Schizophrenia Flashcards
(25 cards)
What is the risk of prescribing antipsychotics in elderly patients?
elderly patient with dementia: small increased risk of mortality and an increased risk of stroke or transient ischaemic attack
elderly patients: susceptible to postural hypotension.
What are the side effects of antipsychotics?
anti-muscarinic: dry mouth, blurred vision, urinary retention, constipation
alpha adrenoceptor blockade: postural hypotension, hypothermia
5-HT: weight gain, photosensitisation
histamine blockade: sedation
dopamine: reduced positive symptoms, movement disorder/EPSE, hyperprolactinaemia, impotence, gynaecomastia, weight gain
What are the 1st gen antipsychotics?
Typical antipsychotics
- promazine: chlorpromazine, levomepromazine
- cyazine: pericyazine
- azine: fluphenazine, trifluoperazine
- haloperidol (most EPSE)
- thixol: flupenthixol
- pimozide
- sulpiride
What are the 2nd gen antipsychotics?
Atypical antipsychotics
- amisulpride
- aripiprazole
- clozapine, olanzapine
- lurasidone, paliperidone, risperidone
- quetiapine
When is clozapine used?
resistant schizophrenia: after 2 or more drugs including a 2nd gen have been tried for at least 6-8 weeks each
What are the EPSE symptoms caused by antipsychotics?
ADAPPT
acute dystonia: uncontrolled muscle spasm
akathisia: restlessness
parkinsonian symptoms: bradykinesia, tremor
prolactinaemia: breast swell, weight gain
tardive dyskinesia: involuntary movements
Which antipsychotics do and do not cause weight gain?
COW - clozapine, olanzapine = weight gain
do NOT - aripiprazole, haloperidol, lurasidone, cariprazine
Which antipsychotics do and do not cause diabetes/hyperglycaemia?
QORC - quetiapine, olanzapine, risperidone, clozapine
do NOT - 1st gen, haloperidol, fluphenazine
Which antipsychotics do and do not cause hyperproloactinaemia?
DO - risperidone, amisulpride, sulphide, 1st gen
do NOT - aripiprazole, clozapine, quetiapine
Which antipsychotics cause postural hypotension?
clozapine, quetiapine
Which antipsychotics do and do not cause cardiac side effects?
QT prolongation, arrhythmias
DO - all 1st gen especially haloperidol and pimozide
do NOT - aripiprazole, clozapine, risperidone, flupenthixol
Which antipsychotics cause decreased libido?
risperidone, haloperidol
Which antipsychotics do and do not cause EPSE?
DO - 1st gen
do NOT - 2nd gen: clozapine, quetiapine, aripiprazole
Which antipsychotics do and do not cause sexual dysfunction?
DO - risperidone, haloperidol, olanzapine
do NOT - aripiprazole, quetiapine
What is a major risk with all antipsychotics? What is the treatment?
neuroleptic malignant syndrome: hyperthermia, fluctuating consciousness, muscle rigidity
treatment: bromocriptine or dantrolene
lasts 5-7 days after stopping (longer for depot)
What is the MHRA warning for clozapine?
potentially fatal risk of intestinal obstruction, faecal impaction, and paralytic ileus: report constipation
monitor blood concentration when: stopping smoking (inducer), infection, concomitant medications that can affect levels
blood monitoring due to the risk of agranulocytosis
What are the red flags for clozapine?
MAG
myocarditis and cardiomyopathy: reported in first 2 mths of use, report tachycardia, discontinue
agranulocytosis and neutropenia: need leucocyte and differential blood count monitoring, report infectious symptoms
gastrointestinal obstruction: report constipation
What happens if clozapine doses are missed?
> 2 missed doses: needs to be re-titrated
What is the MHRA warning for haloperidol?
caution when used for delirium: increased risk of adverse neurological and cardiac effects
before initiation: baseline ECG and correction of any electrolyte disturbances is required
What is the MHRA warning for aripiprazole?
risk of pathological gambling
counsel patients on the risk and to be alert for the development of new or increased urges to gamble and other impulse control symptoms
- such as excessive eating or spending, or hypersexuality
What is a major side effects of haloperidol?
QT prolongation
What is a disadvantage of antipsychotic depot injections?
more EPSE than oral preparations
side effects are prolonged
What are counselling points for clozapine?
photosensitisation at higher dosages: avoid direct sunlight
report constipation and smoking cessation
What monitoring is needed for antipsychotics?
FBC, U+Es
LFTs (hepatotoxicity with phenothiazines): baseline, yearly
lipids, weight: baseline, 3 months, yearly
fasting blood glucose: baseline, at 4–6 months, yearly.
ECG: baseline
BP: baseline, dose changes
prolactin concentration: baseline, 6 months, yearly
CVD risk, physical health monitoring: yearly
