pharmacology 2

Question 1

Antipsychotics

Answer 1

Used to manage psychosis and other illnesses which cause a loss
of contact with reality
(aka neuroleptics – 1st gen.

Question 2

an leave

the person experiencing these symptoms at risk

Answer 2

• Perceptual disturbances, hallucinations, delusions, thought
disorders and/leading to bizarre or unusual behaviours

Question 3

most common diagnoses requiring antipsychotic

Answer 3

Schizophrenia, schizo-affective disorder and other psychotic

disorders

Question 4

• Other conditions may also respond to

antipsychotic medication

Answer 4

bipolar disorder, major depression,

delirium and substance-induced psychosis

Question 5

Antipsychotic medications are broken into two main groups

Answer 5

Classic/Typical (first generation) and Atypical (second

generation – 1990’s onwards)

Question 6

Typical Antipsychotics

Answer 6

• Centrally-acting dopamine receptor antagonist
• The higher the affinity with D2 receptors, the more powerful
the drug
• Better at reducing positive symptoms of schizophrenia than
the negative symptoms
• Alter brain structure (increase basal ganglia volume,
decrease cortical volumes)

Question 7

Major Problem Typical Antipsychotics

Answer 7

• Disrupts other dopaminergic pathways in the brain:
• Extrapyramidal system
• Hypothalamic-pituitary connection regulating hormone
secretion (PROLACTIN levels)

Question 8

• Extrapyramidal system

Answer 8

that modulates voluntary

movements

Question 9

Motor disturbances or extrapyramidal side effects (EPSEs)

Answer 9

• Dystonia
• Pseudo-Parkinsonism
• Akathisia
• Tardive dyskinesia (TD, TDK):

Question 10

Dystonia

Answer 10

involuntary muscle contractions that cause twisting, movement, odd
posture, “look-ups” (oculogyric crisis)

Question 11

• Pseudo-Parkinsonism:

Answer 11

: slowness and rigidity that can mimic parkinsonism (D2

receptor involvement)

Question 12

Akathisia:

Answer 12

involuntary movements that can’t be controlled eg marching in place

Question 13

Tardive dyskinesia (TD, TDK)

Answer 13

facial grimacing, ‘piano fingers’, jaw swinging,

blinking, restlessness

Question 14

Treating EPSEs

Answer 14

Using antimuscarinic drugs (such as benztropine) and/or reducing or stopping
the antipsychotic medication can be effective in reversing dystonia,
pseudoparkinsonism and akathisia
• Tardive dyskinesia doesn’t usually respond to benztropine or to reducing or
stopping antipsychotics - Prevention is the most effective alternative
(indication, efficacy, dose)

Question 15

Commonly Prescribed
Antipsychotics
Typicals:

Answer 15

\:
• Haldol (haloperidol)
• Loxitane (loxapine)
• Mellaril (thioridazine)
• Moban (molindone)
• Navane (thiothixene)
• Prolixin (fluphenazine)
• Serentil (mesoridazine)
• Stelazine (trifluoperazine)
• Trilafon (perphenazine)
• Thorazine (chlorpromazine)

Question 16

Atypicals:

Answer 16

• Abilify (aripiprazole)
• Clozaril (clozapine)
• Geodon
(ziprasidone)
• Risperdal
(risperidone)
• Seroquel
(quetiapine)
• Zyprexa (olanzapine)

Question 17

Atypical Antipsychotics - Developed as a

Answer 17

response to the adverse
effects of Typicals
Atypical antipsychotics may interact with dopamine receptors, but
also appear to produce effects on other systems

Question 18

Atypical Antipsychotics are less prone to

Answer 18

Less prone to produce extra-pyramidal side-effects (EPSEs),

particularly motor disturbances

Question 19

Clozapine

Answer 19

was the first of these
Atypicals, developed in 1958 but then
withdrawn due to the potentially fatal
side-effect of agranulocytosis
(neutropenia) – approved for use 30
years later in treatment-resistant
schizophrenia

Question 20

Neuroleptic Malignant Syndrome (NMS)

Answer 20

NMS is a dangerous adverse effect of antipsychotic medications
of any kind Uncommon, but FATAL if diagnosis and intervention are not RAPID!

Question 21

Typical NMS presentation involves:

Answer 21

Hyperthermia (temp >380C)
• Muscle rigidity (“lead pipe” rigidity)
• PLUS two of the following – diaphoresis, dysphagia,
incontinence, changes in level of consciousness (confusion to
coma), mutism, elevated or labile BP, creatine phosphokinase
(CPK) elevation, tremor or tachycardia

Question 22

Neuroleptic Malignant Syndrome (NMS)

Answer 22

Obviously, treatment must be given URGENTLY!
Immediately cease the offending antipsychotic!!
• Commence medical care
• Correct dehydration and electrolyte imbalance
• Monitor for and respond to symptoms of cardio-respiratory
and renal failure
• Consider the administration of medications to counter
agitation and other symptoms
Alternative antipsychotic treatment must be considered –
returning to the same/different antipsychotic medication
requires medical supervision