antipsychotic medications

Question 1

what is the moa of high potency 1st gen typical antipsychotics?

Answer 1

D2 dopamine receptor antagonists  bind to D2 receptor with high affinity

Question 2

what is the moa of low potency 1st gen- typical?

Answer 2

: less affinity for D2 receptor but can react with nodopaminergic  cardiotoxic and antocholinergic adverse effects

Question 3

what is the moa of 2nd gen - atypical?

Answer 3

Serotonin-dopamine 2 antagonists
- Affect dopamine and serotonin NT within 4 key pathways (mesolimbic/ mesocortical  mood and thoughts, nigrostriatal  movement, tuberohypophyseal  endo eg prolactin regulation)

Question 4

name some high potency 1st gen typical?

Answer 4

Haloperidol, pimzaole, sulpiride, amisulpiride, fluphenazine, flupenthixol

Question 5

nmae some low potency 1st gen - typical?

Answer 5

Chloropromazine/ thiodazine -

Question 6

name some 2nd gen atypical

Answer 6

Risperidone, quetiapine. Clozapine, olanzapine

Question 7

what are side effects of risperidone?

Answer 7

increased risk of hyperprolactinemia, weight gain/ sedation

Question 8

what are side effects of quetiapine?

Answer 8

: weight gain, dyslipidaemia, hyperglycaemia, orthostatic hypotension

Question 9

what are side effects of olanzapine?

Answer 9

VERY HIGH weight gain, dsylipidemia, hyperglycaemia, may cause hyperprolactinaemia

Question 10

what are side effects of aripiprzole?

Answer 10

partial D2 agonists  no EPS, no QT elongation, has got many interactions

Question 11

what are side effects of clozapine?

Answer 11

• 1% risk of agranulosis/ neutropenia
• Need FBC: baseline, weekly (18wks), every 2weeks for a yr, then every 4wks following
• Postural hypotension, drowsy, weight gain, ?diabetes, constipation, seizures  if dose above 600mg/day

Question 12

how many pts with schizophrenia undergoing treatment become treatment resistant?

Answer 12

1/3

Question 13

what side effects can occur from central histamine (H1)?

Answer 13

sedation, weight gain

Question 14

what side effects can be seen with central adrenergic alpha blocker?

Answer 14

: postural hypotension  fainting, falls, injury. Sexual dysfunction

Question 15

what are antimuscarinic effects?

Answer 15

• Central: agitation, disorientation, hallucinations, seizures
• Peripheral: dry mouth, blurred vision, constipation, urinary retention

Question 16

what cardiac effects does antipsychotic medication?

Answer 16

Cardiotoxicity esp primozide
QTc interval effected

Question 17

what skin reactions can occur from antipsychotics?

Answer 17

Allergic dermatitis on skin contact esp chloropromazine
Photosensitivity: chlorpromazine
- Limit sun exposure and wear suncream

Question 18

what rare complication can be seen with chlorpromazine?

Answer 18

jaundice 1 in 1000

Question 19

what extra pyramidal effects can be seen?

Answer 19

acute dsytonia
acute akathasia
neuroleptic induced parkinsonsims
drug induced tardive dsykinesia

Question 20

what is acute dystonia?

Answer 20

Slow, contained muscular contraction:

Question 21

what specifically can occur within acute dystonia?

Answer 21

Neck, jaw, tongue, eyes (oculogyric crisis), eyelids( blepharospasm), glossopharyngeal (speaking and swallow)

Question 22

which drugs can cause acute dsytonia?

Answer 22

Usually 1st gen drugs
Straight away reaction

Question 23

who is most at risk of acute dystonia?

Answer 23

Mainly males, under 40
Can affect anyone

Question 24

how is acute dystonia managed?

Answer 24

Management:
Procyclidine 5mg PO
Syrup if jaw locked
IM if needed
Change drug

Question 25

what is acute akathisia?

Answer 25

Subjective feeling of discomfort and restlessness Agitation, dysphoria, standing, sitting in rapid succession Mainly motor symptoms

Question 26

how is acute akathisia managed?

Answer 26

Management: Reduce dose Change drug Propranolol/ benzo

Question 27

what is neuroleptic induced parkinsonism?

Answer 27

Classic motor PD symptoms: Muscle stiffness – cogwheel, shuffling gait, stooped posture, drooling, mask like face, coarse tremor

Question 28

how do you manage neuroleptic induced parkinsonism?

Answer 28

Management: Reduce antimuscarinics to lowest dose and stop after 4wks

Question 29

what is drug induced tardive dyskinesia?

Answer 29

Abnormal, involving choreiform movements

Question 30

what specific movements can be seen within drug induced tardive dyskinesia?

Answer 30

- Affecting head, trunk, limbs Fly catching tongue, lip puckering, grimacing, can affect resp muscles if severe, exacerbated by stress

Question 31

when does drug induced tardive dyskinesia occur?

Answer 31

Rare until 6mths of drugs 1st gen after 1yr

Question 32

who is most at risk of drug induced tardive dyskinesia?

Answer 32

Common in females, >50yrs, prior brain damage

Question 33

what management is seen within drug induced tardive dyskinesia?

Answer 33

Management: Reduce dose to lowest Try 2nd gen

Question 34

what is dantrolene?

Answer 34

muscle relaxant used in NMS

Question 35

what needs to be included within an antipsychotic counselling?

Answer 35

- Starting treatment : what to expect - How to take - How long for it to start working - Do not just stop - Risk of relapse upon discontinuation - Possible side effects and what to do if they occur - Signposting for more info

Question 36

what can cause adherence issues?

Answer 36

- Lack of insight - Adverse effects - Relationships with clinicans/ healthcare team - Stigma of taking drug - Social situations