Lecture on Antipsychotic Medications and Their Side Effects

These flashcards cover essential aspects of antipsychotic medications, including symptoms of psychosis, treatment options, side effects, monitoring requirements, and factors influencing medication choice.

What positive symptoms are associated with increased levels of dopamine in psychosis?

Delusions, hallucinations, and disorganization.

What are some negative symptoms of psychosis?

Social withdrawal, neglect, and poor hygiene.

What is a common treatment for the first episodes of psychosis?

Oral antipsychotic medications and psychological interventions like CBT.

What factors influence the choice of antipsychotic medication?

The choice depends on side effects; any can be used except clozapine.

What are some metabolic side effects associated with antipsychotic medications?

Weight gain and diabetes.

What are extrapyramidal symptoms?

Movement disorders caused by antipsychotic medication, such as tardive dyskinesia and dystonia.

What monitoring requirements are there for antipsychotics, before initiation

Weight, fasting glucose, HbA1C, lipids, BP, ECG, FBC, RFT, LFT, Prolactin

How often do we measure weight with antipsychotics

Weekly for 1st 6 weeks, 12 weeks, 1 year then yearly

How often do we monitor fasting glucose, HbA1C, Lipids, BP

Start, at 12 weeks, 1 year then yearly

When should we monitor FBC, RFT, LFT and prolactin

Yearly

What should be monitored when a patient is on clozapine?

Leucocyte and differential blood counts weekly for 18 weeks, then fortnightly until one year, then monthly.

What are the types of antipsychotics

1st gen + 2nd gen

What are the 1st gen antipsychotics

Phenothiazines, butyrophenones, thioxanthenes, others

What drugs are part of the butyrophenones class

Benperidol, haloperidol

How are phenothiazines categorised?

3 groups - group1, 2, and 3

What medications are part of group 1

Chlorpromazine, levomepromazine, promazine

What serious side effect is associated with clozapine?

Agranulocytosis and thrombocytopenia.

Which 2 antipsychotics have a high risk of sedation

Clozapine, chlorpromazine

Which 2 antipsychotics have very low risk of sedation?

Amisulpride, aripiprazole

What medications have high risk of extrapyramidal side effects

Haloperidol, zuclopenthixol, fluphenazine

What medications have a very low risk of EPSEs

Clozapine, quetiapine, aripiprazole

Which medication have a high anticholinergic effect

Clozapine

Which meds have a lower anticholinergic side effect profile?

Amisulpride, aripiprazole

Which medications have a higher risk of QT prolongation?

Haloperidol, primozide

Which medications have a low risk of QT prolongation

Aripiprazole, zylcopenyhixol

What cardiovascular side effects can occur with certain antipsychotics?

QT interval prolongation and postural hypotension.

Which medications can cause postural hypotension

Aripiprazole, risperidone, clozapine, quetiapine (ARCQed)

Which medication can cause hypertension

Clozapine

Which medications can increase risk of stroke

Risperidone and olanzapine

Which drugs increase risk of hyperglycaemia

Risperidone, olanzapine, quetiapine, clozapine

Which drugs have increased risk of weight gain

Olanzapine, clozapine

Which drugs have lower risk of hyperprolactinamia

Clozapine, olanzapine, quetiapine, aripiprazole,

What other side effects are caused by all antipsychotics

Galactorrhoea and sexual dysfunction, sedation

What is a risk if patients stop smoking while on olanzapine?

Increased adverse effects due to changes in drug concentration.

Which drugs interact with antipsychotics

Drugs with: sedative action, hypotensive effect, cause QT prolongation

CYP enzyme inducers and inhibitors

When would we use clozapine

When 2+ antipsychotics including 1 2nd gen for an adequate period of time

What is the MHRA warning associated with clozapine and monitoring for toxicity

When pt stops smoking or switches to e-cigarette monitor for toxicity or when pt has pneumonia or other serious infection

What should be considered for patients requiring long-term treatment with antipsychotics?

Use of long-acting depot injections to monitor adherence.

How often should we monitor leucocytes and differential blood counts when using clozapine

Weekly for 18 weeks, then every 2 weeks until 1 year then monthly until after 4 week of stopping

How would you identify aggranulocytosis and thrombocytopenia

Monitor leucocytes and differential blood counts

What symptoms should we look out for suggesting myocarditis, pericarditis, pericardial effusion and cardiomyopathy?

Tachycardia at rest - stop meds and report

What symptom do we look out for suggestive of intestinal peristalsis impairment

Constipation which can go up to paralytic ileus - this should be treated with laxative

What are some side effects of clozapine beyond agranulocytosis and the general SEs?

Myocarditis, pericarditis, cardiomyopathy,thromboembolism, neuroleptic malignant syndrome, intestinal paresis, and seizures.

What is the recommendation during pregnancy for patients on clozapine?

Avoid clozapine use during pregnancy and breastfeeding.