Antipsychotics

Question 1

Haloperidol

Answer 1

typical antipsychotic

Question 2

flupenthixol

Answer 2

typical antipsychotic

Question 3

chloropromazine

Answer 3

typical antipsychotic

Question 4

are EPSE more common with typical or atypical

Answer 4

typical

Typical antipsychotics are unselective in their blocking effect at the dopamine D2 receptor and so decrease positive symptoms and increase negative symptoms.

Question 5

What are the 4 types of EPSE

Answer 5

Parkinsonism

Acute dystonia

Akathisia

Tardive dyskinesia

Question 6

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

diagnosis and manegemnt?

Answer 6

acute dystonia

procyclidine

Question 7

on antipsychotic

late onset of choreoathetoid movements, abnormal, involuntary, most common is chewing and pouting of jaw

diagnosis and management

Answer 7

tardive dyskinesia

tetrabenazine

Question 8

what typical antipsychotic is associated with long QT

Answer 8

haloperidol

Question 9

other side effects of typical antipsychotics other than EPSE

Answer 9

Extrapyramidal side effects (EPSEs): parkinsonism, akathisia, dystonia, dyskinesia

Hyperprolactinaemia: leads to sexual dysfunction, increased risk of osteoporosis, amenorrhoea in women, galactorrhoea, gynaecomastia and hypogonadism in men

Metabolic side effects: weight gain, increased risk of developing type 2 diabetes, hyperlipidaemia, increased risk of developing metabolic syndrome

Anticholinergic side effects: tachycardia, blurred vision, dry mouth, constipation, urinary retention

Neurological side effects: seizures, neuroleptic malignant syndrome (potentially life-threatening)

prolonged QT interval (particularly haloperidol)

Question 10

young patients with tachycardia and tachypnoea, hypertension, fever, muscle rigidity, hyporeflexia

diagnosis? invetsigation? management?

Answer 10

Neuroleptic malignant syndrome

Elevated CK

1. immediate cessation of the dopamine antagonist (or restarting or continuing of the dopamine agonist)
2. admission to medical ward
3. IV fluids to prevent renal failure
4. dantrolene may be useful in selected cases
   thought to work by decreasing excitation-contraction coupling in skeletal muscle by binding to the ryanodine receptor, and decreasing the release of calcium from the sarcoplasmic reticulum
5. bromocriptine, dopamine agonist, may also be used

A delay of at least 2 weeks in restarting antipsychotic treatment is advised following full resolution of NMS

Question 11

olanzapine

Answer 11

atypical antipsychotic

Question 12

risperidone

Answer 12

atypical antipsychotic

Question 13

quetiapine

Answer 13

atypical antipsychotic

Question 14

amisulpride

Answer 14

atypical antipsychotic

Question 15

aripiprazole

Answer 15

atypical antipsychotic

Question 16

clozapine

Answer 16

atypical antipsychotic

Question 17

Side effects of atypical antipsychotics

Answer 17

less likely to cause EPSE and hyperprolactinameia but still can

Metabolic side effects: weight gain, increased risk of developing type 2 diabetes, hyperlipidaemia, increased risk of developing metabolic syndrome

Anticholinergic side effects: tachycardia, blurred vision, dry mouth, constipation, urinary retention, dizziness

Neurological side effects: seizures, neuroleptic malignant syndrome (potentially life-threatening)

Elderly : increased risk of stroke
Elderly : increased risk of venous thromboembolism

clozapine is associated with agranulocytosis

Question 18

Adverse effects of clozapine

Answer 18

agranulocytosis (1%), neutropaenia (3%)
reduced seizure threshold - can induce seizures in up to 3% of patients
constipation
myocarditis: a baseline ECG should be taken before starting treatment
hypersalivation
weight gain

Question 19

What do you need to monitor clozapine

Answer 19

FBC

Question 20

name 3 typcial antipsychotics

Answer 20

Haloperidol
Flupenthixol
Chlorpromazine

Question 21

how often do you monitor FBC in pts on clozapine

Answer 21

checking the FBC every week for the first 18 weeks, every second week up to 1 year, and then at monthly intervals.