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afsha - mental health disorders > side effects of anti psychotics > Flashcards

side effects of anti psychotics Flashcards

1
Q

is there difference in efficacy between each antipsychotic drug

A

little difference (other than clozapine)

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2
Q

is there a 1st line antipsychotic drug

A

no first line that is suitable for all pt
properties of individual drugs need to be considered and discussed with pt or carers when prescribing

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3
Q

when do extrapyramidal symptoms occur and which drugs are they most likely to occur with

A
  • dose related
  • most likely to occur with high doses of high potency 1st gen antipsychotics e.g.
    • piperazine G3 phenothiazines - fluphenzine and trifluoperazine
    • butyrophenones: benperidol and haloperidol
    • 1st gen depot preps
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4
Q

name the two group 3 piperazine phenothiazine 1st gen antipsychotics that you are most likely to get extrapyramidal symptoms with if the pt is taking high doses

A

trifluoperazine and fluphenazine

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5
Q

name the 5 first gen antipsychotics you are most likely to get extrapyridamol symptoms with if taking high doses

A
  • perazine phenothiazines: trifluoperazine and fluphenzine
  • haloperidol and benperifol
  • depot 1st gen preps
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6
Q

name the 4 second gen antipsychotics for which extrapyridamol symptoms are less common, as they have lower liaility for both acute and late onset extrapyridamol symptoms

A

clozapine
quetiapine
olanzapine
aripiprazole

COQA

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7
Q

what are pakinsonian symptoms, and who are they more likely to appear in and when might it happen

A

includes bradykinesia, tremor
may occur more commonly in elderly females or those with pre-existing neurological damage such as stroke, and may appear gradually

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8
Q

what is dustonia and who is it more likely to occur in and when may it happen

A

uncontrolled muscle spasm in any part of the body
occurs more commonly in young males
acute dystonia can appear within hours of starting antipsychotics

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9
Q

what is akathisia and when may it occur and what might it be mistaken for

A

restlessness
characteristically occurs within hours to weeks of starting antipsychotic treatment or on dose increase
may be mistaken for psychotic agitation

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10
Q

the following extrapyramidal symptom may be mistaken for psychotic agitstion

A

akathisia (restlessness)

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11
Q

what is tardive duskinesia and when may it occur and who is it more likely to occur in

A

abnormal involuntary movements of lips, tongue, face, and jaw
can develop on long-term or high-dose therapy, or even after discontinuation
in some patients it can be irreversible
more common in elderly females

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12
Q

in some patients, the following extrapyramidal symptom can be irreversible

A

tardive dyskinesia - abnormal involunaty movement of lips, tongue, face, jaw

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13
Q

name 4 main extrapyramidal symptoms

A

parkinsonian symptoms (including bradykinesia, tremor)
dystonia (uncontrolled muscle spasm in any part of body)
akathisia (restlessness)
tardive dyskinesia (abnormal involuntary movement of lips, tongue, face, jaw)

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14
Q

what to do when parkinonsian symptoms are identified e.g. bradykinesia, tremor

A

review treatment with the aim of reducing exposure to high dose and high potency antipsychotics (i.e. piperazine phenothiazines like fluphenazine and trifluoperazine, haloperidol and benperidol and the depot preparations)

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15
Q

this drug class can releiev symptom burden (parkinsonian symptoms with antipsychotics) but they should not be routinely prescribed for prophylaxis

A

antimuscarinic drugs

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16
Q

what is the most serious manifestation of late-onset extrapyramidal symptoms for which there is no satisfactory treatment

A

tardive dyskinesia

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17
Q

Tardive dyskinesia is the most serious manifestation of late-onset extrapyramidal symptoms for which there is no satisfactory treatment. it occurs more commonly in

A

elderly females

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18
Q

what to do with antipsychotic drugs if tardive dyskinesia occurs

A

Antipsychotic treatment should be carefully and regularly reviewed
Any changes to dose or drug should be made gradually, over weeks or months, to minimise the risk of withdrawal tardive dyskinesia
However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development.

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19
Q

which antipsychotic drugs cause hyperprolactinaemia

A

most of them - both 1st and 2nd gen

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20
Q

why do antipsychotics cause hyperprolactinaemia

A

most (both 1st and 2nd gen) increase prolactin conc to some extent because dopamine inhibits prolactin release
the antipsychotics work by blocking dopamine, therefore increasing prolactin

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21
Q

this drug reduces prolactin concentration in a dose dependent manner because it is a dopamine receptor partial agonist

A

aripiprazole

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22
Q

aripirazole REDUCES prolactin concentration (opposite of hyperprolactinaemia which is a common SE of most antipsychotics) to some extent because …

A

it is a dopamine receptor partial agonist

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22
Q

1st generation antipsychotics and the following TWO 2nd gen are MOST likely to cause sympomatic hyperprolactinaemia

A

1st gen (+sulpiride) risperidone, amisulpride,

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23
Q

hyperprolactinaemia is very rare with the following 5 antipsychotics (2nd gen)

A
  • aripiprazole
  • asenapine
  • cariprazine
  • clozapine
  • quetiapine
24
Q

clinical symptoms of hyperprolactinaemia include the following 6

A

sexual dysfunction
reduced bone mineral density
menstrual disturbances
breast enlargement
galactorrhoea
possible increased risk of breast cancer

25
Q

sexual dysfunction is a side effect of which antipsychotics?

A

all

26
Q

Sexual dysfunction is reported as a side-effect of all antipsychotic medication. What are 3 contributing factors to this?

A

physical illness
psychiatric illness
substance misuse

27
Q

Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. explain 3

A

Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men

28
Q

these 3 drugs have higher prevalence to cause sexual dysfunction

A

Risperidone, haloperidol, and olanzapine

HOR

29
Q

these 2 drugs have the lowest risk of sexual dysfunction

A

aripiprazole and quetiapine

AQ

30
Q

what to do with antipsychotic drugs if sexual dysfunction is thought to be antipsychotic induced

A

Expert sources advise to consider dose reduction or discontinuation (where appropriate), or switching medication

31
Q

antipsychotic drugs are associated with CV side effects such as … (3)

A

tachycardia
arrhythmias
hypotension

32
Q

This CV side effect is a particular concern with pimozide

A

QT interval prolongation

33
Q

QT interval prolongation is a particular concern with this drug

A

pimozide

34
Q

the overall risk of QT interval prolongation is probably dose related, but there is also a higher probability of QT interval prolongation in pt using …. (3)

A

pimozide (paricular concern is QT interval prolongation)
pt using any IV antipsychotic drug
any antipsychotic drug or combination or antipsychotic drugs with doses exceeding recommended maximum

35
Q

Antipsychotic drugs with a low tendency to prolong QT interval include

A

aripiprazole, asenapine, clozapine, flupentixol, fluphenazine decanoate, loxapine, olanzapine, paliperidone, prochlorperazine, risperidone, and sulpiride.

36
Q

postural hypotension is a common cardiac side effect of which antipsychotics

A

all

37
Q

Postural hypotension is a common cardiac side-effect of antipsychotic drugs, usually presenting acutely during the initial dose titration; however,

A

it can also be a chronic problem

38
Q

postural hypotension is bad because it can lead to

A

syncope and dangerous falls related injuries, especially in the elderly

39
Q

what are the 2nd gen that are most likely to cause postural hypotension

A

clozapine
quetiapine

40
Q

what is used to mimimise postural hypotension

A

slow dose titration

41
Q

schizophrenia is associated with these metbaolic disorders

A

insulin resistance and diabetes

42
Q

Schizophrenia is associated with insulin resistance and diabetes; do antipsychotics further increase this risk?

A

the risk of diabetes is probably increased in all patients with schizophrenia who take antipsychotic drugs

43
Q

these 2 have the lowest risk of diabetes in the 2nd gen antipsychotic class

A

amisulpride
aripiprazole

AA

44
Q

some evidence suggests that this generation of antipsychotic drugs are less liekly to cause diabetes than the other generation

A

1st gen less likely than 2nd gen

45
Q

of the 1st gen, the following 2 drugs have the lowest risk of diabetes

A

haloperidol
fluphenazine

46
Q

which antipsychotics cause weight gain

A

all

47
Q

these 2 drugs commonly cause weight gain

A

olanzapine
clozapine

48
Q

the following drugs are least likely to cause weight gain

A

Amisulpride, asenapine, aripiprazole, cariprazine, haloperidol, lurasidone hydrochloride, sulpiride, and trifluoperazine

49
Q

what is neuroleptic malignant syndrome and which drugs does it occur with?

A

rare but potentially fatal side-effect of all antipsychotic drugs

50
Q

what are the symptoms of neuroleptic malignant syndrome

A

hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with fever, tachycardia, labile blood pressure, and sweating

51
Q

a patient is in A&E. she is in and out of consiousness, has fever, is sweating, has hyperthermia and have tachycardia. when looking at her drug history, you suspect she has the following. What do you do?

A

these are some symptoms of neuroleptic malignant syndrome
rare but potentially fatal SE of all antipsychotics due to D2 blockade
expert sources advice discontinuation for at least 5 days, pref longer
allow signs and symptoms of NMS to resolve completely

52
Q

how long is it advised to discontinue antipsychotic drugs for if a patient has neuroleptic malignant syndrome

A

essential to discontinue for at least 5 days, pref longer
allow for signs and symptoms of NMS to resolve completely

53
Q

these two drugs have been used in the treatment of neuroleptic malignant syndrome

A

bromocriptine
dantrolene

54
Q

hyperglycaemia is more likely with these antipsychotics (CROQ)

A

clozapine
risperidone
olanzapine
quetiapine

55
Q

Hypotension more likely with CQ

A

clozapine and quetiapine

56
Q

QT prolongation most common with these two

A

pimozide
haloperidol

57
Q

extrapyrimdal SE most likely in these 2 groups of 1st gen

A

group 3 phenothiazine
butyrophenones

afsha - mental health disorders (10 decks)

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