1 - PSY - Antipsychotics

Question 1

AP’s effective Tx for wide range of conditions..?

Answer 1

psychosis
anxiety
mood disorders
insomnia
rapid tranq
n + v
hiccups
tics incl in tourettes

Question 2

3 main Tx aims using AP’s in psychosis

Answer 2

alleviate +ve Sx and -ve Sx of psychosis

minimise SE’s including metabolic disturbances

Question 3

Which APs give more EPSE’s

Answer 3

typicals

Question 4

what are the 4 main EPSE’s

Answer 4

akathisia - profound inner restlessness
parkinsonism - usually after several days to weeks, clinically identical to idiopathic PD - tremor, bradykinesia, rigidity
acute dystonia - involuntary mm spasms giving brief sustained abnormal postures
tardive dyskinesia - abnormal invol hyperkinetic movements - potentially irreversible . eg head nodding, grimacing

Question 5

What are the features of Metabolic syndrome

Answer 5

WEIGHT

We - waist expanded (central obesity)
ig - impaired glucose (+insulin resistance)
h - HTN + HDL low (+LDL high)
t - TG’s high

most APs increase risk of this

Question 6

Neuroleptic malignant syndrome - when? what should be done?

Answer 6

most frequently when initiating treatment - can be any time

medical emergency - all APs stopped and senior physician involvement

Question 7

Neuroleptic malignant syndrome Sx -

Answer 7

FALTER
Fever ( hyperthermia)
Autonomic instability
Leukocytosis/Low pH (met acidosis)
Tremor/Tachycardia
Elevated creatinine kinase
Rigidity of muscles

Question 8

AP’s causing weight gain - ++++/++/-

Answer 8

++++ olanzapine, clozapine
++ quetiapine, risperidone
- aripirazole

Question 9

AP’s causing sedation

++++/+++/++/+/-

Answer 9

\++++ clozapine
\+++olanzapine
\++ quetiapine
\+ risperidone
- aripiprazole

Question 10

AP’s causing metabolic disturbances ++++/+++/+/-

Answer 10

++++ clozapine
+++ olanzapine
+ risperidone, quetipine
- aripirazole

Question 11

What to check before commencing AP

Answer 11

FBC, U+E, LFT, PRolactin, HbA1c, fasting lipids, check ECG, weight and BP