Antipsychotics 2nd gen (atypical)

Question 1

Antipsychotic - atypical indications

Answer 1

Psychomotor agitation, schizophrenia (negative symptoms), bipolar (especially acute episodes)

Question 2

2nd gen atypical antipsychotic drugs

Answer 2

QORC, quetiapine, olanzapine, risperidone, clozapine

Question 3

Antipsycotic atypical MOA 2nd gen

Answer 3

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

Question 4

Difference between 1st gen and 2nd gen antipsychotic

Answer 4

2nd gen has better efficacy in treatment resistant schizophrenia (especially clozapine) and negative symptoms, lower risk of extrapyramidal symptoms

Question 5

Antipsychotics caution

Answer 5

CVD

Question 6

Side effects

Answer 6

EPS, metabolic disturbance ( weight gain, DM/lipid changes), prolong QT and cause arrhythmias. Breast symptoms and sexual dysfunction, agranulocytosis (clozapine)

Question 7

Clozapine C/I

Answer 7

Severe heart disease of neutropenia history

Question 8

Best time to take oral antipsychotic meds

Answer 8

Bedtime

Question 9

Antipsychotic monitoring

Answer 9

FBC, renal, hepatic required at the start and during treatment but intense programme needed for clozapine due to agranulocytosis risk, monitor cardio and metabolic effects ( weight, lipid profile fasting blood gluclose at baseline and intermittently)