Antipsychotics Flashcards
(22 cards)
Give 6 typical antipsychotics
haloperidol chlorpromazine flupentixol fluphenazine sulpride zuclopenthixol
Give 6 atypical antipsychotics
Olanzapine Risperidone Aripiprazole Amisulpride Quetiapine Clozapine
What types of side effects can antipsychotics have?
Extrapyramidal Anti-muscarinic Anti-histaminergic anti- adrenergic Increased Prolactin levels Prolong QT interval NMS Metabolic - impaired glucose tolerance, hypercholerolaemia
Describe extrapyramidal side effects
Parkinsonism - bradykinesia, rigidity, tremor, postural instability, masked facies, shuffling gait - weeks or months
Akathisia - unpleasant feeling of restlessness - first months - reduce dose of antipsychotic and give propanolol
Dystonia - acute painful contractions in the muscles of the neck, jaw, eyes - occulogyric crisis - within days
Tardive dyskinesia - choreoathetoid movmeemtn - abnormal involuntary movements - chewing/pouting
Describe anti-muscarinic side effects
blurred vision
urinary retention
dry mouth
constipation
Describe anti-histaminergic side effects
sedation
weight gain
describe anti-adrenergic side effects
postural hypotension
tachycardia
ejaculatory failure
What happens when prolactin levels are increased?
sexual dysfunction reduced bone density menstrual disturbances breast enlargement galactorrhea
What are the side effects of clozapine
hyper salivation
agranulocytosis - neutropenia
What is neuroleptic malignant syndrome? Features?
Investigations?
How is it treated?
Complications?
Occurs when taking antipsychotics (anti-dopaminergic) or dopaminergic drugs usually when drug is stopped or reduced
First 10 days of treatment or after increasing dose
Pyrexia, muscle rigidity, confusion, fluctuating consciousness, autonomic instability (tachycardia, fluctuating BP), delirium
Creatine kinase raised, LFTs deranged, FBC - leucocytosis
Stop antipsychotic IV fluids to prevent renal failure Cooling Dantrolene (muscle relaxant) Bromocriptine - Dopamine agonist Consider benzodiazepine
Pulmonary Embolism, renal failure, shock
What are contraindications to antipsychotics?
coma
CNS depression
phaeochromocytoma
How is clozapine monitored?
WCC weekly for 18 weeks, fornightly for 1 year and then monthly
BM baseline, 4-6 months, yearly
What is the effect of haloperidol on the heart?
long QT
How long should antipsychotics be given for?
For at least 1-2 years following the psychotic episode
How should antipsychotics be stopped?
Gradually stopped over 3 weeks
Which antipsychotic has more extrapyramidal side effects - olanzapine or chlorpromazine?
Chlorpromazine - typicals
Which antipsychotic is better tolerated - amisulpride or sulpride?
Amisulpride - atypicals
What atypical antipsychotic has the best side effect profile especially wrt prolactinaemia?
Aripiprazole
What investigations before starting antipsychotic?
FBC, U&E, LFT Clozapine - WCC Tasing blood glucose Blood lipids ECG BP Prolactin Weight Creating kinase - then again if NMS is suspected
What monitoring for haloperidol
ECG - prolongs QT
Also pimodzide
What monitoring for olanzaapine?
Fasting blood glucose at baseline, one month, 4-6 months
What can you offer if non-adherence is a problem?
Depot injection
