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Therapeutics > Psychotics > Flashcards

Psychotics Flashcards

1
Q

What are the symptoms of delirium with an acute confusion and aggression?

A

Impaired awareness, confusion, disorientation

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2
Q

What are the indications for the neuroleptics?

A

Primary
Schizophrenia
Mania
Organic psychosis

Others
Nausea and vomiting
Intractable hiccups
Tourette’s syndrome
Behaviour disorders
Anaesthesia

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3
Q

Examples of Phenothiazines (side chain)

A

Aliphatic e.g. chlorpromazine

Piperazine e.g. prochloperazine, fluphenazine

Piperidine e.g. thioridazine*, pericyazine

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4
Q

Examples of Butyrophenones.

A

Haloperidol
Droperidol

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5
Q

Examples of Thioxanthenes.

A

Flupenthixol, zuclopenthixol

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6
Q

Indications for Chlorpromazine.

A

Schizophrenia

Mania

Organic psychosis

Tranquillization in emergency aggressive behavioural disturbances

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7
Q

What are the contraindication for the Chlorpromazine?

A

coma, severe mental depression, severe liver impairment, significant cardiac disorders, glaucoma, bone marrow depression

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8
Q

What are the adverse effects of chlorpromazine?

A

EPSEs, sedation, postural hypotension, anticholinergic side effects, epileptogenic, photosensitivity ,jaundice, agranulocytosis

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9
Q

Contraindication for Haloperidol.

A

Parkinson’s and pt with history of EPSEs from neuroleptics

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10
Q

The adverse effects of Haloperidol.

A

less anticholinergic, hypotensive, least epileptogenic BUT increased risk of EPSEs

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11
Q

With what drugs does the Chlorpromazine interact with?

A

anticholinergics, antiepileptics, antihypertensives, antiparkinsonism drugs, CNS depressants , enzyme inducers

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12
Q

With what drugs does haloperidol interact with?

A

Lithium –neurotoxicity
As with other antipsychotic drugs

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13
Q

What is the indication for clozapine-dibenzodiazepine?

A

Resistant psychosis

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14
Q

What are the contra-indication for clozapine?

A

in history of drug induced agranulocytosis

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15
Q

What are the adverse effects of Clozapine?

A

Weight gain, agranuloctosis and neutropenia, sedation, postural hypotension, anticholinergic s/e.LESS EPSEs, myocarditis rare. Constipation!

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16
Q

What is important to monitor when a patient is on Clozapine?

A

WCC monitoring essential.

17
Q

Describe the EPSE as a complication.

A

Acute dystonic reaction- spasm of muscles of tongue, face, neck, and back (torticollis, protrusion of the tongue, facial grimacing, oculogyric crisis, opisthotonus, truncal dystonia and laryngeal spasm) vs seizure

18
Q

Risk factor for EPSE.

A

young male

19
Q

Treatment for EPSE

A

biperiden 2mg IM/IV, benzodiazepine if necessary, if c/o pain analgesia
Stop neuroleptic until symptoms full resolution

20
Q

What are the signs parkinsonism?

A

bradykinesia, rigidity, tremor

21
Q

Treatment for Parkinsonism.

A

reduce dose- lowest effective dose
Prescribe anticholinergic orphenadrine 50-150mg

22
Q

What are signs akathisia?

A

motor restlessness vs anxiety

23
Q

What is the treatment of akathisia

A

Reduce dose
Add anticholinergic if necessary

24
Q

What are the signs tardive dyskinesia?

A

syndrome of choreoathetoid and or other involuntary movements, usually of face, lips and tongue +/- arms legs and trunk

25
Q

what is the treatment of tardive dyskinesia?

A

PREVENTION N.B. lowest effective dose for the shortest time

Gradually withdraw

Consider changing to atypical antipsychotics (less tendency for EPSEs)

26
Q

What is the aetiology of neuroleptic malignant syndrome?

A

Dopamine blockade in the hypothalamus

27
Q

Presentation of NMS.

A

Hyperpyrexia
Sweating
Unstable blood pressure
Changes in LOC (stupor or catatonia like state)
Muscle rigidity

28
Q

Adverse effects of atypical neuroleptics.

A

Less EPSEs (not devoid of EPSEs), prolactin effects, ↑weight gain
Clozapine EDL- reserved for treatment resistant psychosis
Major s/e agranulocytosis & neutropenia
Associated with QT prolongation

29
Q

Effects of Phenothiazines in pregnant or lactating.

A

Behavioural changes in children as it can be excreted in breast milk.

Therapeutics (12 decks)

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