Antipsychotics 1st gen typical

Question 1

Antipsychotic 1st gen typical indication

Answer 1

Psychomotor agitation, schizophrenia (negative symptoms), bipolar (especially acute episodes), nausea and vomiting (especially palliative)

Question 2

Antipsychotic 1st gen MOA

Answer 2

Block post-synaptic dopamine D2 receptors. Blocking mesolibic/mesocortical pathway between midbrain and limbic/frontal cortex largely responsible for antipsychotic effect.

D2 receptors in chemoreceptor trigger zone enables it to be used in nausea and vomiting. There are sedative effects.

Question 3

Antipsychotic 1st gen drugs

Answer 3

Haloperidol, chlorpromazine, prochlorperazine

Question 4

What stops intractable hiccups

Answer 4

haloperidol

Question 5

Antipsychotic 1st gen side effects

Answer 5

Extra pyramidal symptoms (EPS) from effect on nigrostriatal pathway , acute dystonic reactions =

akathesia, neuroleptic malignant syndrome (rigidity, confusion, autonomic dysregulation, pyrexia) all early in treatment.

Tardive dyskinesia is a later side effect,
QT prolongation, drowsiness, hypotension, erectile dysfunction, hyperprolactinaemia ( menstrual disturbance, galactorrhoea, breast pain)

Question 6

Tardive dyskinesia

Answer 6

pointless, involuntary repetitive movements like lip smacking,

Question 7

Akathesia

Answer 7

restlessness

Question 8

Neuroleptic malignant syndrome

Answer 8

Rigidity, confusion, autonomic dysregulation, pyrexia

Question 9

Dystonic reactions

Answer 9

Parkinsonian/muscle spasms,

Question 10

Antipsychotic 1st gen caution

Answer 10

Avoid in dementia (increase death/stroke risk), elderly need lower dose

Question 11

Antipsychotic 1st gen interactions

Answer 11

QT interval (amiodarone, macrolides, quinine, SSRI)

Question 12

Antipsychotic monitoring

Answer 12

Need to monitor improvement and control of symptoms can take several weeks check neurological, respiratory and cardio depression

Question 13

What is used for rapid antipsychotic treatment

Answer 13

Haloperidol IM