Anti-Psychotics

Question 1

MoA first generation antipsychotics?

Answer 1

Block central dopamine receptors

Question 2

What are first gen antipsychotics most effective for?

Answer 2

Reducing positive Sx of schizophrenia inc hallucinations and delusions

Question 3

Typical AEx 1st gen antipsychotics?

Answer 3

1. CNS (EPS, tardive dyskinesia, sedation, NMS)
2. Anticholinergic effects
3. CV effects (a-blockade, cardiac rhythm disturbances)
4. Endocrine effects
5. Weight gain

Question 4

What are the CNS AEx of 1st gen antipsychotics?

Answer 4

1. Extrapyramidal symptoms: Parkinsonian syndrome, acute dystonias, akathisia
2. Tardive dyskinesias: late onset choreiform and athetoid movements of trunk, extremities or mouth
3. Sedation
4. Neuroleptic malignant syndrome

Question 5

What is neuroleptic malignant syndrome?

Answer 5

• Development of severe muscle rigidity and elevated temp a/w use of neuroleptic meds
• > =2
• -diaphoresis
• -dysphagia
• -tremor
• -incontinence
• -changes in LoC, confusion-coma
• -mutism
• -tachy
• -elevated / labile BP
• -leukocytosis
• -lab evidence of muscle injury (elevated CK)

Question 6

Treatment NMS?

Answer 6

• Stop antipsychotics
• Full examination
• Exclude other organic causes
• Transfer to ICU
• ->supportive measures (02, cooling, IVT)
• -> bromocriptine
• -> dantrolene
• Call med and psych regs
• BZD for agitation if req’d
• Wait >5d before rechallenge

Question 7

Why are second gen antipsychotics used more frequently?

Answer 7

Less likely to produce NMS, EPS, tardive dyskinesia.

BUT many have own side effects that can limit use

Question 8

Chronic disease which may be caused by 2nd gen Antipsychotics? (and names of most likely to cause)

Answer 8

?increased risk of TIIDM.

Two of most concern: olanzapine, clozapine.

Question 9

Side effects of chlorpromazine?

Answer 9

Sedation and orthostatic hypotension very common

Question 10

Haloperidol AEx?

Answer 10

EPS VERY COMMON

Question 11

OLANZAPINE site of action?

Answer 11

Serotonin-dopamine antagonist

Question 12

Half life olanzapine?

Answer 12

31h (longer than other 2nd gen)

Question 13

Risperidone site of action?

Answer 13

Serotonin-dopamine antagonist

Question 14

Half life risperidone?

Answer 14

VARIABLE:

• 3 in fast metabolisers
• 120 in slow metabolisers

Question 15

AEx risperidone?

Answer 15

• EPS with high doses
• postural hTN
• increased prolactin
• weight gain
• sedation
• decreased concentration

Question 16

AEx olanzapine?

Answer 16

• Increased prolactin
• Orthostatic hTN
• Anticholindergic AEx
• Weight gain
• SOMNOLENCE

Question 17

Ix alongside olanzapine?

Answer 17

ALT levels (drug affects liver)

Question 18

AEx clozapine?

Answer 18

• Agranulocytosis
• Anticholinergic AEx
• Weight gain
• Sedation
• Neuroleptic malignant syndrome

Question 19

Ix clozapine?

Answer 19

FBE:

• weekly for first 6/12
• biweekly thereafter

Question 20

Quetiapine AEx?

Answer 20

• Orthostatic hTN
• Somnolence
• Transient weight increase

Question 21

Ix in quetiapine therapy?

Answer 21

-Slit lamp at baseline and every 6/12 (for those at risk of developing cataracts)

Question 22

Aripiprazole site of action?

Answer 22

• Partial agonist at dopamine and serotonin 1A receptors

- antagonist at post-synaptic serotonin 2A receptors

Question 23

Half life aripiprazole?

Answer 23

75h (longest of 2nd gen antipsychotics)

Question 24

AEx aripiprazole?

Answer 24

• HA
• Nausea
• Anxiety
• Insomnia
• Somnolence

NON SEDATING;
NO increased risk of:
-weight gain
-Somnolence

Question 25

Causes for non-compliance on behalf of pt?

Answer 25

-lack of understanding re: 
>MoA
>dosage, regularity
>duration
-unrealistic expectations
-asymptomatic
-intolerable AEx
-drug-drug interactions
-stigma
-denial of illness
-sidelining

Question 26

Doctor factors in non-compliance

Answer 26

• Poor therapeutic alliance
• Inadequate education
• Treatment resistance, not non compliance
• Wrong Dx - not non compliance
• Wrong drug for Sx or phase