Antipsychotics: Difference between revisions
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Antipsychotics are mostly used to treat patients with [[Psychosis|psychosis]]. They are split into two groups - '''a'''typical and typical. The classification is based on the side | Antipsychotics are mostly used to treat patients with [[Psychosis|psychosis]]. They are split into two groups - '''a'''typical and typical. The classification is based on the side effects. Typical (or 'first-generation') antipsychotics were the first developed and had a set of [[Extra Pyramidal Side Effects|characteristic side effects]]. The atypical (or 'second-generation') antipsychotics, which came later, were so named because they did not cause the same characteristic side-effects to the same extent. | ||
Yes, it's a really rubbish way to classify the drugs and the person who did it needs to | Yes, it's a really rubbish way to classify the drugs and the person who did it possibly needs to be [[sectioned]]... | ||
===Mode Of Action=== | ===Mode Of Action=== | ||
| Line 20: | Line 20: | ||
====Medical Conditions==== | ====Medical Conditions==== | ||
*Arrhythmias - due to prolongation of QT-complex | *Arrhythmias - due to prolongation of QT-complex | ||
*Diabetes - with olanzapine due to weight gain side-effect | *[[Diabetes]] - with olanzapine due to weight gain side-effect | ||
===Side-Effects=== | ===Side-Effects=== | ||
The typical side effects mentioned above are the '''Extra-Pyramidal Side-Effects''' (EPSE): | The typical side effects mentioned above are the [[Extra Pyramidal Side Effects|'''Extra-Pyramidal Side-Effects''' (EPSE)]]: | ||
*Tardive dyskinesia | *Tardive dyskinesia | ||
| Line 43: | Line 43: | ||
*Risk of [[Diabetes|diabetes]] - olanzapine (high risk), clozapine (moderate risk) | *Risk of [[Diabetes|diabetes]] - olanzapine (high risk), clozapine (moderate risk) | ||
*Increased prolactin - amisulpride. | *Increased prolactin - amisulpride. | ||
**Symptoms include: galactorrhoea, amenorrhoea and | **Symptoms include: galactorrhoea, [[amenorrhoea]] and [[infertility]], sexual dysfunction | ||
**inhibition of dopamine in the tuberoinfindibular pathway which is linked to the pituitary - one of the four dopamine pathways | **inhibition of dopamine in the tuberoinfindibular pathway which is linked to the pituitary - one of the four dopamine pathways | ||
*Sedation - olanzapine | *Sedation - olanzapine | ||
Clozapine must be specifically mentioned as it causes [[Agranulocytosis|agranulocytosis]]. As such white cell count needs to be regularly monitored, measured once a week for the first few weeks. | |||
===Generic Names=== | ===Generic Names=== | ||
Latest revision as of 08:43, 13 March 2013
Antipsychotics are mostly used to treat patients with psychosis. They are split into two groups - atypical and typical. The classification is based on the side effects. Typical (or 'first-generation') antipsychotics were the first developed and had a set of characteristic side effects. The atypical (or 'second-generation') antipsychotics, which came later, were so named because they did not cause the same characteristic side-effects to the same extent.
Yes, it's a really rubbish way to classify the drugs and the person who did it possibly needs to be sectioned...
Mode Of Action
Excess release of dopamine in the mesolimibic pathways has been linked to psychotic experiences. Antipsychotics block D2 in all four dopamine pathways of the brain, thus stopping this excess dopamine.
Indications
- Schizophrenia
- Psychosis (secondary to depression or a physical problem)
- Delirium
- Mania (acutely)
Contraindications
Drugs
If you can find any major ones, feel free to add them
Medical Conditions
- Arrhythmias - due to prolongation of QT-complex
- Diabetes - with olanzapine due to weight gain side-effect
Side-Effects
The typical side effects mentioned above are the Extra-Pyramidal Side-Effects (EPSE):
- Tardive dyskinesia
- Dystonia
- Akasthia ('restless legs') - general feeling of restlessness which can be incredibly distressing
- Parkinsonian symptoms
- Pill-rolling tremor (3-5Hz)
- Cog-wheel rigidity
- Bradykinesia
- Stooped posture
- Shuffling gait
- Micrographia (small handwriting)
These side effects are caused by
Other side effects
These are the important ones, specific to atypicals:
- Weight gain - clozapine, risperidone, olanzapine, amisulpride
- Risk of diabetes - olanzapine (high risk), clozapine (moderate risk)
- Increased prolactin - amisulpride.
- Symptoms include: galactorrhoea, amenorrhoea and infertility, sexual dysfunction
- inhibition of dopamine in the tuberoinfindibular pathway which is linked to the pituitary - one of the four dopamine pathways
- Sedation - olanzapine
Clozapine must be specifically mentioned as it causes agranulocytosis. As such white cell count needs to be regularly monitored, measured once a week for the first few weeks.
Generic Names
Typical
- Haloperidol
- Chlorpromazine
- Flupenthixol
Atypical
- Olanzapine
- Risperidone
- Amisulpride
- Clozapine