antipsychotics Flashcards
mechanism for all antipsychotics w exception of clozapne
dopamine d2 receptor antagonists - most second gen also block serotonin receptors.
acute dystonia presentation and management
involuntary sustaianed muscular contractions - occurs within 72hrs and treat w procyclidine.
management of akathisa
propranolol/ benzos/ maybe chnage antipsychotic
parkinsonism management
procyclidine
tardive dyskinesia presentation
rhythmic, involuntary movements - chewing, grimacing.
common in patients on long term treatment.
Tardive dyskinesia treatment
withdraw drug, chnage to one w lower d2 affinity, avoid anticholinergics
oresentation of neuroleptic malignant syndrome
neuromuscular abnormalities - severe lead pipe rigidity
altered consciousness
autonomic dysfunction - hyperthermia, tachycardia, sweating and labile blood pressure
occurs within 4-11 days of initiation or dose increase
bloods seen in neuroleptic malignant syndrome
elevated creatinine kinase, white cells, LFTs w metabolic acidosis
neuroleptic malignant syndrome management
discontinue drug, active cooling, fluids and ICU admission
clozpapine indication
treatment resistant schizophrenia - 2 or more antipsychotics for appropriate dose and time
why is clozapine use limited
risk of bone marrow suppression w agranulocytosis
clozapine monitoring
FBC before, weekly for 18 weeks, then months - neutrophils monitored closely
Pts need to contact GP if they develop a sore throat or become unwell
risks associated w clozapine
agranulocytosis, myocarditis, cardiomyopathy, severe constipation and bowel obstruction
contraindications for antipsyhcotics
- parkinsons
- lewy body demntia
- known arrhytmias or family hx of sudden death - should have qtc monintored before and during treatment
antipsychotic monitoring
metabolic - lipids, blood sugar, BP, weight, waist circumference - use statins, anti hypertensives and weight loss support if needed.
CV - ECG esp in those w underlying probelms or family hx
