Anti-Psychotic drugs

Question 1

What are the risks of the typical first-generation antipsychotics and give examples of 1st gen antipsychotics

Answer 1

Can cause extrapyramidal side effects
Chlorpromazine
Haloperidol
Flupentixol

Question 2

Give some examples of 2nd gen antipsychotics

Answer 2

Amisulpride
Aripiprazole 
Olanzapine
Quetiapine
Risperidone

Question 3

What are the extrapyramidal symptoms and describe them

Answer 3

Acute pseduoparkinsonism (tremor or rigdity)

Acute dystonia (abnormal face and body movements)

Acute Akathisia (Inner restlessness)

Chronic Tardive dyskinesia (involuntary movement of faces)

Question 4

What is hyperprolactinaemia and what drug is it common in and what are the symptoms

Answer 4

Increase prolactin concentration to some extent in dopamine inhibits prolactin release

Common with risperidone and amisulpride

Symptoms include: sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement and galactorrhoea

Question 5

What is sexual dysfunction common in which drug

Answer 5

Haloperidol and risperidone

Question 6

What are the cardiovascular side effects

Answer 6

Risk of QT interval prolongation with doses exceeding recommended maximum: tachycardia, arrhythmias, hypotension possible

Question 7

What is hyperglycaemia, weight gain and diabetes common with

Answer 7

Clozapine
Olanzapine
Quetiapine
Risperidone
Regular monitoring necessary

Question 8

Who is most at risk for hypotension and interference with temperature regulations

Answer 8

Risk of dangerous falls and hypothermia in elderly
Clozapine
Quetiapine
Chlorpromazine

Can all cause postural hypotension associated with synscope

Question 9

What are the monitoring requirements for antipsychotics and duration

Answer 9

Required at start therapy and annually thereafter:
Full blood count
Urea and electrolytes
Liver function tests

Blood lipids and weight measured at baseline at 3 months then yearly

Fasting blood glucose measured at baseline at 4-6 months and then yearly

BP monitoring advised before starting therapy and frequently during dose titration

ECG may be required for those with CV disease

Prolactin concentration at start of therapy, at 6 months and then yearly

Patients with schizophrenia should have physical health monitoring at least once per a year (CV disease risk assessment)