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PR - CNS > PSYCHOSIS + SCHIZOPHRENIA > Flashcards

PSYCHOSIS + SCHIZOPHRENIA Flashcards

1
Q

What are the positive symptoms?

A
  • Delusions
  • Hallucinations
  • Disorganisation
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2
Q

What are the negative symptoms?

A
  • Social withdrawal
  • Neglect
  • Poor hygiene
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3
Q

Which drug is most commonly used in practice for the treatment of psychosis and schizophrenia?

A

aripiprazole due to the smaller side effects profile

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4
Q

What are the 1st gen antipsychotics?

A

Phenothiazines and butyrophenone
Others: thioxanthenes
pimozide, sulpride

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5
Q

Group 1 phenothiazines

A

chlorpromazine, levomepromazine
promazine

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6
Q

Group 1 phenothiazines properties

A
  • Most sedation
  • Moderate antimuscarinic and EPSEs
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7
Q

Group 2 phenothiazines

A

periciazine

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8
Q

Group 2 phenothiazines properties

A
  • Moderate sedation
  • Least EPSEs
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9
Q

Group 3 phenothiazines

A

fluphenazine
prochloperazine
trifluoperazine

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10
Q

Group 3 phenothiazines properties

A
  • Moderate sedation
  • High EPSEs (e.g. someone with parkinson’s, we must avoid these)
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11
Q

Butyrophenones

A

benperidol, haloperidol

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12
Q

Butyrophenones properties

A
  • Moderate sedation
  • High EPSEs (similar to group 3 phenothiazines)
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13
Q

Thioxanthenes

A

flupentixol
zuclopentixol

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14
Q

Thioxanthenes properties

A
  • Moderate sedation
  • Antimuscarinic effects
  • EPSEs
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15
Q

Pimozide and sulpride

A
  • Reduced sedation
  • Antimuscarinic effects
  • EPSEs
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16
Q

2nd generation antipsychotis

A

Amisulpride
Aripirazole
Clozapine (very specialist)
Olanzapine
Quetiapine
Risperidone

17
Q

Antipsychotic Side effects

A
  • EPSEs
    o Most in group 3 phenothiazines an butyrophenones
  • Hyperprolactinaemia
    o Least in aripiprazole
  • Sexual disfunction
  • CV Sfx: QT prol most common in haloperidol and pimozide
  • Hypotension
    o Clozapine and quetiapine
  • Hyperglycaemia
    o Clozapine, Risperidone, Olanzapine, Quetiapine (CiROQ)
  • Weight gain
    o Clozapine and olanzapine
  • Neuroleptic malignant syndrom
    o Stop treatment
    o Treat with bromocrimptine (ergot-derived dopamine receptor agonist)
    o Should resolve in 5-7 days
18
Q

Which antipsychotics cause weight gain?

A

olanzapine and clozapine

19
Q

Which antipsychotics cause EPSEs?

A

Most in group 3 phenothiazines ad butyrophenones

20
Q

Which antipsychotic least causes hyperprolactinaemia?

A

Least in aripiprazole

21
Q

Which antipsychotics cause hypotension?

A

Clozapine and quetiapine

22
Q

Which antipsychotics cause hyperglycaemia?

A

o Clozapine, Risperidone, Olanzapine, Quetiapine (CiROQ)

23
Q

Monitoring parameters

A
  • Weight
    o Start, weekly for first 6 weeks, 12 weeks and then 1 yr then yearly
  • Fasting blood glucose, HbA1c and blood lipid conc: start,12 weeks, 1 yr then yearly
  • ECG: before initiation
  • BP: start, 12 weeks, 1 yr, then yearly
  • FBC, UAE, LFTs: start, then yearly
24
Q

Which antipsychotics causes neuroleptic malignant syndrome?

A

o Stop treatment
o Treat with bromocrimptine (ergot-derived dopamine receptor agonist)
o Should resolve in 5-7 days

25
Q

How often should you monitor a patient’s weight?

A

Start, weekly for first 6 weeks, 12 weeks and then 1 yr then yearly

26
Q

How often should you monitor a patient’s fasting blood glucose, HbA1c and blood lipid conc?

A

start, 12 weeks, 1 yr then yearly

27
Q

When should you do an ECG?

A

before initiation

28
Q

How often should you monitor a patient’s blood pressure?

A

start, 12 weeks, 1 yr, then yearly

29
Q

How often should you monitor a patient’s FBC, UAE, LFTs?

A

start, then yearly

30
Q

Clozapine indication

A

Severe resistant psychosis and schizophrenia
* Only used when 2+ antipsychotics including one 2nd gen has been used for 6-8 weeks each

31
Q

What happens if you miss a dose of clozapine?

A
  • If missed more than two doses = specialist reinitiation
32
Q

Monitoring for clozapine

A
  • Monitory leukocyte and differential blood counts:
    o Weekly for 18 weeks
    o Fornightly till one year
    o Monthly
33
Q

Side effects of clozapine

A

Myocarditis and cardiomyopathy
* Report and stop on tachycardia

Agranylocytes and neutropenia
* Monitor leucocyte and differential blood counts

GI disturbances
* Reduces intestinal peristalsis rate
* Report and stop on constipation = intestinal block

PR - CNS (61 decks)

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