Antipsychotics

Question 1

what is mechanism of action of typical antipsychotics?

Answer 1

dopamine D2 receptor antagonists
blocking dopaminergic transmission in the mesolimbic pathways

Question 2

what is the mechanism of action of atypical antipsychotics?

Answer 2

act on a variety of receptors (D2, D3, D4, 5-HT)

Question 3

what are the adverse effects of typical antipsychotics?

Answer 3

• extrapyramidal side effects
• hyperprolactinaemia

Question 4

what are the adverse effects of atypical antipyschotics?

Answer 4

• extrapyramidal side effects
• hyperprolactinaemia
• metabolic effects

extrapyramidal and hyperprolactinaemia is less common than with typical antipsychotics

Question 5

typical or atypical antipsychotic?
haloperidol

Answer 5

typical

Question 6

typical or atypical antipsychotic?
chlopromazine

Answer 6

typical

Question 7

typical or atypical antipsychotic?
clozapine

Answer 7

atypical

Question 8

typical or atypical antipsychotic?
risperidone

Answer 8

atypical

Question 9

typical or atypical antipsychotic?
olanzapine

Answer 9

atypical

Question 10

what are extrapyramidal side-effects?

Answer 10

• parkinsonism
• acute dystonia
• akathisia
• tardive dyskinesia

Question 11

what is acute dystonia?

Answer 11

sustained muscle contraction (e.g. torticollis, oculogyric crisis)

Question 12

how is acute dystonia managed?

Answer 12

procyclidine

Question 13

what is akathisia?

Answer 13

severe restlessness

Question 14

what is tardive dyskinesia?

Answer 14

condition where your face, body or both make sudden, irregular movements which you cannot control
e.g. chewing and pouting

Question 15

what risks are increased in elderly patients prescribed antipsychotics?

Answer 15

• increased risk of stroke
• increased risk of venous thromboembolism

Question 16

what side-effect is particularly associated with haloperidol?

Answer 16

prolonged QT interval

Question 17

what are the antimuscarinic side-effects?

Answer 17

• dry mouth
• blurred vision
• urinary retention
• constipation

Question 18

what side-effects are associated with clozapine?

Answer 18

• agranulocytosis
• reduced seizure threshold
• constipation
• myocarditis
• hypersalivation

Question 19

typical or atypical antipsychotic?
quetiapine

Answer 19

atypical

Question 20

typical or atypical antipsychotic?
amisulpride

Answer 20

atypical

Question 21

typical or atypical antipsychotic?
aripiprazole

Answer 21

atypical

Question 22

how should a patient with poor compliance be managed?

Answer 22

monthly IM antipsychotic depot injections

Question 23

when clozapine prescribed?

Answer 23

resistant psychosis following trials of two other antipsychotics

Question 24

in what condition should typical antipsychotics be avoided?

Answer 24

parkinson’s disease

Question 25

what antipsychotic should be trialed in a patient who has already tried a antipsychotic and experienced galactorrhoea?

Answer 25

apriprazole

tolerable side effect profile, particularly for prolactin elevation

Question 26

what antipsychotic is best prescribed if the patient is worried about weight gain?

Answer 26

aripiprazole

Question 27

what should be done before starting clozapine?

Answer 27

• FBC - to monitor white blood cells
• baseline ECG - to monitor for myocarditis

Question 28

what is one of the most common side effects of clozapine?

Answer 28

constipation/intestinal obstruction

Question 29

what is the next point of action if clozapine has been missed for 2 days?

Answer 29

slowly re-titrate dose