Antipsychotics 1.3 COPY

Question 1

Metabolic Side Effects

Answer 1

• More common with atypical, though can occur
with all
• Substanial, often reversible
• Sedation, lack of movement
• Endocrinological changes
• Can result in
– New Onset or Worsening of Type II Diabetes
– Hypertension
– Hyperlipidemia

Question 2

Metabolic side effects rankings

Answer 2

Clozapine, Olanzapine: Wt gain: ++++ Lipids: +++ GLucose:+++

Chlorpromazine: Wt gain: +++ Lipids: +++, GLucose ++

Risperidone: Wt gain: + Lipids +/- Glucose +/-

Haloperidol: Wt gain: +/- Lipids: - Glucose: -

Regular measurements of body mass index, waist
circumference, serum lipids, and either fasting blood glucose or
hemoglobin A1c should be carried out.

Question 3

Leukopenia, agranulocytosis:

Answer 3

– Clozapine (1-2% of patients) rare with other
antipsychotics
– Potentially fatal
– Occurs between 6-18 weeks of treatment
• Regular monitoring of blood cell counts should be
conducted.

Question 4

• Perioral tremor – “rabbit syndrome”:

Answer 4

– Rare, tends to occur following prolonged
antipsychotic use (years)
– Can treat with anticholinergic antiparkinson drugs

Question 5

Cardiac Effects:

Answer 5

– Thioridazine leads to minor T wave abnormalities
in pharmacological doses
• Overdose associated with major ventricular
arrhythmias
– Ziprasidone QT prolongation

Question 6

Contraindications

Answer 6

Pregnant and nursing mothers

Question 7

Drug Interactions

Answer 7

– Central depressants and opioid analgesics
– Amphetamines antagonize antipsychotic
effects
– Centrally acting anticholinergics may worsen
tardive dyskinesia
– SSRI’s may worsen extrapyramidal symptoms
– Most antipsychotic agents can add to
hypotensive effect of antihypertensives