine.

58
Q

There is an increased risk of CNS and respiratory depression when olanzapine is used with which class of drugs?

A

Benzodiazepines.

59
Q

If administering olanzapine IM, what monitoring is required?

A

Blood pressure, pulse, and respiratory rate for at least four hours.

60
Q

How long should be left between administration of IM olanzapine and parenteral benzodiazepines?

A

At least one hour.

BNF Chapter 4 - CNS (13 decks)

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