Drugs

Question 1

What are the extra pyramidal side effects? (4)

What class of anti-psychotics are particularly associated with them?

Answer 1

Parkinsonism, Acute dystonias (torticollis, oculogyric crisis), Akathisia, Tardive Dyskinesia ( Procyclidine)

More commonly associated with typical/first generation antipsychotics

Question 2

What are the 8 main domains of side effects to antipsychotics?

Answer 2

i) EPS - Parkinsonism, Akathisia, Acute Dystonia, Tardive Dyskinesia
ii) Thrombophilic - ELDERLY. Risk of stroke and VTE.
iii) Antimuscarinic - dry mouth, blurred vision, urinary retention, constipation
iv) Metabolic/Endocrine - weight gain, sedative, galactorrhoea, impaired glucose tolerance
v) Neuroleptic malignant Syndrome - pyrexia, muscle stiffness
vi) reduced seizure threshold (more associated with atypicals i.e. clozapine)
vii) Cardiac - Prolonged QT
viii) Haematological - agranulocytosis, neutropenia

Question 3

Features of benzodiazepine withdrawal syndrome (9)

Answer 3

Perceptual disturbance
Loss of appetite 
Insomnia
Irritability
Anxiety
Tremor
Tinnitus
Perspiration 
Seizures

Question 4

Most dangerous TCA in overdose?

Answer 4

Dosulepin and Amitiptyline

• Lofepramine is safest TCA

Question 5

Describe the actions of antipsychotics

Answer 5

D2 Receptor antagonists

- Block DA transmission in mesolimbic pathways.