Antipsychotics

Question 1

Give 6 typical antipsychotics

Answer 1

haloperidol
chlorpromazine
flupentixol
fluphenazine
sulpride
zuclopenthixol

Question 2

Give 6 atypical antipsychotics

Answer 2

Olanzapine
Risperidone
Aripiprazole
Amisulpride
Quetiapine
Clozapine

Question 3

What types of side effects can antipsychotics have?

Answer 3

Extrapyramidal
Anti-muscarinic
Anti-histaminergic
anti- adrenergic
Increased Prolactin levels
Prolong QT interval
NMS
Metabolic - impaired glucose tolerance, hypercholerolaemia

Question 4

Describe extrapyramidal side effects

Answer 4

Parkinsonism - bradykinesia, rigidity, tremor, postural instability, masked facies, shuffling gait - weeks or months

Akathisia - unpleasant feeling of restlessness - first months - reduce dose of antipsychotic and give propanolol

Dystonia - acute painful contractions in the muscles of the neck, jaw, eyes - occulogyric crisis - within days

Tardive dyskinesia - choreoathetoid movmeemtn - abnormal involuntary movements - chewing/pouting

Question 5

Describe anti-muscarinic side effects

Answer 5

blurred vision
urinary retention
dry mouth
constipation

Question 6

Describe anti-histaminergic side effects

Answer 6

sedation

weight gain

Question 7

describe anti-adrenergic side effects

Answer 7

postural hypotension
tachycardia
ejaculatory failure

Question 8

What happens when prolactin levels are increased?

Answer 8

sexual dysfunction
reduced bone density
menstrual disturbances
breast enlargement
galactorrhea

Question 9

What are the side effects of clozapine

Answer 9

hyper salivation

agranulocytosis - neutropenia

Question 10

What is neuroleptic malignant syndrome? Features?
Investigations?
How is it treated?
Complications?

Answer 10

Occurs when taking antipsychotics (anti-dopaminergic) or dopaminergic drugs usually when drug is stopped or reduced

First 10 days of treatment or after increasing dose
Pyrexia, muscle rigidity, confusion, fluctuating consciousness, autonomic instability (tachycardia, fluctuating BP), delirium

Creatine kinase raised, LFTs deranged, FBC - leucocytosis

Stop antipsychotic
IV fluids to prevent renal failure
Cooling
Dantrolene (muscle relaxant)
Bromocriptine - Dopamine agonist
Consider benzodiazepine

Pulmonary Embolism, renal failure, shock

Question 11

What are contraindications to antipsychotics?

Answer 11

coma
CNS depression
phaeochromocytoma

Question 12

How is clozapine monitored?

Answer 12

WCC weekly for 18 weeks, fornightly for 1 year and then monthly
BM baseline, 4-6 months, yearly

Question 13

What is the effect of haloperidol on the heart?

Answer 13

long QT

Question 14

How long should antipsychotics be given for?

Answer 14

For at least 1-2 years following the psychotic episode

Question 15

How should antipsychotics be stopped?

Answer 15

Gradually stopped over 3 weeks

Question 16

Which antipsychotic has more extrapyramidal side effects - olanzapine or chlorpromazine?

Answer 16

Chlorpromazine - typicals

Question 17

Which antipsychotic is better tolerated - amisulpride or sulpride?

Answer 17

Amisulpride - atypicals

Question 18

What atypical antipsychotic has the best side effect profile especially wrt prolactinaemia?

Answer 18

Aripiprazole

Question 19

What investigations before starting antipsychotic?

Answer 19

FBC, U&E, LFT
Clozapine - WCC
Tasing blood glucose 
Blood lipids
ECG
BP
Prolactin
Weight
Creating kinase - then again if NMS is suspected

Question 20

What monitoring for haloperidol

Answer 20

ECG - prolongs QT

Also pimodzide

Question 21

What monitoring for olanzaapine?

Answer 21

Fasting blood glucose at baseline, one month, 4-6 months

Question 22

What can you offer if non-adherence is a problem?

Answer 22

Depot injection