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Y3 Psychiatry > Treatment of Schizophrenia > Flashcards

Treatment of Schizophrenia Flashcards

1
Q

name three first generation drugs for schizophrenia

A

chlorpromazine
haloperidol
sulpride

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2
Q

name three second generation drugs for schizophrenia

A

clozapine
olanazapine
risperidone

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3
Q

name a third generation drug for schizophrenia

A

apiprazole

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4
Q

what class of drugs are the vast majority of medications used for schizophrenia?

A

dopamine antagonists

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5
Q

what dopamine pathway is the target of treatment of schizophrenia?

A

mesolimbic

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6
Q

what percentage of dopamine receptors should we aim to block in schizophrenia management and why?

A

60-80%

minimal side effects but maximum effect

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7
Q

what causes extra-pyramidal side effects in schizophrenia management?

A

interference with the nigrostriatal pathway

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8
Q

what group of drugs are extra-pyramidal side effects seen with?

A

first generation drugs

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9
Q

name three extra pyramidal side effects that can arise from use of dopamine antagonists

A

acute dystonic reaction
Parkinsonism
tardive dyskinesia

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10
Q

how long does it take an acute dystonic reaction to come on?

A

minutes

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11
Q

how does an acute dystonic reaction present?

A

increased tone
energetic
torticollis
tongue protrusion

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12
Q

what is torticollis?

A

a painfully twisted and tilted neck

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13
Q

how does tardive dyskinesia present?

A

involuntary repetitive oro-facial movements

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14
Q

how long does tardive dyskinesia last?

A

long term

often permanent

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15
Q

how are extra pyramidal side effects managed?

A

procyclidine (first line)
trihexyphenidyl
orphenadrine

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16
Q

what dose of procyclidine is given for extra pyramidal side effects?

A

5mg

either PO or IM

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17
Q

besides EPSE, name three possible dopaminergic side effects of schizophrenia treatment

A

neuroleptic malignant syndrome
Hyperprolactinaemia
akathisia

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18
Q

what is the duration of onset for neuroleptic malignant syndrome?

A

24-72 hours

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19
Q

what can happen if neuroleptic malignant syndrome is not treated?

A

lasts days

can be fatal

20
Q

how does neuroleptic malignant syndrome present?

A

increasing muscle tone
pyrexia
changing pulse and BP

21
Q

how can neuroleptic malignant syndrome result in death?

A

rhabdomyolysis
acute renal failure coma
death

22
Q

what investigation is done for neuroleptic malignant syndrome?

A

creatinine kinase

23
Q

how is neuroleptic malignant syndrome managed?

A

stop causative drug
rapid cooling and renal support
skeletal muscle relaxants
dopamine agonists

24
Q

name a skeletal muscle relaxant that may be given in neuroleptic malignant syndrome

A

dantrolene

25
Q

name a dopamine agonist that may be given in neuroleptic malignant syndrome

A

bromocriptine

26
Q

what inhibits prolactin release?

A

dopamine

27
Q

what effect do dopamine antagonists have on prolactin levels?

A

blocking dopamine leads to increased prolactin release

28
Q

what are the symptoms of Hyperprolactinaemia in women?

A

galactorrhea
decreased libido
amenorrhoea

29
Q

what are the symptoms of Hyperprolactinaemia in men?

A

gynaecomastia
ED
oligospermia
decreased libido

30
Q

what symptoms are seen in both sexes in Hyperprolactinaemia?

A

reduced bone mineralisation and bone density - can lead to osteoporosis

31
Q

what is another name for akathisia?

A

restless legs

32
Q

when does akathisia present after treatment?

A

days-weeks

33
Q

what is the first line management for akathisia?

A

beta blocker e.g. propranolol

34
Q

what is the second line management for akathisia?

A

benzodiazepines e.g. clonazepam

35
Q

what are the possible anti cholinergic effects of schizophrenia management?

A

dry mouth
blurred vision
constipation

36
Q

what is a possible 5-HT2 side effect in schizophrenia management?

A

weight gain

37
Q

what anti-adrenergic side effect can be seen in schizophrenia management?

A

postural hypotension

38
Q

what is the “best” anti-psychotic agent and why?

A

clozapine

best for non responders and negative syndromes

has anti suicidal properties

39
Q

name six possible side effects of clozapine treatment

A 
agranulocytosis 
myocarditis 
constipation 
weight gain 
sedation 
sialorrhoea
40
Q

what can agranulocytosis due to clozapine use lead to?

A

neutropenic sepsis

41
Q

what is the average weight gain in patients started on clozapine?

A

10kg

42
Q

what is the first step in the management of schizophrenia?

A

second generation drug for 6-8 weeks

43
Q

what is the second step in the management of schizophrenia?

A

1st or 2nd generation drug for 6-8 weeks

44
Q

what is the third step in the management of schizophrenia?

A

reassess diagnosis
consider psychological input
check compliance

45
Q

what is the fourth step in the management of schizophrenia?

A

increase dose

combination therapy

46
Q

what is the last line management for schizophrenia?

A

clozapine

Y3 Psychiatry (24 decks)

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