CNS 5

Question 1

State when antipsychotics are used?

Answer 1

Used short term to calm disturbed pt who may be suffering from schizophrenia, brain damage, mania, toxic delirium or agitated depression

Question 2

Positive symptoms of schizophrenia

Answer 2

Hallucinations and delusion

Question 3

Negative symptoms of schizophrenia

Answer 3

Social withdrawal
Apathy/ lack of interest, enthusiasm/ withdrawn

Question 4

Antisychotics are used to relieve what symptoms of schizophrenia

Answer 4

Positive symptoms
And less effective for negative symptoms

Question 5

The 2nd generation of antipsychotics are better at treating ….

Answer 5

Negative symptoms of schizophrenia

Question 6

Which generation of antipsychotics has more Extrapyramidal side effects

Answer 6

First generation

Question 7

Second generation of antipsychotics (atypical)

Answer 7

Amisulpride
Aripiprazole
Clozapine
Lurasidone
Olanzapine
Paliperidone
Quetiapine
Risperidone

Question 8

Memory trick for Ist generation

Answer 8

AZine or ol

Question 9

Memory trick for 2nd generation Antipsychotics

Answer 9

One or pines

Question 10

Facts about first generation Antipsychotics

Answer 10

Acts predominantly by blocking D2 receptors in the brain
Non selective for any of the dopamine pathways in the brain hence can cause a range of Side effects especially EPSE and elevated prolactin

Question 11

Facts about 2nd generation Antipsychotics

Answer 11

More selective on a specific D receptor, hence less side effect
Better at tx negative symptoms of schizophrenia

Question 12

Facts about Clozapine

Answer 12

It is a D1, D2, 5HT2A , Alpha I adrenoceptor and Muscarinic receptor Antagonist

Question 13

What’s the indication for clozapine

Answer 13

It is licensed for tx of schizophrenia in pts who are unresponsive or intolerant to other antipsychotics

Question 14

MHRA/CSM warning for clozapine

Answer 14

Potentially fatal risk of intestinal obstruction, faecal impaction and paralytic ileus
Pt should seek medical advice before taking the next dose of clozapine if constipation develops
2. Monitor blood concentrations for toxicity in certain clinical situations eg stop smoking, switching to e cigarette, pneumonia or serious infections, concomitant meds which may increase clozapine levels
Blood monitoring should be carried out to manage the risk of Agranulocytosis

Question 15

Contraindications of clozapine

Answer 15

Bone marrow disorders, hx of Agranulocytosis, drug intoxication, hx of neutropenia, paralytic ileus, severe cardiac disorders, uncontrolled epilepsy and CNS depression

Question 16

Mnemonic for clozapine

Answer 16

CLOSE DA bloody door
DA- Dopamine and Alpha 1 receptors
Close door, last option
Bloody- Agranulocytosis/ blood disorder

Question 17

Monitoring clozapine

Answer 17

Monitor prolactin( for signs of Hyperprolactineamia eg breast enlargement and Galactorrhea)
2. Monitor physical health and CVD risk assessment for at least once a year
3. Monitor leukocyte and blood count
4. Monitor blood clozapine conc in certain clinical conditions
5. Close supervision during initiation (risk of collapse due to HTN and convulsion)
6.monitor blood lipids and fasting glucose

Question 18

Patient and carer advice Clozapine

Answer 18

Photosensitization at higher doses( avoid direct sunlight)
Driving and skilled task- drowsiness enhanced by etoH
Advise on how to administer clozapine oral suspension and orodispersible tablet
Suspension: shake well for 90s when dispensing or if visibly settled and stand for 24hrs before use. Otherwise shake well for 10sec before use. May be diluted with water
Orodispersibel tablet: place on tongue ,allow to dissolve and swallow

Question 19

Facts about Antisychotics depot injection

Answer 19

Long acting used for maintenance therapy for pts who can’t comply with oral tx
They have more EPSE than oral tx

Question 20

Which depot injection Antisychotics prevent relapse?

Answer 20

Zupenthixol

Question 21

A depot injection antipsychotics used to tx agitated and aggressive pt is known as

Answer 21

Flupentixol