schizophrenia drugs Flashcards
what are some first generation anti-psychotics
-chlorpromazine
-haloperidol
-zuclopenthixol
-flupentixol
-trifluperazine
-prochlorperazine
-perphenazine
-sulpiride
what are some second generation anti-psychotics
-clozapine
-olanzapine
-quetiapine
-risperidone
-paliperidone
-lurasidone
what is the third generation anti-psychotic
aripirazole
which anti-psychotics for acute treatment
second gen
dopaminergic side effects
-extra pyramidal side effects
-neuroleptic malignant syndrome
-hyperprolactinaemia
-akathesia/restless legs
different types of extra pyramidal side effects
-acute dystonia
-Parkinsonism
-tardive dyskinesia
symptoms of acute dystonia
-onset in minutes
-increasing muscle tone
-energetic
-torticolis
-oculogyric crisis
-tongue protrusion
symptoms of parkinsonism
-bradykinesia
-cogwheeling rigidity
-resting tremor
-shuffling gait
-dead-pan facial expression
symptoms of tardive dyskinesia
-long-term often permanent
-involuntary repetitive oro-facial movements
-blinking, grimacing, pouting, lip smacking common
-may involve limbs and or trunk
how do you treat EPSE
-procyclidine 5mg
-trihexyphenidyl
-orphenadrine
what are the three main features of neuroleptic malignant syndrome
-autonomic instability
-malignant hyperpyrexia
-increasing muscle tone
progression of neuroleptic malignant syndrome
increasing muscle tone, pyrexia, changing pulse/BP > rhabdo > ARF >coma > death
investigation for neuroleptic malignant syndrome
creatinine kinase
treatment for neuroleptic malignant syndrome
-stop antipsychotic
-rapid cooling, renal support
-skeletal muscle relaxants e.g. dantroline
-dopamine agonists e.g. bromocriptine
how can antipsychotics cause high prolactin
affects the tuberoinfundibular pathway
-prolactin release inhibited by dopamine
-blockade of dopamine leads to increased prolactin release
high prolactin features in women
-galactorrhoea
-decreased libido, decreased arousal, anorgasmia
-amenorrhoea, anovulation
high prolactin features in men
-gynaecomastia
-erectile dysfunction, oligospermia
-decreased libido
high prolactin features in men and women
-decreased bone mineralisation
-decreased bone density > osteoporosis
-falls > fractures
presentation of akathisia
-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
treatment of akathisia
1st) beta blocker - propranolol
2nd) benzodiazepines - clonazepam
anticholinergic side effects
-dry mouth
-blurred vision
-constipation
5HT2 receptor blockade side effects
-weight gain
-metabolic syndrome
-type 2 DM
anti-adrenergic side effects
postural hypotension
other important side effects
-hepatotoxicity
-prolonged QT interval
-photosensitivity
what would clozapine be used for
non-responders
-good for negative symptoms
-anti-suicidal
side effects of clozapine
-agranulocytosis > neutropenic sepsis
-myocarditis
-constipation > gastric paresis > obstruction > perforation
-weight gain
-sedation
-sialorrhoea
what needs monitored when on clozapine
-blood tests
-ECGS
what are the four dopamine pathways
-mesolimbic
-mesocortical
-tuberoinfundibular
-nigrostriatal
mesolimbic pathway in schizophrenia
-overactive due to too much dopamine
-causes positive symptoms
mesocortical pathway in schizophrenia
-underactive due to reduced dopamine
-causes negative symptom
tuberoinfundibular pathway in schizophrenia
affected by antipsychotics
-increased prolactin
-glactorrhoea, gynaecomastia etc
nigrostriatal pathway in schizophrenics
affected by antipsychotics
-extra pyramidal side effects
first line for schizophrenia
2nd gen anti-psychotic
-risperidone or olanzapine
-adequate dose 6-8 weeks
second line for schizophrenia
a different 2nd gen or a first gen
-first gen could be haloperidol
-adequate dose for 6-8 weeks
third line for schizophrenia
Check diagnosis
-consider psychological input
-optimise social supports
-check compliance (do they need a depot)
fourth line
consider clozapine
5th line
higher dose or consider two antipsychotics
examples of depots
IM
-deltoid or gluteal
-weekly to 3 monthly
