Atypical antipsychotics

Question 1

What contraindications should be excluded before prescribing atypical antipsychotics?

Answer 1

• Hepatic impairment

- Phaeochromocytoma (tumour of the adrenal gland)

Question 2

How would you explain the MOA of atypical antipsychotics to a patient?

Answer 2

• Schizophrenia is thought to be caused by problems with dopamine receptors in your brain
• Atypical antipsychotics work by blocking these receptors

Question 3

How should atypical antipsychotics be taken?

Answer 3

• Tablet daily or depot injection every 2-4 weeks
• Dose built up over a week or two
• Dose adjusted depending on response
• Takes several days to weeks to work

Question 4

What monitoring is required before prescribing atypical antipsychotics and during treatment?

Answer 4

Before:
- HR, BP, weight, waist circumference, ECG, HbA1c, fasting glucose, lipid profile, prolactin

During:

• Weight every week for 6 weeks
• 3 months, 12 months, and then annually: HR, BP, weight, waist circumference, ECG, HbA1c, fasting glucose, lipid profile, prolactin

Question 5

What important side effects of atypical antipsychotics should patients be made aware of?

Answer 5

• Anti-dopaminergic (tardive dyskinesia, tremor, movement disorders)
• Anti-cholinergic (constipation, dry mouth)
• Anti-histaminergic (weight gain, dizziness, drowsiness)
• Anti-adrenergic (hypotension)
• Neuroleptic malignant syndrome (high fever and muscle rigidity)
• Clozapine: agranulocytosis and reduced seizure threshold
• Withdrawal
• Hyperglycaemia and diabetes
• Hyperprolactinaemia (sexual dysfunction, menstrual disturbance, galactorrhoea)
• Prolonged QT