Schizophrenia Flashcards
What are antipsychotics used for?
Used to calm disturbed patients
Used to stabilise mood aswell
Positive and negative symptoms
Positive - thought disorder, hallucinations, delusions
Negative - Social withdrawal, Apathy (lack of enthusiasm)
Time frame for deeming antipsychotics effective
4 to 6 weeks
1st generation and 2nd generation side effects
1st -
- Act mainly by blocking D2 receptors
- Cause a range of SE, especially EPSE and elevated prolactin
2nd - Act on a variety of receptors, hence less typical side effects- more metabolic side effects
- Better at treating negative symptoms of schizophrenia
What do 1st generations end in
Azines/ol
What do 2nd generations end in
Apine/one
What can 2 or more schizophrenic drugs lead to
QT prolongation, cardiac issues - use ECG to rule out issues
What is the dosage like for emergency IM
lower dose as no first pass metabolism
What can it lead to in elderly patients?
Postural hypotension
What is used in last resort
Clozapine
If people are not compliant, what can be used
Depot
What are some side effects of 1st generation
Acute psuedoparkinsonism (tremors, rigidity) - give antimuscarinics like procyclidine
Acute dystonia = procyclidine
Acute akathisia (inner restlessness) - discontinue
Chronic tardive dyskinesia (rhythmic involuntary movements) - switch to an alternative
Side effects of 2nd generation - hyperprolactinemia
Risperidone, amisulpride (RA)
Side effects of 2nd generation - sexual dysfunction
Haloperidol, olanzapine, riperidone (HOR)
Side effects of 2nd generation - hyperglycaemia
Clozapine, olanzapine, quetiapine, risperidone
(COQR)
Side effects of 2nd generation - postural hypotension
Clozapine, chlorpromazine, quetiapine (CQC)
What are some monitoring required with antipsychotics
Full blood count and U+Es - at the start then annually
Blood lipids + weight - baseline, at 3 months then yearly
Fasting blood glucose at baseline- 4-6 months, then yearly
Blood pressure and ECG
Prolactin - baseline, 6 months, yearly
What is the main thing with pimozide
ECG required - real risk of sudden death and QTC prolongation
Main points with chlorpromazine
Risk of acute dystonic reactions like facial and skeletal muscle spasms
Contact sensitisation - tablets should be handled with care and avoid direct contact
Main points with clozapine
Agranulocytosis - blood
Keep eye out for infections
Intestinal obstruction
Hypersalivation (kwells)
Keep an eye out if stop smoking
Main points with olanzapine
Weight gain
CNS and respiratory depression
What should be monitored with olanzapine IM
BP, pulse and respiratory rate should be monitored for at least 4 hours after IM
