Antipsychotics

Question 1

mechanism of typical antipsychotics ?

Answer 1

D2 dopamine receptor antagonist

Question 2

mechanism of atypical antipsychotics ?

Answer 2

serotonin dopamine receptor 2 antagonists

Question 3

side effects of typical antipsychotics ?

Answer 3

extrapyramidal side effects

• tardive dyskinesia
• acute dystonia
• akathisia
• parkinsonism

increased risk of stroke and VTE 
antimuscarinic: dry mouth, blurred vision, urinary retention, constipation 
weight gain 
sedation 
elevated prolactin (may cause galactorrhea) 
impaired glucose tolerence 
reduced seizure threshold 
prolonged QT interval 
neuroleptic malignant syndrome

Question 4

side effects of atypical antipsychotics ?

Answer 4

clozapine: agranulocytosis, neutropenia
weight gain
hyperprolactinaemia
increased risk of VTE and stroke

Question 5

side effects of clozapine ?

Answer 5

agranulocytosis 
neutropenia 
reduced seizure threshold 
constipation 
myocarditis 
hyper salivation

Question 6

treatment for extrapyramidal side effects ?

Answer 6

procyclidine

Question 7

what atypical antipsychotic has highest risk of hyperlipidaemia and sedation ?

Answer 7

olanzapine

Question 8

when should clozapine be used ?

Answer 8

BNF states clozapine should only be used in treatment of schizophrenia when patient is unresponsive to 2 or more antipsychotics (one must be a 2nd generation antipsychotic) and each trialled for 6-8 weeks

Question 9

what tests are monitored when a patient is on antipsychotics ?

Answer 9

FBC, U&E, LFT 
- initially, annually 
lipids, BMI
- initially, 3 months, annually 
fasting glucose, prolactin
- initially, 6 months, annually  
blood pressure
- baseline, frequently during dose titration 
ECG 
- baseline 
CV risk assessment 
- annually