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neuro > schizophrenia drugs > Flashcards

schizophrenia drugs Flashcards

1
Q

what are some first generation anti-psychotics

A

-chlorpromazine
-haloperidol
-zuclopenthixol
-flupentixol
-trifluperazine
-prochlorperazine
-perphenazine
-sulpiride

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2
Q

what are some second generation anti-psychotics

A

-clozapine
-olanzapine
-quetiapine
-risperidone
-paliperidone
-lurasidone

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3
Q

what is the third generation anti-psychotic

A

aripirazole

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4
Q

which anti-psychotics for acute treatment

A

second gen

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5
Q

dopaminergic side effects

A

-extra pyramidal side effects
-neuroleptic malignant syndrome
-hyperprolactinaemia
-akathesia/restless legs

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6
Q

different types of extra pyramidal side effects

A

-acute dystonia
-Parkinsonism
-tardive dyskinesia

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7
Q

symptoms of acute dystonia

A

-onset in minutes
-increasing muscle tone
-energetic
-torticolis
-oculogyric crisis
-tongue protrusion

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8
Q

symptoms of parkinsonism

A

-bradykinesia
-cogwheeling rigidity
-resting tremor
-shuffling gait
-dead-pan facial expression

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9
Q

symptoms of tardive dyskinesia

A

-long-term often permanent
-involuntary repetitive oro-facial movements
-blinking, grimacing, pouting, lip smacking common
-may involve limbs and or trunk

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10
Q

how do you treat EPSE

A

-procyclidine 5mg
-trihexyphenidyl
-orphenadrine

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11
Q

what are the three main features of neuroleptic malignant syndrome

A

-autonomic instability
-malignant hyperpyrexia
-increasing muscle tone

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12
Q

progression of neuroleptic malignant syndrome

A

increasing muscle tone, pyrexia, changing pulse/BP > rhabdo > ARF >coma > death

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13
Q

investigation for neuroleptic malignant syndrome

A

creatinine kinase

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14
Q

treatment for neuroleptic malignant syndrome

A

-stop antipsychotic
-rapid cooling, renal support
-skeletal muscle relaxants e.g. dantroline
-dopamine agonists e.g. bromocriptine

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15
Q

how can antipsychotics cause high prolactin

A

affects the tuberoinfundibular pathway
-prolactin release inhibited by dopamine
-blockade of dopamine leads to increased prolactin release

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16
Q

high prolactin features in women

A

-galactorrhoea
-decreased libido, decreased arousal, anorgasmia
-amenorrhoea, anovulation

17
Q

high prolactin features in men

A

-gynaecomastia
-erectile dysfunction, oligospermia
-decreased libido

18
Q

high prolactin features in men and women

A

-decreased bone mineralisation
-decreased bone density > osteoporosis
-falls > fractures

19
Q

presentation of akathisia

A

-manifests within days-weeks of treatment
-pacing
-rocking from foot to foot
-unable to sit or stand still
-poor sleep as a result
-links to increased suicide risk

20
Q

treatment of akathisia

A

1st) beta blocker - propranolol
2nd) benzodiazepines - clonazepam

21
Q

anticholinergic side effects

A

-dry mouth
-blurred vision
-constipation

22
Q

5HT2 receptor blockade side effects

A

-weight gain
-metabolic syndrome
-type 2 DM

23
Q

anti-adrenergic side effects

A

postural hypotension

24
Q

other important side effects

A

-hepatotoxicity
-prolonged QT interval
-photosensitivity

25
Q

what would clozapine be used for

A

non-responders
-good for negative symptoms
-anti-suicidal

26
Q

side effects of clozapine

A

-agranulocytosis > neutropenic sepsis
-myocarditis
-constipation > gastric paresis > obstruction > perforation
-weight gain
-sedation
-sialorrhoea

27
Q

what needs monitored when on clozapine

A

-blood tests
-ECGS

28
Q

what are the four dopamine pathways

A

-mesolimbic
-mesocortical
-tuberoinfundibular
-nigrostriatal

29
Q

mesolimbic pathway in schizophrenia

A

-overactive due to too much dopamine
-causes positive symptoms

30
Q

mesocortical pathway in schizophrenia

A

-underactive due to reduced dopamine
-causes negative symptom

31
Q

tuberoinfundibular pathway in schizophrenia

A

affected by antipsychotics
-increased prolactin
-glactorrhoea, gynaecomastia etc

32
Q

nigrostriatal pathway in schizophrenics

A

affected by antipsychotics
-extra pyramidal side effects

33
Q

first line for schizophrenia

A

2nd gen anti-psychotic
-risperidone or olanzapine
-adequate dose 6-8 weeks

34
Q

second line for schizophrenia

A

a different 2nd gen or a first gen
-first gen could be haloperidol
-adequate dose for 6-8 weeks

35
Q

third line for schizophrenia

A

Check diagnosis
-consider psychological input
-optimise social supports
-check compliance (do they need a depot)

36
Q

fourth line

A

consider clozapine

37
Q

5th line

A

higher dose or consider two antipsychotics

38
Q

examples of depots

A

IM
-deltoid or gluteal
-weekly to 3 monthly

neuro (26 decks)

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