antipsychotics

Question 1

4 key dopaminergic pathways in the brain

Answer 1

mesocortial, mesolimbic, nigrostriatal and tuberoinfundibular

Question 2

pathway of mesocortical

Answer 2

ventral tegmentum to cerberal cortex

Question 3

pathway of mesolimbic

Answer 3

ventral tegmentum to limbic system

Question 4

pathway of nigrostriatal

Answer 4

substantia nigra to basal ganglia

Question 5

pathway of tuberoinfundibular

Answer 5

hypothalamus to anterior pituitary

Question 6

symptoms of too little dopamine in the mesocortical pathway

Answer 6

negative symptoms (lack or apathy, affective flattening, anhedonia) and cognitive disorders

Question 7

negative symptoms of psychosis

Answer 7

absence of a thought, behaviour or feeling e.g. lack of apathy, anhedonia, attention deficit, affective flattening

Question 8

which dopamine pathway in the brain is responsibe for the negative symptoms of psychosis

Answer 8

mesocortical

Question 9

symptoms of too much dopamine in the mesolimbic pathway

Answer 9

positive symptoms - hallucinations, thoughts disorders and delusions

Question 10

symptoms of under active dopamine in the nigrostriatal pathway

Answer 10

parkinsonian symptoms - intention tremor, dystonia, bradykinesia and rigidity

Question 11

symptoms of too little dopmaine in the tuberoinfundibular pathway

Answer 11

loss of dopamine inhibiton on prolactin –> galactorrhoea, gynaecomastia, menstrual dysfunction and low libido

Question 12

what are extrapyramidal side effects

Answer 12

tremor, slurred speech, dystonia, anxiety, distress and paranoia

Question 13

what antipsychotic drugs have a high risk of extrapyramidal side effects

Answer 13

typicals with high D2 receptor affinity

Question 14

what is clozapine prescribed for

Answer 14

treatment resistant psychosis (i.e. limited response to trial of 2 antipsychotics)

Question 15

chloropromazide are a/typical

Answer 15

typical

Question 16

risperidone, olanzapine, quetiapine and aripiprazole are a/typical

Answer 16

atypical

Question 17

general sides effects of typical antipsychotics

Answer 17

weight gain, abnormal LFTs and hypertriglyceridemia/cholesterolemia/glycemia

Question 18

which atypical antipsychotics give hypertriglyceridemia/cholesterolemia/glycemia

Answer 18

olanzapine and quetiapine

Question 19

which atypical antipsychotic gives extrapyramidal side effects

Answer 19

risperidone

Question 20

treatments for EPS

Answer 20

anticholinergics
anxiolytics
beta-blockers

Question 21

features of extrapyramidal side effects

Answer 21

parkinsonian tremor, rigidity and bradykinesia, akathisia

Question 22

what is akathisia

Answer 22

“inner restlessness” - jittery, skins crawling etc

Question 23

bloods to do before starting antipsychotics

Answer 23

fasting lipid profile
fasting blood sugar
LFTs
FBC

Question 24

3 big side effects of antipsychotics

Answer 24

tardive dyskinesia
neuroleptic malignant syndrome
extrapyramidal side effects

Question 25

which atypical antipyschotic starts working 2 weeks sooner than the others

Answer 25

olanzapine - 4 weeks instead of 6

Question 26

true/false - risperidone is the most likely atypical to give hyperprolactinaemia

Answer 26

true - acts on tuberoinfundibular pathway

Question 27

mechanism of typical antipsychotics

Answer 27

D2 dopamine receptor antagonists - stop dopamine binding

Question 28

mechanism of atypical antipsychotics

Answer 28

serotonin and D2 antagonists

Question 29

true/false - low affinity typical antipsychotics have a higher risk of EPS

Answer 29

false - high affinity –> higher antagonism of dopamine –> less available to nigrostriatal –> EPS

Question 30

name 4 disorders which antipsychotics are indicated in

Answer 30

schizophrenia
schizoaffective disorder
bipolar disorder with psychotic features
psychotic depression