CNS - PSYCHOSIS & SCHIZOPHRENIA

Question 1

How would you administer antipsychotics in an emergency?

Answer 1

IM route

lower dose than oral as it doesn’t undergo first pass metabolism

rx must always specify the dose

Question 2

Why should you be careful when prescribing antipsychotics in the elderly?

Answer 2

• At increased risk of stroke or TIA
• more susceptible to postural hypotension
• more susceptible to hypo/hyperthermia

Question 3

Which atypical antipsychotic is licensed for patients >65?

Answer 3

Risperidone

Question 4

What are the EPS symptoms?

Answer 4

• Acute pseudoparkinsonism e.g. tremors - treat with antimuscarinic
• acute dystonia (abnormal face and body movements) - treat with antimuscarinic
• Acute akathisia (Restlessness) - discontinue or treat with diff antipsychotic
• Chronic tardive dyskinesia (involuntary movement of tongue face and jaw) - usually develops long term, may be irreversible on withdrawing.

Question 5

What are the symptoms of hyperprolactinaemia?

Answer 5

• sexual dysfunction
• reduced bone mineral density
• menstrual disturbances
• breast enlargement
• galactorrhoea (milky nipple discharge)

Question 6

Which antipsychotics affect sexual dysfunction?

Answer 6

• haloperidol

- risperidone

Question 7

What can cause postural hypotension?

Answer 7

• clozapine
• chlorpromazine
• quetiapine
• USE WITH CAUTION IN ELDERLY

Question 8

How can you reverse the effects of antipsychotic induced neuroleptic malignant syndrome?

Answer 8

bromocroptine or dantrolene

Question 9

How do you monitor antipsychotics in general?

Answer 9

• FBC
• Lipids
• ECG
• BP

Question 10

What interacts with antipsychotics?

Answer 10

• Drugs that prolong QT
• EPS - metoclopramide
• Sedative drugs - benzos, hypnotics, opioids
• Antihypertensives
• TCAs, antihistamines, antimuscarinics

Question 11

What are the 2 main adverse effects of First generation anti-psychotics?

Answer 11

• More EPS

- More hyperprolactinaemia (high levels of prolactin in blood)

Question 12

Which First generation anti-psychotics are the most sedative?

Answer 12

• Chlorpromazine
• Levomepromazine
• Promazine

Question 13

Which First generation anti-psychotics have the most EPS?

Answer 13

• Prochlorperazine

- Haloperidol

Question 14

Which First generation anti-psychotic has the least EPS?

Answer 14

Pericyazine

Question 15

Which Second generation anti-psychotic has the most hyperprolactinaemia?

Answer 15

• Amisulpride

- Risperidone

Question 16

Which Second generation anti-psychotics should you be cautious with in diabetes?

Answer 16

• olanzapine (weight gain)
• Quetiapine (hyperglycaemia)
• clozapine

Question 17

What are examples of metabolic side effects of Second generation anti-psychotics?

Answer 17

• hyperglycaemia - risperidone, olanzipine, clozapine, quetiapine
• weight gain - clozapine and olanzapine
• lipid changes

Question 18

When would you use clozapine?

Answer 18

• For resistant schizophrenia
• Tried 2 or more drugs for at least 6-8 weeks each
• Try clozapine for at least 8-10 weeks to assess effectiveness

Question 19

What happens if you miss more than 2 doses of clozapine?

Answer 19

re-initiate by specialist

Question 20

What are the side effects of clozapine?

Answer 20

• Myocarditis and cardiomyopathy - tachycardia in first 2 months
• Agranulocytosis and neutropenia - FBC every week for 18 weeks
• GI obstruction - constipation

Question 21

What are the interactions of clozapine?

Answer 21

• immunosuppressants

- aminosalicylates