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CNS > Psychosis & Schizophrenia 1+2 > Flashcards

Psychosis & Schizophrenia 1+2 Flashcards

1
Q

What’s another name for Antipsychotics and what are they used for?

A

Also known as neuroleptics and tranquilisers.
They are used for Psychoses and Schizophrenia.

Used short term to calm disturbed patients suffering from schizophrenia, brain damage, mania, toxic delirium, or agitated depression.

And used for short term alleviation of severe anxiety.

A lot of patients may need long life treatment.

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2
Q

What are positive symptoms?

A

Positive symptoms are things added into the head.

  • Thought disorder
  • Hallucinations
  • Delusions
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3
Q

What are negative symptoms?

A

Negative symptoms are things that have been taken away

  • Social withdrawal
  • Apathy (lack of interest/enthusiasm)
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4
Q

Which symptoms are Antipsychotics effective against?

A

Most effective against positive symptoms.

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5
Q

Give examples of 1st generation antipsychotics?

A

1st
- Chlorpromazine
- Levomepromazine
- Promazine
- Periciazine
- Fluphenazine
- Perphenazine
- Prochlorperazine
- Trifluoperazine
- Butyrophenones (haloperidol & benperidol)
- Thioxanthenes (flupentixol & zuclopenthixol)
- Diphenylbutylpiperidines (pimozide)
- Substituted benzamides (sulpiride)

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6
Q

Give examples of 2nd generation antipsychotics?

A
  • Amisulpride
  • Aripiprazole
  • Clozapine
  • Lurasidone
  • Olanzapine
  • Paliperidone
  • Quetiapine
  • Risperidone
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7
Q

Memory trick to remember 1st and 2nd generation antipsychotics?

A

Most 1st end in ‘azine’ or ‘ol’

Most 2nd end in ‘apine’ or ‘one’

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8
Q

What’s the main difference between 1st & 2nd generation antipsychotics?

A

1st Generation:
- Acts predominantly by blocking D2 receptors in brain.
Non-selective for any of the 4 Dopamine pathways in brain hence can cause range of S.E especially EPSE & elevated prolactin.

2nd Generation:
- Act on a variety of receptors but are more selective.
- They act on specific D receptors, hence less side effects
- They are better at treating negative symptoms of schizophrenia

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9
Q

What are the three main groups of Phenothiazines?

A

Group 1 - Chlorpromazine, levopromazine & promazine
(has sedative effects and moderate antimuscarinic & EPSE)

Group 2 - Pericyazine & pipotiazine (moderate sedative & fewer EPSE than 1 & 3) - least EPSE
(moderate sedation)

Group 3 - Prochlorperazine, trifluroperazine, fluphenazine, perphenazine (few sedative & antimuscarinic effects but more EPSE than 1 & 2) - most EPSE
(least sedation)

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10
Q

Can Antipsychotic drugs be given to the elderly? And why?

A

No, it should be avoided because it increases their risk of a stroke.
Especially those with dementia.

Do not use in elderly to treat mild to moderate psychotic symptoms - balance benefits and risk.

If you do use, reduce initial dose and review treatment reguarly

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11
Q

What are some extrapyramidal side effects?

A

Watch a YouTube video on it:

ADAPPT
- Acute Dystonia (stiffness of muscles)

  • Akathisia (inability to stay still)
  • Parkinsonian symptoms (tremor) - as antipsychotics block dopamine
    (can be suppressed if antimuscarinic drugs are given)
  • Increased prolactin concentration and hyperprolactinaemia
  • Tardive dyskinesia
    (THIS IS OFTEN NOT REVERSIBLE)

Stop drug at earliest signs, to stop full progression

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12
Q

What are the side effects of Antipsychotics?

A
  • Weight gain
  • Diabetes/hyperglycaemia
  • Postural hypotension
  • Hyperprolactinaemia
  • Cardiac side effects (QT prolongation, tachycardia, arrhythmia, hypotension etc)
  • Decreased libido
  • EPSE
  • Sexual dysfunction
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13
Q

Which antipsychotic drugs cause weight gain?

A
  • Clozapine
  • Olanzapine

(more common in 2nd generation)

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14
Q

Which antipsychotic drugs cause weight diabetes/hyperglycaemia?

A

Risperidone, quetiapine, clozapine & olanzapine

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15
Q

Which antipsychotic drugs cause postural hypotension?

A

Clozapine & Quetiapine

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16
Q

Which antipsychotic drugs cause Hyperprolactinaemia?

A

Risperidone, amisulpride, sulphide & 1st generation antipsychotics

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17
Q

Which antipsychotic drugs cause cardiac side effects?

A

All of them, esp Pimozide

18
Q

Which antipsychotic drugs cause decreased libido?

A

Risperidone & haloperidol

19
Q

Which antipsychotic drugs cause EPSE?

A

1st generation

20
Q

Which antipsychotic drugs cause sexual dysfunction?

A

Risperidone, haloperidol & Olanzapine

21
Q

Which Antipsychotic drugs can be given as an alternative to weight gain, when it occurs?

A

Amisulpride, aripriprazole, haloperidol

22
Q

Which Antipsychotic drugs can be given as an alternative to diabetes/hyperglycaemia when it occurs?

A

1st generation, haloperidol & fluphenazine

23
Q

Which Antipsychotic drugs can be given as an alternative to postural hypotension, when it occurs?

A

NO ALTERNATIVE

24
Q

Which Antipsychotic drugs can be given as an alternative to Hyperprolactinaemia, when it occurs?

A

Aripiprazole, clozapine, olanzapine, risperidone, prochlorperazine, flupentixol

25
Q

Which Antipsychotic drugs can be given as an alternative to decreased libido, when it occurs?

A

NO ALTERNATIVE

26
Q

Which Antipsychotic drugs can be given as an alternative to sexual dysfunction, when it occurs?

A

Aripiprazole & quetiapine

26
Q

Which Antipsychotic drugs can be given as an alternative to EPSE, when it occurs

A

2nd generation (clozapine, olanzapine, quetiapine & aripiprazole)

27
Q

What need to be monitored with Antipsychotics?

A
  • FBC, Urea, electrolytes, liver function - at the start and then annually
  • Blood lipids, weight, fasting blood glucose & ECG
  • BP, prolactin conc, physical health monitoring (including CVD risk), at least once a year
28
Q

What are the rules for Cessation of Antipsychotics?

A
  • High risk of relapse if medication is stopped after 1-2 years.
    So withdrawal after long term use should be gradual.
  • Monitor patients for 2 years after withdrawal for signs of relapse
29
Q

What patient and carer advice must be given with Antipsychotics?

A
  • Photosensitisation could occur at high doses = avoid direct sunlight
  • Drowsiness can effect performance of skilled tasks especially at the start of treatment = so careful when driving.
30
Q

What kind of drug is Clozapine?

A

It is a D1, D2, 5HT2A, alpha 1adrenoreceptor and muscarinic receptor antagonist.

31
Q

What is the indication for Clozapine?

A

Schizophrenia in patients intolerant or unresponsive to other antipsychotics & psychosis in Parkinson’s disease.

So it is the last option

32
Q

What are the MHRA/CSM warnings for Clozapine?

A
  1. Potentially fatal risk of intestinal obstruction, faecal impaction & paralytic ileus

Patients should seek medical advice before taking next dose if constipation occurs.

  1. If Clozapine is used with another medication - monitor blood concentrations for toxicity.
33
Q

Why must blood monitoring be carried out for Clozapine?

A

To manage risk of agranulocytosis/blood disorder.

34
Q

For which situations must blood concentration for toxicity of Clozapine, be monitored in?

A
  • Stop smoking
  • Switching to e-cigs
  • Pneumonia
  • Reduced clozapine metabolism is suspected
35
Q

What are the contraindications for Clozapine?

A
  • Bone marrow disorders
  • History of agranulocytosis
  • Drug intoxication
  • History of neutropenia
  • Paralytic ileus
  • Severe cardiac disorders
  • Uncontrolled epilepsy
  • Severe CNS depression
36
Q

What monitoring must be done for Clozapine?

A
  • Monitor signs of hyperlacticaemia (breast enlargement & galactorrhoea)
  • Monitor leucocytes & blood count
  • Monitor blood clozapine concentration in certain clinical conditions
  • Monitor blood lipids and fasting glucose
  • Patients with schiz should have physical health monitoring and CVD risk assessment at least once a year

During initation, there must be close supervision.

37
Q

What patient and carer advice must be given with Clozapine?

A
  • Photosensitisation at higher dose (avoid direct sunlight)
  • Drowsiness may occur at start of treatment, effects enhanced by alcohol
  • Give advice on how to administer/take Clozapine oral suspension & orodispersible tablets
38
Q

What are the directions for Clozapine suspension and Orodispersible tablets?

A

Suspension = If the oral suspension is clearly settled, shake it well for 90 seconds before dispensing, or let it stand for 24 hours before using; if not, shake it well for 10 seconds before using.

Orodispersible tablets = Place on tongue, allow to dissolve and swallow

39
Q

When are antipsychotic depot injections used?

A

Used for maintenance therapy for patients who can’t comply with oral treatment.

40
Q

Do Depot injections have more or less EPSE than oral preparations?

A

More EPSE

41
Q

What are examples of Antipsychotic depot injections?

A

Zupenthixol (to prevent relapse)

Flupentixol (for agitated and aggressive patients)

CNS (14 decks)

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