antipsychotic drugs

Question 1

what are the positive and negative symptoms of schizophrenia?

Answer 1

negative: social withdrawal/loss of interest in things
positive: hallucinations, delusions, thought disorder

Question 2

which out of positive or negative symptoms of schizophrenia are antipsychotics better at treating?

Answer 2

positive

Question 3

name some examples of 1st generation antipsychotics

Answer 3

end in ‘azines’ and ‘ol’
: azines are ol school

chlorpromazine
levomepromazine
promazine
fluphenazine
haloperidol and benperidol
flupentixol and zuclopenthixol
pimozide
pericyazine
prochlorperazine
sulpride

Question 4

list some examples of 2nd generation antipsychotics

Answer 4

APINE or ONE

• amisulpride
• aripiprazole
• clozapine
• lurasidone
• olanzapine
• paliperidone
• quetiapine
• risperidone

Question 5

what are the main differences between 1st gen and 2nd gen antipsychotics?

Answer 5

1st gen: work by blocking D2 receptors and are non selective so cause more s/e especially EPSE s/e.

2nd gen: work on specific D receptors and are more selective so cause less s/e. are also better at treating negative symptoms of schizophrenia

Question 6

which out of group 1, group 2 and group 3 phenothiazine derivatives has the MOST EPSE [extrapyramidal side effects]

Answer 6

group 3

Question 7

what are examples of group 1 phenothiazine derivatives [3]?

Answer 7

chlorpromazine
levopromazine
promazine

Question 8

what are group 2 of phenothiazine derivatives? [2]

Answer 8

periciazine

pipotiazine

Question 9

what are examples of group 3 phenothiazines derivatives? [4]

Answer 9

prochlorperazine
trifluroperazine
fluphenazine
perphenazine

Question 10

what are the risks of antipsychotics in elderly pt with dementia?

Answer 10

can increase risk of stroke/TIA and mortality in elderly pt with dementia
can cause postural hypotension and hyper/hypothermia

Question 11

what are extrapyramidal side effects?

Answer 11

ADAPT
acute dystonia [involuntary movements of neck/face/muscles]
akathisia [restlessness and cant stay still]
parkinsonism symptoms [tremor]
tardive dyskinesia [involuntary movement of jaw/tongue/face]

Question 12

What electrolyte imbalance is included in EPSE side effects and what do they cause?

hyperkalaemia
hyponatraemia
hypercalaemia
hyperprolactonaemia

Answer 12

hyperprolactinaemia [high prolactin levels]

causes sexual dysfunction, reduced bone density, breast enlargement, menstrual changes, galactorrhoea [milky discharge from breast]

Question 13

which 2nd gen antipsychotic has fewer s/e compared to the others?

Answer 13

aripiprazole

Question 14

name some other s/e that may occur with antipsychotics? [5]

Answer 14

blood dyscrasia
diabetes/hyperglycaemia
decreased libido
hypotension
weight gain

Question 15

what can ALL antipsychotics cause?
tachycardia
arrhythmia
hypotension
QT interval prolongation
all of the above

Answer 15

all of the above

Question 16

which out of 1st gen or 2nd gen antipsychotics are more likely to cause insulin resistance and diabetes?

Answer 16

2nd gen

Question 17

which 1st gen antipsychotics have the lowest risk of causing diabetes? [2]

Answer 17

• fluphenazine

- haloperidol

Question 18

of the 2nd generation antipsychotics, which drugs have the lowest risk of diabetes? [2]

Answer 18

amisulpride and aripiprazole

Question 19

which 2 antipsychotics have the LOWEST risk of sexual dysfunction?

Answer 19

aripiprazole and quetiapine

Question 20

which parameters are monitored at the start of antipsychotic treatment and then annually? [3]

Answer 20

FBC
liver function
urea and electrolytes

Question 21

which parameters are monitored once a year during antipsychotic treatment? [3]

Answer 21

blood pressure
prolactin conc
physical health monitoring [CVD risk]

Question 22

what are the general monitoring requirements for antipsychotics?

Answer 22

blood lipids
weight
fasting blood glucose
ECG

Question 23

How long may you monitor pt after withdrawal to check if signs of relapse occur?
1 year
3 months
2 years
6 months

Answer 23

2 years

Question 24

what are the pt and carer advice associated with antipsychotics? [2]

Answer 24

photosensitisation - avoid direct sunlight

driving: drowsiness may affect performance of skilled tasks

Question 25

what is the mechanism of action of clozapine?

Answer 25

it is a D1, D2, 5HT2A receptor

Question 26

what is the indication of clozapine?

Answer 26

licensed for schizophenia in pt intolerant or unresponsive to conventional antipsychotics [last option]

Question 27

what are the MHRA warnings of clozapine? [3]

Answer 27

potential risk of faecal impaction, intestinal obstruction and paralytic ileus. seek medical advice if constipation occurs

• monitor blood to manage risks of agranulocytosis
• monitor blood conc for toxicity when given with other anti-psychotics, in certain clinical situation eg stopping smoking, pneumonia, infection

Question 28

what are the contraindications of clozapine? [8]

Answer 28

history of agranulocytosis
bone marrow disorders
drug intoxication
history of neutropenia
paralytic ileus
severe cardiac disorders
uncontrolled epilepsy
severe cns depression

Question 29

what are the monitoring requirements of clozapine? [5]

Answer 29

• prolactin levels
• leucocytes and blood count
• clozapine blood conc
• blood lipids and fasting glucose
• pt with schizophrenia should have physical health checks annually

Question 30

what are the pt and carer advice for clozapine?
for suspension?
for orodispersible tablet?

Answer 30

• photosensitisation: avoid direct sunlight
• drowsiness may occur driving and skilled tasks affected
• oral suspension: shake well for 90s or if visibly settled and has been left out for 24 hours. other than that, shake well for 10 seconds before use and may be diluted with water
• orodispersible: place on tongue, allow to dissolve and swallow

Question 31

when are long acting depot injections for antipsychotis used?

Answer 31

for adherence in maintenance treatment for ppl who cannot comply with oral formulation

Question 32

which out of oral and depo injections antipsychotics contain the most EPSE s/e?

Answer 32

injections