Anti-Psychotics

Question 1

What can anti-psychotics be subdivided into?

Answer 1

• Typical (first generation)

- Atypical (second generation)

Question 2

Give 3 examples of typical anti-psychotics?

Answer 2

• Chlorpromazine
• Prochlorperazine
• Haloperidol

Question 3

Give 4 examples of atypical anti-psychotics?

Answer 3

• Risperidone
• Quetiapine
• Olanzapine
• Clozapine

Question 4

Why are older antipsychotic medications less commonly prescribed now?

Answer 4

Due to increased risk of extrpyramidal side effects

Question 5

What type of anti-psychotic is first line in schizophrenia?

Answer 5

Atypical

Question 6

When should clozapine be prescribed?

Answer 6

Only if treatment with two or more antipsychotics has failed

Question 7

What is the mechanism of action of anti-psychotics?

Answer 7

Block post-synaptic dopamine D2 receptors in the brain, and thus increase dopamine levels

Question 8

Why do typical anti-psychotics have more side effects?

Answer 8

They are non-specific and affect other receptors in addition to dopamine D2 receptors

Question 9

What are the routes of delivery of anti-psychotics?

Answer 9

• PO
• IM
• SC

Question 10

What should be done before starting a patient on an antipsychotic as a depot injection?

Answer 10

Should be given a test dose

Question 11

What are the indications for antipsychotics?

Answer 11

• Schizophrenia
• Bipolar
• Agitation and restlessness in elderly

Question 12

What should be done before prescribing an anti-psychotic for agitation and restlessness in the elderly?

Answer 12

Review each patient clinically before prescribing, and investigate the cause of agitation

Question 13

What are the contraindications to typical anti-psychotics?

Answer 13

Parkinson’s

Question 14

When should clozapine be used with caution?

Answer 14

Cardiovascular disease

Question 15

When should all anti-psychotics be used with caution?

Answer 15

Elderly

Question 16

Why should anti-psychotics be used with caution in the elderly?

Answer 16

More susceptible to antipsychotic side effects

Question 17

When should anti-psychotics be avoided?

Answer 17

Dementia

Question 18

Why should anti-psychotics be avoided in dementia?

Answer 18

Dementia and use of antipsychotics has been correlated with high risk of stroke and death

Question 19

What might anti-psychotics interact with?

Answer 19

• Amiodarone
• Macrolides
• SSRIs
• Quinine
• Alcohol
• Opioids

Question 20

What might happen if anti-psychotics are given with amiodarone, macrocodes, SSRIs, or quinine?

Answer 20

Increased risk of QT interval prolongation

Question 21

What might happen if anti-psychotics are given with alcohol or opioids?

Answer 21

Sedation and increased CNS effects

Question 22

What might clozapine interact with?

Answer 22

Carbamazepine

Question 23

What might happen if clozapine is given with carbamazepine?

Answer 23

Increased risk of agranulocytosis

Question 24

What might quetiapine interact with?

Answer 24

Grapefruit juice (increases exposure to quetiapine)

Question 25

What should be done before starting an anti-psychotic?

Answer 25

- Weight - Waist circumference - Pulse rate - BP - Assessment of general health, including blood tests - ECG

Question 26

Why is a health check done before starting anti-psychotics?

Answer 26

Risk of metabolic disturbances being caused by antipsychotics, thus a baseline assessment of patients general health should be undertaken

Question 27

What monitoring is required with clozapine?

Answer 27

Monitor FBC weekly for 18 weeks, then fortnightly until 1 year, then every 4 weeks

Question 28

Why is it important to monitor FBC with clozapine?

Answer 28

Causes agranulocytosis in 1% of patients

Question 29

What should be done if WCC <1.5x10^4 with clozapine?

Answer 29

Discontinue immediately

Question 30

What monitoring is required with some anti-psychotics?

Answer 30

Prolactin concentration (idk which ones and I cba to look it up)

Question 31

When should prolactin concentration be measured with some anti-psychotics?

Answer 31

At the start of therapy, at 6 months, then yearly

Question 32

What should you do if patients who start to show signs of hyperprolactinaemia, with regards to monitoring?

Answer 32

Consider prolactin monitoring, even if this adverse effect is not commonly associated with their anti-psychotic drug

Question 33

What are the general side effects of anti-psychotics?

Answer 33

- Sedation - Extra-pyramidal side effects - Weight gain, hypertension, diabetes mellitus, and hypercholestrolaemia - Sexual dysfunction

Question 34

How can the side effect of sedation be beneficial?

Answer 34

In agitated patients

Question 35

What are the specific side effects of clozapine?

Answer 35

- Neutropenia | - Agranulocytosis

Question 36

What are the specific side effects of risperidone?

Answer 36

- Gynaecomastia | - Galactorrhoea

Question 37

Why does risperidone cause gynaecomastia and galactorrhea?

Answer 37

It raises prolactin

Question 38

How should which antipsychotic to use be chosen?

Answer 38

Prior to starting antipsychotic medication, the doctor should discuss different options for antipsychotic drugs with the patient, and explain the benefits, risks, and side effects of each drug. The patient should be asked which side effects they are willing to accept, and should be involved in the final decision of which antipsychotic to start

Question 39

Describe the use of anti-psychotics in pregnancy?

Answer 39

There have been reports of extra-pyramidal side effects and withdrawal symptoms in the neonate when antipsychotic medications have been taken in the 3rd trimester. In this case, neonates must be monitored for respiratory distress and CNS effects such as agitation and hypotonia

Question 40

Can anti-psychotics be used in breastfeeding?

Answer 40

They should be avoided due to lack of information confirming short and long term safety