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Psychiatry (mixed 2) > Antipsychotic medication > Flashcards

Antipsychotic medication Flashcards

0
Q

What symptoms do antipsychotics relieve in schizophrenia

A

Positive symptoms (hallucinations, delusions, disordered thinking)

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1
Q

Classes of antipsychotics

A

Typical antipsychotics (D2 receptor antagonists)

Atypical antipsychotics (serotonin/dopamine antagonists)

Lithium

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2
Q

What drug might improve negative symptoms in schizophrenia

A

Clozapine (atypical antipsychotic)

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3
Q

Primary indications for antipsychotics

A

Schizophrenia
Mania
Psychosis due to another medical condition
Substance-induced psychotic disorder

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4
Q

Secondary/other indications for antipsychotics

A 
Behavioral disorders (adjunctive therapy)
Acute sedation
Intractable hiccups
Tourette's syndrome
Delerium
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5
Q

Potential cause of extrapyramidal side effects

A

Blockade of dopamine receptors in the corpus striatum

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6
Q

What antipsychotics have greatest potential for EPSEs

A

Piperizine-type phenothiazines (fluphenazine)

Butyrophenones (haloperidol)

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7
Q

What are the four early appearing movement disorders seen in EPSEs

A

Acute dystonic reactions - esp young males (lower dose and give anticholinergic)

Parkinsonian signs - bradykinesia, rigidity and tremor (lower dose or switch to atypical)

Akathisia - subjective and observed motor restlessness

Neuroleptic malignant syndrome - tetrad of fever, muscle rigidity, altered mental status, autonomic dysfunction (increased CK used to diagnose

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8
Q

What is the late appearing movement disorder seen in EPSEs

A

Tardive dyskinesia - choreoathetoid and/or persistent involuntary movements (commonly face, lips and tongue)

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9
Q

Apart from EPSEs what other side effects can typical antipsychotics have

A

Disturbance of temp regulation
Anticholinergic symptoms - confusion, dry mouth, blurred vision, constipation, tachycardia, urinary retention, closed-angle glaucoma
Cardiovascular - postural hypotension, prolonged QT
Hypersensitivity - skin, cholestatic jaundice
Blood dyscrasias - decrease leukoplesis, agranulocytosis
Endocrine - increased prolactin, menstrual change, weight gain

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10
Q

Common typical antipsychotics

A

Butyrophenones - haloperidol
Phenothiazine, aliphatic side chain - chlorpromazine
Piperazine-type phenothiazines - fluphenazine, trifluoperazine
Diphenylbutylpiperidine derivatives - thioridazine, pimozide
Thioxanthines - flupentixol, zuclopenthixol
Benzamides - supiride, amisulpride

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11
Q

Common name for sodium valproate

A

Epilim

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12
Q

Indications for sodium valproate

A

All forms of epilepsy
Tonic-clonic seizures
Prophylaxis of migraine
Acute manic phase of bipolar

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13
Q

Can sodium valproate be used in pregnancy

A

No (category D). Facial deformities, neural tube defects - risk in first trimester

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14
Q

What is the difference between sodium valproate and valproic acid

A

Sodium valproate is converted to valproic acid (the active agent). Therefore, lower doses of valproic acid are equivalent to higher doses of sodium valproate

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15
Q

What is chlorpromazine

A

Typical antipsychotic. Phenothiazine with an aliphatic side chain

16
Q

Indications for chlorpromazine

A

One of most sedative antipsychotics. Useful for violent/agitated patients. (Intractable hiccups)

17
Q

Which group of patients are particularly prone to EPSEs

A

Hyperthyroidism

18
Q

What is haloperidol

A

Typical antipsychotic. Butyrophenone.

19
Q

What is fluphenazine

A

Typical antipsychotic. Piperazine-type phenothiazine. Good for chronic schizophrenia.

Available in depot prep = fluphenazine decanoate

20
Q

What is trifluoperazine

A

Typical antipsychotic. Piperazine-type phenothiazine. Used in psychosis and as a forth line Rx in anxiety states

21
Q

What is pimozide

A

Typical antipsychotic. Piperadine phenothiazine. Selective dopamine antagonist (less sedative, less EPSE)

22
Q

Indications for pimozide

A

Psychosis

Tic disorders

23
Q

What is flupentixol

A

Typical antipsychotic. Thioxanthene.

24
Q

What is zuclopentixol

A

Typical antipsychotic. Thioxanthene. Available in depot preparation

25
Q

What is amisulpride

A

Typical antipsychotic. Benzamide. Selective dopamine antagonist

26
Q

Adverse events with amisulpride

A

QT prolongation
Ventricular arrhythmias
Torsades de pointes
Sudden death

27
Q

What is sulpiride

A

Typical antipsychotic. Benzamide. Selective dopamine antagonist.

Not recommended in manic/hypomanic states

28
Q

What group of patients should you treat with caution especially with atypical antipsychotics

A

Patients with dementia. Increased risk of cerebrovascular accidents

29
Q

What neuroleptic has the greatest tendency to cause agranulocytosis and neutropenia

A

Clozapine

30
Q

Three most commonly used atypical antipsychotics in SA

A

Clozapine
Olanzapine
Risperidone

31
Q

Indications for clozapine

A

Treatment resistant schizophrenia
Recurrent suicidal behavior in psychotic disorders
Drug induced psychosis in Parkinson’s disease

32
Q

What monitoring should be done with clozapine therapy

A

Hematological
Orthostatic hypotension (lead to cardiac arrest)
Seizures
Constipation

33
Q

Indications for olanzapine

A

Psychotic disorders
Acute moderate/severe mania
Prevention of bipolar episode recurrence

34
Q

When to use olanzapine with caution

A

(C/I) closed angle glaucoma, <12yo

Hepatic impairment
Diabetes mellitus
Benzodiazepine use (esp when given IM)

35
Q

Indications for risperidone

A

Acute and chronic schizophrenic psychoses with positive and/or negative symptoms (or prominent affective symptoms)

Acute mania

Manage behavioral symptoms (aggression, wandering, agitation)

Can use in in children >5 with disruptive behavioural disorders with neurodevelopmental defects

36
Q

Why start risperidone on lower dose initially

A

Minimize risk of orthostatic hypotension (from alpha blockade)

Psychiatry (mixed 2) (16 decks)

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