Schizophrenia Antipsychotics Lecture Notes

Practice flashcards covering first-generation (typical) and second-generation (atypical) antipsychotics, including specific drug characteristics, dosing, and monitoring requirements.

Typical/Conventional Antipsychotics

First-generation drugs that predominantly block dopamine $D2$ receptors in the brain.

Haloperidol Decanoate

A long-acting, oil-based (sesame seed oil) injection of Haloperidol.

Haloperidol Acetate

A short-acting, water-based injection of Haloperidol.

Zuclopenthixol Decanoate

A long-acting depot injection containing an oil base or thin vegetable coconut oil.

Promazine

A water-based injection recommended as first-line treatment over Haloperidol for rapid tranquilisation situations.

Chlorpromazine

A typical antipsychotic available in tablets and liquid that causes photosensitivity, requiring the use of suncream.

Atypical Antipsychotics

Second-generation drugs that act on a range of receptors; examples include Risperidone, Paliperidone, and Olanzapine.

Risperidone

A second-generation drug that is broken down into Paliperidone within the body.

Risperdal consta

A refrigerated injection that takes $2$ weeks to be released and requires $3$ injections at $2$ weeks apart to reach steady state.

Okedi

A monthly injection that does not require refrigeration.

Paliperidone

An expensive second-generation drug available in monthly and $3$ monthly injections that does not require refrigeration.

Zypadhera

A long-acting Olanzapine injection given $2$-weekly or monthly that can cause post injection syndrome.

Post injection syndrome

A condition characterized by falling over due to low $BP$, requiring patients to be monitored for up to $3$ hours after a Zypadhera injection.

Aripiprazole

A partial agonist that balances serotonin and dopamine by blocking dopamine where it is too high and increasing it where it is too low.

Lurasidone

A tablet-only medication in the UK that must be taken with a snack or food of at least $350$ kcal.

Clozapine

A drug used when $2$ or more antipsychotics are ineffective, acting as an antagonist for $D1$, $D2$, $5-HT2A$, alpha1-adrenoceptor, and muscarinic receptors.

Neutropenia and Agranulocytosis

Two serious blood-related risks associated with the use of Clozapine.

Enzyme CYP1A2/P4501A1

Liver enzymes induced by chemicals in cigarette or vape smoke that quicken the breakdown of medications like Clozapine.

$$33\%$$

The percentage by which Clozapine levels in the body can drop if a patient smokes.

$$75\%$$

The percentage by which Clozapine levels can increase if a patient stops smoking.

Clozapine Blood Monitoring

A schedule of weekly tests for the first $18$ weeks, then $2$-weekly for the next $6$ months, then monthly thereafter.

$48$ hours

The time limit for a missed Clozapine dose, beyond which the medication must be re-titrated.

Quetiapine

A second-generation drug available as tablets and liquid, though the liquid form is rarely prescribed due to high cost.