Antipsychotics

Question 1

What are antipsychotics used for?

Answer 1

Used to Tx psychotic disorders and psychotic symptoms associated with psychiatric and other medical illnesses.

Question 2

What are typical antipsychotics?

Answer 2

First generation antipsychotics. Sometimes referred to as neuroleptics. Classified according to potency and to treat psychosis by blocking dopamine (D2) receptors.

Question 3

What are atypical antipsychotics?

Answer 3

Second generation antipsychotics. Newer antipsychotics block both dopamine (D2) and serotonin (2A) receptors.

Question 4

Actions of antipsychotics:

Answer 4

Most antipsychotics have a number of action and receptor interactions in the brain that contribute to their varied efficacy and side effect profiles.

Question 5

Efficacy in treating positive Sx:

Answer 5

Both typical and atypical antipsychotics have similar efficacies in treating the positive psychotic symptoms such as hallucinations and delusions.

Question 6

What should you monitor for a patient on Clozapine?

Answer 6

Pt. should have routine WBC counts to monitor for agranulocytosis. These WBC counts should be performed weekly of the first 6 months of treatment and can decrease in frequency thereafter.

Question 7

What should be monitored when prescribing lithium?

Answer 7

Lithium, creatinine and thyroid levels.

Question 8

What should you be aware of when using atypical antipsychotics in the elderly?

Answer 8

Although atypical antipsychotics are used to treat the symptoms of dementia and delirium, studies show an increased risk of all-cause mortality and stroke when using these agents in the elderly.

Question 9

Drug efficacy in treating negative Sx of psychosis:

Answer 9

Atypical antipsychotics may be more effective in treating negative symptoms, such as flattened affect and social withdrawal.

Question 10

Why are both typical and atypical antipsychotics still first line?

Answer 10

Atypical antipsychotics had largely replaced typical antipsychotics in use due to their favorable side effect profile. However, evidence for metabolic syndrome, weight gain, and other previously underappreciated side effects, as well as the significant cost of these medications, means that both classes are first line. Each med must be considered based on the patient and the side effect profile.