Anti psychotics

Question 1

How to anti psychotics work?

Answer 1

Antipsychotics act as dopamine D2 receptor antagonists, blocking dopaminergic transmission in the mesolimbic pathways.

Question 2

Name 3 x extra pyramidal side effects of anti psychotics

Answer 2

1. Parkinsonism
2. Acute dystonia
3. Akathisia
4. Tardive dyskinesia

Question 3

acute dystonia

Answer 3

Involuntary sustained muscular contractions or spasms, often of the neck (spasmodic torticollis)

Clenched jaw (trismus)

Protruding tongue

Eyes roll upwards (oculogyric crisis)

These features happen more in young men and will usually occur within 72 hours of the beginning of treatment

Question 4

akathisia

Answer 4

severe restlessness

Question 5

tardive dyskinesia

Answer 5

1. late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible,
2. most common is chewing and pouting of jaw
3. No treatment to stop it

Question 6

Name some antimuscarinic side effects

Answer 6

dry mouth
 blurred vision
urinary retention
constipation
sedation
weight gain

Question 7

Endocrine side effects on antipsychotics?

Answer 7

raised prolactin: galactorrhoea, impaired glucose tolerance

Question 8

Anti psychotic induced emergecy

Answer 8

neuroleptic malignant syndrome: pyrexia, muscle stiffness

Question 9

Name two other side effects of anti psychotics

Answer 9

reduced seizure threshold (greater with atypicals)

sprolonged QT interval (particularly haloperidol)

Question 10

What is the main advantage of atypical antipsychotics?

Answer 10

No extra pyramidal side effect

Question 11

What are atypical antipsychotics used first line in?

Answer 11

Schizophrenia

Question 12

Name 3 anti psychotics

Answer 12

clozapine
olanzapine
risperidone

Question 13

Name two major side effects of olanzopine

Answer 13

higher risk of dyslipidemia and obesity

Question 14

What is the indication for clozapine use?

Answer 14

only be used in patients resistant to other antipsychotic medication.

Question 15

Why is full blood count monitoring required in clozapine?

Answer 15

agranulocytosis (1%), neutropaenia (3%)

Question 16

Which patients is clozapine contra indicated in?

Answer 16

Epileptic patients because it reduced the seizure threshold

Question 17

What are the commonly used first generation (typical) antipsychotic agents?

Answer 17

Chlorpromazine

Haloperidol

Question 18

What are the commonly used second generation (atypical) antipsychotic agents?

Answer 18

Clozapine
Olanzapine
Quetiapine
Risperidone

Question 19

What is the primary mechanism of action of clozapine when used as an antipsychotic?

Answer 19

Serotonin (5HT-2) antagonist and D4 receptor antagonist

It is also a weak agonist of D2 receptors.

Question 20

What are the main side effects of the antipsychotic medications as a result of D2 receptor blocking?

Answer 20

Extrapyramidal side effects

Hyperprolactinaemia

Question 21

What are the features of Parkinsonian syndrome, an extrapyramidal side effect of antipsychotic agents?

Answer 21

Muscular rigidity
Bradykinesia
Resting tremor

Question 22

Why is it particularly important to warn smokers about clozapine?

Answer 22

moking induces P450 enzymes which means that doses for smokers will often be higher than for non-smokers. This is relevant if the smoker decides to stop smoking without warning their doctor.