Anti-Psychotic Medications Flashcards
(27 cards)
What is the classification of anti-pyschotic drugs? What is the difference?
Typical vs Atypical
Typical are more prone to cause EPSEs
Give some examples of typical anti-psychotics
Phenothiazines- Trifluoperazine (high potency), chlorpromazine (low potency)
Butyrophenones- Haloperidol (high potency)
Thioxanthenes- Flupentixol, Zuclopenthixol
What are some advantages of typical APs?
Side effect profiles are known due to long duration of use
Cheap
Available as injections so can be given for aggression/agitation or as a long acting depot if compliance is an issue
What side effects are due to APs action of dopamine receptors?
Movement disorder- Pseudo-parkinsonism, Acute dystonia, Tardive Dyskinesia, Akathisia
Sexual Dysfunction/ Impotence- Increased Prolactin
Galactorhoea- Increased Prolactin
Menstrual Disturbance- Increased prolactin
What are being affected by APs causes the EPSEs?
Nigrostriatal Area
What are the features of pseudo-parkinsonism?
Stooped posture Shuffling gait Pill rolling tremor Rigidity Bradykinesia Pill Rolling Tremor
What are the features of akathisia?
Restless legs
Pacing
Inability to keep still
Feet in constant motion
What are the features of acute dystonia?
Facial grimacing
Involuntary upward eye movement
Muscle spasms of tongue, face, neck and back
Laryngeal Spasm- Risk of airway closure
What are the features of tardive dyskinesia?
Lip smacking
Protrusion of tongue
Chewing motion
Facial dyskinesia
How should you treat EPSEs?
Stop the AP/ Reduce the dose
Switch to an atypical AP
Anti-muscarinic- Procyclidine
Anti-cholinergic- Benztropine, trihexyphenidyl
Anti-cholinergics are due to excitatory action of ACh at the basal ganglia
What anti-cholinergic side effects can be caused by APs?
Constipation
Blurred Vision
Dry mouth
Confusion
How should you treat tardive dyskinesia?
Stop all APs
This is an irreversible side effect
How should akathisia be treated?
Beta blockers
Benzodiazepine
What side effect do APs cause at histamine receptors?
Sedation
What side effects do AP casue due to their action at alpha 1 receptors?
Postural hypotension
Impotence
What is neuroleptic malignant syndrome?
- Autonomic instability- fluctuating temperature, HR, BP
- Increased muscle tone and rigidity
- Prolonged contraction and little movement begins to cause muscle breakdown
- There is therefore CK and Myoglobin release which is detectable on a blood test
- Also changes on consciousness,
What is the treatment for neuroleptic malignant syndrome?
Stop the AP
Supportive Treatment- Fluids, Temperature support (e.g. cooling blankets)
- Dopamine agonists (e.g. bromocriptine) to overcome dopamine blockade
- Muscle relaxants- dantrolene
- Benzodiazepines to control agitation
Give some examples of atypical APs
Olanzapine Risperidone Aripiprazole Quetiapine Clozapine (Treatment resistant schizophrenia)
Less likely to cause EPSEs
What are some advantages of atypical APs?
Less likely to cause EPSEs
Less risk of tardive dyskinesia
As effective as typicals
Some have an effect on negative symptoms of schizophrenia
What are some disadvantages of atypical APs?
- Expensive
- Newer and so less experience of long term effects
- Many only available as oral (except Olanzapine (short acting IM), Risperidone (long acting IM), aripiprazole (short or long acting IM)
What are some important side effects of atypical APs?
EPSE
Sedation
Weight Gain- METABOLIC SYNDROME
Decreased seizure threshold
What are the components of metabolic syndrome?
Visceral obesity Hyperglycaemia High triglycerides Low HDL Insuline resistance
What are patients on atypical APs prone to metabolic syndrome?
Increased appetite with cravings for sweet/carb heavy foods which leads to weight gain and then insulin resistance and other features
What is a very important side effect of clozapine?
Marrow suppression or agranulocytosis
