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Psychiatry > Psychosis - Pharmacology > Flashcards

Psychosis - Pharmacology Flashcards

1
Q

Anti-psychotic drugs are most effective for treating what?

A

Acute, positive symptoms of psychosis

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2
Q

Anti-psychotic drugs can take up to how long to treat positive symptoms of psychosis?

A

3 months

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3
Q

What are some examples of typical anti-psychotics?

A

Chlorpromazine, thioridazine, haloperidol, zuclopenixol

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4
Q

Zuclopenixol is a typical anti-psychotic drug which is given how?

A

As a depot preparation

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5
Q

What is the mechanism of action of typical anti-psychotics?

A

D2 receptor blockade to increase cAMP

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6
Q

What group of side effects are typical anti-psychotics most likely to produce?

A

Extra-pyramidal side effects

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7
Q

What are the 4 main extra-pyramidal side effects?

A

Acute dystonic reaction, akathisia, Parkinsonism and tardive dyskinesia

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8
Q

Extra-pyramidal side effects occur due to D2 receptor blockade where?

A

In the nigrostriatal pathway

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9
Q

How soon after taking an anti-psychotic will an acute dystonic reaction occur?

A

Hours-days

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10
Q

What happens in an acute dystonic reaction?

A

Involuntary, sustained, painful muscle spasms

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11
Q

What can the muscle spasms which occur as a result of an acute dystonic reaction cause to happen?

A

Extensor spasm of the body, torticollis (abnormal neck posturing) and difficulty swallowing

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12
Q

How is an acute dystonic reaction treated? Give an example?

A

Anti-cholinergics e.g. Prochlorperazine

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13
Q

How soon after taking an anti-psychotic drug does akathisia present?

A

Within a few days

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14
Q

What is akathisia? What may patients with this complain of?

A

An internal restlessness - patients will complain of feeling like they need to move constantly and will feel mentally uneasy

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15
Q

Where does akathisia most commonly affect? What may you notice patients doing?

A

The legs / pacing, wriggling, fidgeting

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16
Q

Dysphonia (difficulty speaking) may occur as a result of which extra-pyramidal side effect?

A

Akathisia

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17
Q

How is akathisia treated?

A

By lowering the dose of anti-psychotic until it stops, or changing drug altogether

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18
Q

How soon after taking an anti-psychotic drug does Parkinsonism present?

A

Usually within a month

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19
Q

What are some features of Parkinsonism induced by anti-psychotic drugs?

A

Resting tremor, rigidity, postural instability and bradykinesia

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20
Q

Which anti-psychotic drug is most likely to result in Parkinsonism?

A

Haloperidol

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21
Q

How can Parkinsonism be treated?

A

Can be treated with anti-cholinergics or can stop the drug

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22
Q

How long after taking an anti-psychotic drug does tardive dyskinesia present?

A

Years later

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23
Q

Which extra-pyramidal side effect may persist even after stopping taking the anti-psychotic which was causing it?

A

Tardive dyskinesia

24
Q

Tardive dyskinesia occurs as a result of what?

A

Long term anti-psychotic use

25
Q

How will tardive dyskinesia present?

A

Repetitive, involuntary purposeless movements e.g. grimacing, lip smacking, pursing lips, sticking out tongue

26
Q

Hypothalamic side effects are more likely to occur with which type of anti-psychotic drugs?

A

Typicals

27
Q

What are some side effects of anti-psychotic drugs that result from D2 blockage in the tubulofundibular pathway in the hypothalamus?

A

Hyperprolactinaemia and galactorrhoea, gynaecomastia, sexual dysfunction

28
Q

What are some side effects related to sexual dysfunction that anti-psychotics may cause?

A

Hypogonadism, decreased libido, amenorrhoea, infertility

29
Q

Which ECG change can taking anti-psychotics predispose to? Which type of anti-psychotic is most likely to cause this?

A

QT prolongation - typicals

30
Q

Dopamine blockade by anti-psychotic drugs can lead to low levels of which hormones? What can this lead to?

A

Oestrogen and testosterone / osteoporosis

31
Q

What is the mechanism of action of atypical anti-psychotics?

A

Block many receptors, mostly 5-HT2A > D2

32
Q

Which type of anti-psychotic drugs have a better efficacy against negative symptoms?

A

Atypicals

33
Q

Name some examples of atypical anti-psychotics?

A

Olanzapine, quetiapine, risperidone, aripiprazole, clozapine

34
Q

Why should olanzapine be avoided in people with diabetes?

A

High risk of destabilising blood sugars and causing weight gain

35
Q

Atypical antipsychotics are first line in who?

A

People who have been newly diagnosed with schizophrenia and those experiencing side effects from typicals

36
Q

What is the major side effect of atypical anti-psychotic drugs? This occurs due to blockade of what?

A

Metabolic syndrome / 5-HT2

37
Q

What are the features of metabolic syndrome?

A

Dyslipidaemia, hypertension, weight gain and insulin resistance

38
Q

What are some side effects of anti-psychotic drugs due to histamine blockade? What are the risks of these?

A

Sedation - risk of falls / increased appetite - risk of weight gain

39
Q

What happens when antipsychotic drugs block alpha adrenergic receptors?

A

Decreases the alpha 1 adrenergic activity of blood vessels which interrupts the baroreceptor reflex and causes dizziness, lightheadedness and postural hypotension

40
Q

Muscarinic receptors are the targets of what? Blockade of these receptors can cause what symptoms?

A

Parasympathetic nervous system / dry mouth, blurred vision, constipation, urinary retention

41
Q

When should clozapine be used?

A

When 2 previous anti-psychotic drugs (one of which must have been an atypical) have failed i.e. 3rd line

42
Q

Clozapine may be of especial benefit to who?

A

People with negative symptoms and those who are suicidal

43
Q

What is the reason that clozapine is a 3rd line drug?

A

Agranulocytosis (neutropenia)

44
Q

Describe the monitoring process for people taking clozapine?

A

Weekly FBCs for the first 6 months, fortnightly for the next 6 months and 4 weekly after that

45
Q

If a patient who is taking clozapine presents with any signs of infection - what is the most important thing to do?

A

Check FBCs for neutropenia

46
Q

If a patient taking clozapine stops smoking, what should be done? Why?

A

Decrease the dose since the drug can be metabolised faster

47
Q

Why should patients getting started on clozapine always be in hospital when this is done?

A

Because it can be cardiotoxic and cause myocarditis

48
Q

What are some reasons that clozapine may cause myocarditis?

A

IgE mediated hypersensitivity reaction, cytokine release, hypercatecholaminaemia

49
Q

What should you monitor when starting a patient on clozapine? When should you interfere?

A

ECG, pulse, BP / if ECG shows non-specific ST segment changes this is positive for myocarditis

50
Q

What are some other recognised side effects of clozapine?

A

Constipation, hyper-salivation, weight gain and seizures

51
Q

Overall, which type of anti-psychotic drug is better? Which one specifically?

A

Atypical / clozapine

52
Q

What is neuroleptic malignant syndrome? Who does it tend to occur in?

A

A rare but life-threatening reaction to anti-psychotic medication / most commonly young males

53
Q

How long after starting an antipsychotic or increasing its dose will neuroleptic malignant syndrome occur?

A

Usually within 10 days

54
Q

What will neuroleptic malignant syndrome present with? What are some signs?

A

Pyrexia, rigidity and tachycardia / Raised CK and maybe raised WCC

55
Q

What is the management of neuroleptic malignant syndrome? How long should it take to resolve?

A

Stop antipsychotic drugs, supportive treatment / 1-2 weeks

Psychiatry (20 decks)

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