Anti-Psychotics

Question 1

What is the main use of Antipsychotics?

Answer 1

Schizophrenia

Question 2

What can antipsychotics also be used to manage?

Answer 2

Other forms of psychosis
Mania
Agitation

Question 3

How are antipsychotics classified ?

Answer 3

Typical
Atypical

Question 4

What is the main problem with typical antipsychotics?

Answer 4

Extrapyramidal side-effects

Question 5

What is the mechanism of action of typical antipsychotics?

Answer 5

Dopamine D2 receptor antagonists

Question 6

What do typical antipsychotics block?

Answer 6

Dopaminergic transmission in the mesolimbic pathways

Question 7

What are the main 2 adverse effects of typical antipsychotics?

Answer 7

Hyperprolactinaemia

Extrapyramidal side effects

Question 8

How can hyperprolactinaemia present in men?

Question 9

How can hyperprolactinaemia present in women?

Question 10

What are the 2 most common typical antipsychotics?

Answer 10

Haloperidol

Chlorpromazine

Question 11

What is the mechanism of action of atypical antipsychotics?

Answer 11

Act on a variety of receptors (D2, D3, D4, 5-HT)

Question 12

How are atypical antipsychotics classified?

Answer 12

Serotonin-dopamine 2 antagonists (SDAs)

Question 13

Why are atypical antipsychotics classified as atypical?

Answer 13

They are atypical in the way they affect dopamine and serotonin neurotransmission in the four key dopamine pathways in the brain

Question 14

What are the most common atypical antipsychotics?

Answer 14

Risperidone
Olanzapine
Clozapine
Aripiprazole

Question 15

What is less common with atypical antipsychotics?

Answer 15

Extrapyramidal side-effects
Hyperprolactinaemia

Question 16

What are the main type of adverse effects of atypical antipsychotics?

Answer 16

Metabolic effects

Question 17

What does risperidone function like at higher doses?

Answer 17

A typical antipsychotic

Question 18

What type of side effects does risperidone have?

Answer 18

Extrapyramidal and hyperprolactinaemia

Question 19

Which atypical antipsychotic is good for elevated prolactin levels?

Answer 19

Aripiprazole

Question 20

What are the main side effects of Olanzapine?

Answer 20

Weight gain
Dyslipidaemia (hyperlipidaemia)

Question 21

In which patients would you not use olanzapine?

Answer 21

Overweight or obese

Question 22

When should clozapine be used?

Answer 22

If a patient is resistant to other antipsychotic medication

Question 23

What is the main risk of using clozapine?

Answer 23

Agranualocytosis

Question 24

When is a patient classed as resistant?

Answer 24

After the sequential use of 2 or more antipsychotic drugs, each for 6-8 weeks

Question 25

What are other side effects of clozapine?

Answer 25

Neutropenia Myocarditis Constipation

Question 26

What is the main risk of using clozapine?

Answer 26

Agranulocytosis

Question 27

When would you need to adjust the dose of clozapine?

Answer 27

If smoking is started or stopped during treatment

Question 28

What is essential during the treatment with clozapine?

Answer 28

Full blood count monitoring

Question 29

What should you do if someone on clozapine develops a fever?

Answer 29

Give IV broad spectrum antibiotics

Question 30

What is there an increased risk of with antipsychotics in the elderly?

Answer 30

Increased risk of: Stroke Venous Thromboembolism

Question 31

What are the main adverse effects of antipsychotics?

Answer 31

Tardive Dyskinesia (TD Neuroleptic Malignant Syndrome (NMS) Extrapyramidal side effects

Question 32

What are examples of extrapyramidal side-effects?

Answer 32

Parkinsonism Acute dystonia Akathisia Tardive dyskinesia

Question 33

What is Neuroleptic Malignant Syndrome?

Answer 33

``` Characterised by: Severe muscle rigidity Fever Altered mental status Autonomic instability Elevated WBC, CPK and lfts. Potentially fatal. ```

Question 34

What is acute dystonia?

Answer 34

Sustained muscle contraction

Question 35

What is akathisia?

Answer 35

Severe restlessness

Question 36

What is Tardive Dyskinesia?

Answer 36

Involuntary muscle movements that may not resolve with drug discontinuation

Question 37

How often does a Full blood count (FBC), urea and electrolytes (U&E), liver function tests (LFT) need to be done on someone taking antipsychotics?

Answer 37

* at the start of therapy * annually * clozapine- more frequent FBC- initially weekly

Question 38

How often do Lipids and weight need to be checked in someone taking antipsychotics?

Answer 38

* at the start of therapy * at 3 months * annually

Question 39

How often does fasting glucose and prolactin need to be checked in someone taking antipsychotics?

Answer 39

* at the start of therapy * at 6 months * annually

Question 40

How often does blood pressure need to be checked in someone taking antipsychotics?

Answer 40

* baseline | * frequently during dose titration

Question 41

How often does an Electrocardiogram need to be done on someone taking antipsychotics?

Answer 41

* baseline * Cardiovascular risk assessment * Annually