Drugs

Question 1

What is the first line treatment for new onset psychosis?

Answer 1

Atypical antipsychotics (2nd gen), e.g. Olanzapine, quetiapine, risperidone, amisulparide, aripriprazole

Question 2

Which antipsychotic has the “best” efficacy?

Answer 2

CLOZAPINE

Though it can only be prescribed after trying to other antipsychotics (any type) due to dangerous SFx (agranulocytosis)

Question 3

What is the mechanism of action of 1st generation antipsychotics? (/typical)

Answer 3

Primarily dopamine receptor blockers.

Also - cholinergic, andronergic and histaminergic receptor blockers

Question 4

What is the mechanism of action for second generation (atypical) antipsychotics?

Answer 4

Primarily dopamine receptor blockers (though lower affinity than 1st gen), also 5HT2 antagonists

Question 5

What are the antidopaminergic SFx from the NIGOSTRIATAL PATHWAY associated with typical antipsychotics?

Answer 5

Extrapyramidal movement disorders.
Including: Parkinsonism (resting tremor, bradykinesis, cogwheel rigidity/hypertonia)
Akasthisia
Tardive dyskinesia
Acute dystonia (oculogyric crisis, torticullitis)

Question 6

What are the antidopaminergic SFx from the TUBERO-INFUNDIBULAR pathway from antipsychotics (typical)?

Answer 6

Hyperprolactinaemia
Causes endocrine problems such as galactorrhoea, menstrual disturbance in women, gynaecomastia and sexual dysfunction in men

Question 7

What are the main anticholinergic SFx associated with antipsychotics?

Answer 7

Dry mouth
Urinary retention
Constipation

Question 8

How are the extrapyramidal SFx such as acute dystonia and Parkinsonism managed?

Answer 8

Anticholinergic drugs - procyclidine

Question 9

Give examples of SSRI (first line ADx)

Answer 9

Citalopram, Sertraline

Fluoxetine, paroxetine