antipsychotics

Question 1

indication antipsychotics

Answer 1

schizophrenia, psychosis, agitation

Question 2

mechanism typical antipsychotics

Answer 2

D2 antagonists (block dopamine)

Question 3

examples typical antipyschotics

Answer 3

haloperidol, chlopromazine

Question 4

most common SE typical antipsychotics

Answer 4

extrapyramidal, hyperprolactinaemia

Question 5

common extrapyramidal side effects

Answer 5

parkinsonism // acute dystonia // akathisia (restless) // tradive dyskinesia

Question 6

symptoms acute dystonia in antipsychotic SE

Answer 6

sustained muscle contraction eg torticollis, oculogryic crisis

Question 7

symptoms oculogryic crisis

Answer 7

restlessness, agitation, upward deviation of eyes

Question 8

causes oculogryic crisis

Answer 8

antipsychotics (esp typical), metoclopramide, postencephalitis parkinsons

Question 9

mx oculogryic crisis

Answer 9

IM benzotropine or procylidine

Question 10

mx acute dystonia antipsychotics

Answer 10

procyclidine

Question 11

symptoms tardive dyskinesia antipsychotic SE

Answer 11

late onset, choriod movement eg chewing and pouting jaw

Question 12

antimuscarinic symptoms antipsychotics

Answer 12

dry mouth, blurred vision, urinary retention, constipation

Question 13

endocrine symptoms antipsychotics

Answer 13

weight gain, impaired glucose tolerance, raised prolactin, neuroleptic malignant syndrome

Question 14

what is neuroleptic malignant syndrome

Answer 14

pyrexia, rigid muscle, hypertension, tachycardia, tachypnoa, delirium, agitated

Question 15

blood results neuroleptic malignant syndrome

Answer 15

raised CK (rhabdomyolisis), AKI, leukocytosis (raised WCC)

Question 16

neuroleptic malignant syndrome

Answer 16

stop antipsychotic // IV fluids // dantrolene, brocriptine (dopamine agonist)

Question 17

seizure effect antipsychotics

Answer 17

reduced threshold

Question 18

ECG typical antipsychotics

Answer 18

prolonged QT syndrome - esp haloperidol

Question 19

action atypical antipsychotics

Answer 19

variety of receptors (D2, D3, D4, 5HT)

Question 20

more common side effects of atypical antipsychotics

Answer 20

metabolic eg weight gain!!! (extrapyramidal and hyperprolactin less common)

Question 21

examples atypical antipsychotics

Answer 21

clozapine, olanzapine, risperidone, quatepine, ariprazole

Question 22

which atypical antipsychotics has a good SE profile

Answer 22

aripiprazole - esp good for raised prolactin

Question 23

bad SE clozapine

Answer 23

agranulocytosis // reduced seizure threshold // constipation // myocarditis

Question 24

what must be monitored on clozapine

Answer 24

FBC for agranulocytosis

Question 25

effect of smoking on clozapine

Answer 25

may need dose adjustment - stopping smoking raises clozapine blood levels

Question 26

indication starting clozapine

Answer 26

treatment resistant schizophrenia // trialed a typical and atypical antipsychotic for 6-8 weeks each

Question 27

risks starting elderly on antipsychotics

Answer 27

stroke and VTE

Question 28

when does FBC, U+E, LFT need to be checked with antipyschotics

Answer 28

initially, annually (more for clozapine)

Question 29

when does lipids and weight need to be checked on antipyschotics

Answer 29

initially, 3 months, annually

Question 30

when does glucose and prolactin need to be checked on antipyschotics

Answer 30

initially, 6 months, annually