Antipsychotics

Question 1

Which condition are antipsychotics mainly used in?

Answer 1

Schizophrenia

Question 2

What type of symptoms can you get in schizophrenia ?

Answer 2

positive and negative symptoms

Question 3

Name negative symptoms of schizophrenia

Answer 3

lack of motivation
lack of social interests
‘pulling away from things’

Question 4

Name positive symptoms of schizophrenia

Answer 4

delusions
hallucinations
thought disorders
‘symptoms added into the brain’

Question 5

How are antipsychotics classified as?

Answer 5

1st generation and 2nd generation

Question 6

Which generation of antipsychotics best treat the negative symptoms?

Answer 6

2nd generation

Question 7

What are the MOA of the first generation? Whats the problem with this?

Answer 7

primarily act by blocking the D2 receptors in the brain

They are non-selective so patients get a range of different side effects with it

Question 8

What are the main S/E of 1st generation?

Name the EPSE?

Answer 8

Extra-pyramidal S/E:
haloperidol can cause this

1. Parkinsonia (parkinsons like symptoms like tremor)
2. Dystonia (abnormal muscle usually due to spasms)
   (remember it like dystonia (muscle tone))
3. dyskinesia (impairment of voluntary movement)
4. Akathisia (constantly moving)
5. Tardive dyskinesia (specific to the jaw and the face)

Question 9

What are also linked with the first generation antipsychotics? what differs between them?

Answer 9

phenothiazine derivatives (can be grouped into three subtypes)
S/E is what differs between them
They all cause antimuscarinic side effects (dry mouth, blurred vision), EPS/e

Question 10

What side effects do group 1/2 and 3 of the phenothiazine derivates cause? Name a drug for each class

Answer 10

Group 1: Promazine
sedative effects

Group 2: pericyazine
Antimuscarinic S/E

Group 3: prochloperazine
EPSE

Question 11

What are examples of second generation drugs?

Answer 11

Olanzapine
Risperidone
quetiapine

Question 12

Why is there an advantage in terms of S/E of second generation drugs compared to first generation?

Answer 12

2generation act more specifically on different receptors
So S/E produced are more specific to each individual drug
They have a more distinct clinical profile

Question 13

What are other side effects of antipsychotic drugs?

Answer 13

Drowsiness
Agitation
Dizziness

Question 14

Is there a first line treatment when choosing an antipsychotic?

Answer 14

no.

it depends on patient factors, medical history

Question 15

What are the monitoring requirements of a person on antipsychotics?

Answer 15

urea and electrolytes 
liver function tests
full blood count 
weight
blood glucose - risk of getting diabetes (less with the 1st generation)

Question 16

What antipsychotic that is used as last resort?

Answer 16

clozapine when patients are intolerant to all other antipsychotics

Question 17

If a patient is non-compliant with an antipsychotic, what should be given instead?

Answer 17

Depo-injection - haloperidol, risperidone

Question 18

What drugs are used for hypo-mania and mania? What is their purpose?

if these drugs are inadequate, what could be added onto that?

Answer 18

to control any scute attacks and prevent any recurrence

• Olanzapine, risperidone, quetiapine

added on:
lithium
Sodium valproate

Question 19

When should Na valproate not be used?

Answer 19

woman who are pregnant or wanting to be pregnant coz they can have adverse effects on the baby (check MHRA)

Question 20

What else can olanzapine be used for?

Answer 20

bi-polar

Question 21

Can carbamazpine be used for bipolar?

Answer 21

Yes. If there are 4 or more effective episodes a year

Question 22

In what conditions can lithium be used for?

Answer 22

hypo-mania and mania and in depressive episodes in patients with bipolar disorder

Question 23

Whats the range you should aim for?

Answer 23

0.4 - 1 mmol/L

anything above 2 mmol/L indicates toxicity

Question 24

What are the toxicity signs of lithium?

Answer 24

1. Hypothyroidism
2. Polyuria & polydipsia
3. persistent headache and visual disturbances (intercranial hypertension)
4. Vomiting
5. Diarrhoea
6. Tremor, seizures
7. Muscle weakness
   in serous toxicity it can lead to convulsions and comas

Question 25

Which drugs reduce lithium excretion and therefore increase the plasma concentration of lithium?

Answer 25

1. ACE inhibitors (lisinopril)
2. Diuretics (bendroflumethiazide)
3. Aldosterone antagonists (spironolactone)
4. Potassium-sparing diuretics (amiloride)
5. NSAIDS (diclofenac)

Question 26

If a drug increases lithium excretion, what occurs to their overall plasma concentration?

Answer 26

reduces the plasma conc in the blood

Question 27

Which drug causes this effect?

Answer 27

aminophylline

Question 28

What should a patient on lithium do in order to prevent toxicity?

Answer 28

keep hydrated as dehydration can cause toxicity
and
maintain and constant diet of sodium! cant have too much salt and cant have too little salt
hypo and hypernatraemia

Question 29

What can affect bioavailability of lithium and what should you do in order to maintain the same bioavailability?

Answer 29

Keep to the same brand!