Psychotics Flashcards
What are the symptoms of delirium with an acute confusion and aggression?
Impaired awareness, confusion, disorientation
What are the indications for the neuroleptics?
Primary
Schizophrenia
Mania
Organic psychosis
Others
Nausea and vomiting
Intractable hiccups
Tourette’s syndrome
Behaviour disorders
Anaesthesia
Examples of Phenothiazines (side chain)
Aliphatic e.g. chlorpromazine
Piperazine e.g. prochloperazine, fluphenazine
Piperidine e.g. thioridazine*, pericyazine
Examples of Butyrophenones.
Haloperidol
Droperidol
Examples of Thioxanthenes.
Flupenthixol, zuclopenthixol
Indications for Chlorpromazine.
Schizophrenia
Mania
Organic psychosis
Tranquillization in emergency aggressive behavioural disturbances
What are the contraindication for the Chlorpromazine?
coma, severe mental depression, severe liver impairment, significant cardiac disorders, glaucoma, bone marrow depression
What are the adverse effects of chlorpromazine?
EPSEs, sedation, postural hypotension, anticholinergic side effects, epileptogenic, photosensitivity ,jaundice, agranulocytosis
Contraindication for Haloperidol.
Parkinson’s and pt with history of EPSEs from neuroleptics
The adverse effects of Haloperidol.
less anticholinergic, hypotensive, least epileptogenic BUT increased risk of EPSEs
With what drugs does the Chlorpromazine interact with?
anticholinergics, antiepileptics, antihypertensives, antiparkinsonism drugs, CNS depressants , enzyme inducers
With what drugs does haloperidol interact with?
Lithium –neurotoxicity
As with other antipsychotic drugs
What is the indication for clozapine-dibenzodiazepine?
Resistant psychosis
What are the contra-indication for clozapine?
in history of drug induced agranulocytosis
What are the adverse effects of Clozapine?
Weight gain, agranuloctosis and neutropenia, sedation, postural hypotension, anticholinergic s/e.LESS EPSEs, myocarditis rare. Constipation!
What is important to monitor when a patient is on Clozapine?
WCC monitoring essential.
Describe the EPSE as a complication.
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
Risk factor for EPSE.
young male
Treatment for EPSE
biperiden 2mg IM/IV, benzodiazepine if necessary, if c/o pain analgesia
Stop neuroleptic until symptoms full resolution
What are the signs parkinsonism?
bradykinesia, rigidity, tremor
Treatment for Parkinsonism.
reduce dose- lowest effective dose
Prescribe anticholinergic orphenadrine 50-150mg
What are signs akathisia?
motor restlessness vs anxiety
What is the treatment of akathisia
Reduce dose
Add anticholinergic if necessary
What are the signs tardive dyskinesia?
syndrome of choreoathetoid and or other involuntary movements, usually of face, lips and tongue +/- arms legs and trunk
what is the treatment of tardive dyskinesia?
PREVENTION N.B. lowest effective dose for the shortest time
Gradually withdraw
Consider changing to atypical antipsychotics (less tendency for EPSEs)
What is the aetiology of neuroleptic malignant syndrome?
Dopamine blockade in the hypothalamus
Presentation of NMS.
Hyperpyrexia
Sweating
Unstable blood pressure
Changes in LOC (stupor or catatonia like state)
Muscle rigidity
Adverse effects of atypical neuroleptics.
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
Effects of Phenothiazines in pregnant or lactating.
Behavioural changes in children as it can be excreted in breast milk.
