monitoring antipsychotic drug treatment

Question 1

if a patient is on clopazine, they must be registered with

Answer 1

clozapine patient monitoring service

Question 2

when prescribing an antipsychotic drug for admin in emergency siutation (e.g. for rapid tranquilisation), how often do you need to monitor pt

Answer 2

monitor for SE and vital signs at least every hour until no further concerns about physical health status
monitor every 15 mins if high dose antipsychotic has been given

Question 3

pt with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) ….

Answer 3

atleast annually

Question 4

monitoring for olanzapine

Answer 4

Patients taking olanzapine require more frequent monitoring of these parameters:

weight and lipids: baseline, at 3 months (regularly during this period), every 3 months for the first year, then yearly.

Patients taking olanzapine should have fasting blood glucose tested at baseline, after one months’ treatment, then every 4–6 months.

requires more frequent monitoring than other antipsychotics.

usually, lipids & weight: baseline, at 3 months (weight should be measured at frequent intervals during the first 3 months), and then yearly with antipsychotic drugs
usually,FBG:baseline, at 4–6 months, and then yearly.

Question 5

treatment cessation for all antipsychotic drugs

Answer 5

high risk of relapse if medication is stopped after 1–2 years
Withdrawal of antipsychotic drugs after long-term therapy should always be gradual and closely monitored to avoid the risk of acute withdrawal syndromes or rapid relapse
Patients should be monitored for 2 years after withdrawal of antipsychotic medication for signs and symptoms of relapse

Question 6

clozapine planned wtihdrawal - reduce dose over

Answer 6

1-2 weeks to prevent rebound psychosis

Question 7

there is high risk of relapse if antipsychotic drug is stopped after. ..

Answer 7

1-2 yrs

Question 8

patients should be monitored for …. after withdrawal of antipsychotic meds for signs and symptoms of relapse

Answer 8

2 yrs

Question 9

why should patients be advised to avoid direct sunlight with all antipsychotics

Answer 9

because photosensitisation can occur with higher dosages

Question 10

it is advisable to monitor prolactin conc …

Answer 10

start of therapy, at 6 months, then yearly

Question 11

when to monitor prolactin conc in pt who are not normally associated with symptomatic hyperprolactinaemia

Answer 11

should be considered for prolactin monitoring if they show symptoms of hyperprolactinaemia (such as breast enlargement and galactorrhoea)

Question 12

do you need to monitor BP with amisulpride or aripiprazole

Answer 12

does not affect blood pressure to the same extent as other antipsychotic drugs and so blood pressure monitoring is not mandatory for this drug

Question 13

monitoring of weight with antipsychotics

Answer 13

Weight should be measured at the start of therapy with antipsychotic drugs, then weekly for the first 6 weeks, then at 12 weeks, at 1 year, and then yearly.

Question 14

FBG, HBA1C, blood lipid conc monitoring with antipsychotics

Answer 14

should be measured at baseline, at 12 weeks, at 1 year, and then yearly.

Question 15

before initating antipsychotic drugs, an ECG may be required, esp if …

Answer 15

physical examination identifies cardiovascular risk factors (e.g. high blood pressure), if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient.

Question 16

Blood pressure monitoring for antipsychotics

Answer 16

advised before starting therapy, at 12 weeks, at 1 year and then yearly during treatment and dose titration of antipsychotic drugs.

Question 17

expert sources advise to monitor full blood count, urea and electrolytes, and liver function tests ….

Answer 17

at the start of therapy with antipsychotic drugs, and then yearly thereafter.

Question 18

in children, regular clinical monitoring of endocrine function should be considered when children are taking an antipsychotic known to increase prolactin levels - this includes monitoring

Answer 18

• weight and height
• assessing sexual maturation
• monitoring menstrual function

Question 19

Standard monitoring of weight for antipsychotic drugs

Answer 19

Weight should be measured at the start of therapy with antipsychotic drugs, then weekly for the first 6 weeks, then at 12 weeks, at 1 year, and then yearly.

Question 20

Standard monitoring of FBG, HBA1C and blood lipids for antipsychotics

Answer 20

Fasting blood glucose, HbA1c, and blood lipid concentrations should be measured at baseline, at 12 weeks, at 1 year, and then yearly.

Question 21

Standard BP monitoring for antipsychotic

Answer 21

Blood pressure monitoring is advised before starting therapy, at 12 weeks, at 1 year and then yearly during treatment and dose titration of antipsychotic drugs.

(Amisulpride and aripirazole do not require this)

Question 22

Clozapine and other antipsychotics: monitoring blood concentrations for toxicity
Which other drugs are included in this?

Answer 22

amisulpride, aripiprazole, clozapine, olanzapine, olanzapine embonate, quetiapine, risperidone, and sulpiride

Following fatal cases involving toxicity of clozapine and other antipsychotic medicines, the MHRA advises that monitoring blood concentration of these drugs may be helpful in certain circumstances, such as patients presenting symptoms suggestive of toxicity, or when concomitant medicines may interact to increase blood concentration of amisulpride.

Question 23

What are the 2nd gen depot

Answer 23

aripiprazole, paliperidone, risperidone and olanzapine embonate.

Question 24

How do they affect diabetes

Answer 24

can raise BG levels

Question 25

Standard measuring of prolactin

Answer 25

It is advisable to monitor prolactin concentration at the start of therapy, at 6 months, and then yearly.

Question 26

Patient has started gambling. Which drug and what to do?

Answer 26

Aripiprazole

MHRA

Healthcare professionals are advised to counsel patients and their carers about this risk and to be alert for the development of new or increased urges to gamble and other impulse control symptoms, such as excessive eating or spending, or hypersexuality. The prescriber should consider reducing the dose or stopping the drug if these symptoms occur.

Question 27

What condition can antipsyhcotics exacerbate

Answer 27

parkinsons