PSYCHOSIS + SCHIZOPHRENIA: 2ND Flashcards
MoA
Blocks post-synaptic dopamine (D1-D4) receptors.
Acts on a wide range of other receptors = distinct clinical side effects.
General facts for atypical antipsychotics
More metabolic side effects
May be more effective at treating negative symptoms
Examples
- Amilsulpride
- Quetiapine
- Risperidone
- Olanzapine
- Aripiprazole
- Clozapine
- Paliperidone
- Lurasidone
- Asenapine
What are the main side-effects of second-generation antipsychotics?
- Hyperglycaemia
- Can cause diabetes - Weight gain
- Hyperlipidaemia
- Hyperprolatinaemia
- Sexual dysfunction
- QT-prolongation
- Hypotension and interference with temperature
regulation
Which antipsychotics are most likely to cause hyperprolactinemia?
- Risperidone (second generation)
- Amisulpiride (second generation)
- First generation antipyschotics e.g. Sulpiride
Which antipsychotics are least likely to cause hyperprolactinemia?
- Aripirazole (it reduces prolactin as it is a partial agonist)
- Quetiapine
- Olanzapine
- Clozapine
Why do antipsychotics cause hyperprolactinaemia?
- Dopamine inhibits prolactin release
- Therefore, antipsychotics acting on D2 receptors will reduce dopamine and thus increase prolactin levels
- Some antipsychotics e.g.
Aripiprazole will partially act on
D2 receptors as an agonist, consequently decreasing prolactin
What are the symptoms of hyperpro lactinaemia?
- Sexual dysfunction
- Reduced bone mineral. density
- Menstrual disturbances
- Breast enlargement
- Galactorrhoea
- Possible increased risk of breast cancer
Which antipsychotics are more likely to cause sexual dysfunction?
- Haloperidol
- Olanzapine
- Risperidone
Which antipsychotics are least likely to cause sexual dysfunction?
- Aripiprazole
- Quetiapine
Why do antipsychotics cause sexual dysfunction?
- Decreased libido due to reduced dopamine transmission and hyperprolactinaemia
- Antimuscarinic effects can cause arousal disorders
- Al adrenoreceptor blockers are associated with ejaculation and erection problems in men
Which antipsychotics are most likely to cause QT
prolongation?
- Haloperidol
- Pimozide
Which antipsychotics are least likely to cause QT
prolongation?
- Aripiprazole
- Clozapine
- Flupentixol
- Olanzapine
- Risperidone
- Sulpiride
What are the overall cardiac side-effects of antipsychotics?
- QT prolongation
- Tachycardia
- Arrhythmias
- Hypotension (including postural hypotension)
Which antipsychotics are MOST likely to cause postural hypotension?
- Clozapine
- Quetiapine
- Risperidone
In which particular group is postural hypotension a concern?
- Elderly
- Postural hypotension can result in syncope and dangerous falls
Which antipsychotics are most likely to cause metabolic syndrome e.g.
Diabetes, high lipid, high sugar, etc?
- Clozapine
- Olanzapine
- Risperidone
- Quetiapine
Which antipsychotics are LEAST likely to cause metabolic syndrome e.g.
Diabetes, high lipid, high sugar, etc?
- Aripiprazole
- Amilsupiride
- Haloperidol
Which is more likely to cause metabolic syndrome (i.e. hyperglycaemia and weight gain), First generation OR second generation antipyschotics?
Second generation
antipsychotics are more likely to cause hyperglycaemia and weight gain than first generation
What is Neuroleptic Malignant Syndrome
(NMS) ?
- Rare but fatal side-effect
- If rigidity, hyperthermia, tachycardia, sweating, fluctuating conciosuness occurs then STOP ANTIPSYCHOTIC
- Symptoms may occur after
5-7 days of stopping (longer if depot has been used)
Summary symptoms of NMS?
- High temperature (fever)
- Sweating
- Muscle stiffness
- Changes in mental state e.g.
Confusion, Anxiety
Which antipsychotic may cause
photosensitivity?
Chlorpromazine
Which antipsychotic can lower the seizure threshold?
Clozapine
Which antipsychotic causes anticholinergic (antimuscarinic effects)?
- Clozapine
- Typical antipyschotics
