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4 - PSYCH > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

1st Generation vs 2nd Generation Antipsychotics - MoA and SE

A

1st Gen - Da-, Extrapyramidal S/E

2nd Gen - Da-, Se+ , Metabolic S/E

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2
Q

1st Generation APx

A

Haloperidol

Chlorpromazine

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3
Q

2nd Generation APx

A 
Olanzapine
Risperidone
Quetiapine
Aripiprazole
Clozapine
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4
Q

Effects of Dopamine:

A 
D - Drive
O - psychOsis
P - parkinsonism
A - attention
M - motor
I - inhibition of prolactin
N - narcotics
E - EPSE
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5
Q

Spectrum of EPSE with 1st Gen APx

A

Acute Dystonia - Muscle contraction
Akathisia - Rustle - jitteriness
Akinesia - Hustle - bradykinesia + tremor

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6
Q

Tardive dyskinesia?

A

constant involuntary movement of peri-orbital muscles

Can be irreversible if not treated early

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7
Q

Acute dystonia?

A

Torticollis - wry neck

Oculogyric crisis - bilateral upwards deviation of gaze

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8
Q

Neuroleptic Malignant Syndrome?

A

Reaction to Antipsychotic medication

Confusion + Agitation
Muscular rigidity
Significant Hyperthermia
Seizures

Treat with - Dantrolene + cooling measures

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9
Q

Dopamine antagonism effects

A

Mesolimbic - reduced +ve symptoms
Mesocortical - reduce -ve symptoms
Nigrostriatal - blockade –> EPSE, TD, NMS
Tuberoinfundibular blockade –> hyperprolactinaemia, ED, weight gain

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10
Q

Other side effects of APx

A

Anti-cholinergic - dry mouth, blurred vision, constipation
Anti-histamine - sedation, weight gain
Anti-adrenergic - drops blood pressure

Dyslipidaemia and diabetes

QTC prolongation in all

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11
Q

When should Clozapine be considered

A

After trial of 2 APx without success

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12
Q

S/E of Clozapine

A

weight gain
constipation / intestinal obstruction
excessive salivation
lowers seizure threshold

Severe:
cardiotoxic - myocarditis
arrhythmias
Agranulocytosis / neutropenia

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13
Q

Risperidone - details

A

Worst for hyperprolactinaemia

Less sedating

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14
Q

Olanzapine - details

A

2nd in efficacy behind Clozapine

Weight gain independent of calorific intake

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15
Q

Quetiapine - details

A

Similar to risperidone, but more sedative

Quetiapine = “quiet time”

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16
Q

Aripiprazole

A

Most well tolerated of all APx

but least effect on psychotic symptoms

17
Q

monitoring required for Clozapine

A

Weekly blood tests and ECG - for the first 18 weeks

Then reduces to fortnightly
Then to monthly, until desired effects achieved

18
Q

Drugs interacting with Clozapine

A

Carbamazepine - reduces plasma levels, ^risk agranulocytosis

Benzos - risk of sudden adverse reaction
Ciprofloxacin

4 - PSYCH (8 decks)

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