Psych Medication

Question 1

What is Tardive Dyskinesia

Answer 1

Involuntary repetative movements which occur after years of antipsychotic treatment. 
Jerky, writhing, Spasmodic movements. 
eg. 
Lip smacking / puckering/ pouting
blinking
protruding tongue
swaying truncal movment 
tardive dystonia
vocalisations
grimancing

Question 2

A patient who had been on antipsychotics for a decade has begun to make grimances and stick their tongue out. they do not notice they are doing it and mainly bothers others around them.
What SE are they displaying?

Answer 2

Tardive Dyskinesia

Question 3

Torticolis

Answer 3

Painful asymetrical twisting spasm of the neck

AKA cervical dystonia

Question 4

Opsithotus

Answer 4

Severe spastic hyperextension of neck and back

Question 5

2 other names for “antipsychotics”

Answer 5

neuroleptics

“major tranquilisers”

Question 6

antipsychotics used for

Answer 6

Short term anxiety management
Decrease in positive psychotic symptoms
Prophylaxis between episodes

Question 7

Examples of 1st gen Anti-psychotics

Answer 7

Chlorpromazine
Levopromazine
Haloperidol

Question 8

Pharmacology of 1st Gen anti-psychotics

Answer 8

Non selective Dopamine Blockers

Question 9

Examples of 2nd Gen Anti-psychotics

aka “atypicals”

Answer 9

Clozapine
Olanzapine
Quitiapine
Risperidone

Question 10

Pharmacology of 2nd Gen Anti-psychotics

Answer 10

Selective D1 / D2 / D3 receptor antagonists

Question 11

SE of 1st Gen Anti psychotics

Answer 11

SEDATION 
ANTI-MUSCARINIC EFFECTS
-dry mouth
-constipation
-failure of micturition & urinary retention 
- blurred vision + closed angle glaucoma
EXTRAPYRIMIDAL EFFECTS ++
-parkinsonism
-akathesia
-dystonia
-tardive dyskineia

Question 12

SE of 2nd GEn anti-psychotics

Answer 12

EXTRAPYRIMIDAL EFFECTS
HYPERPROLACTINAEMIA 
-sexual dysfunction
-breast enlargment and galactorhea 
-menstrual disturbance
- osteroporosis 
CARDIOVASCULAR
-weight gain
-prolonged QT, tachycardia & arythmia
-hypOtension
-blood dyscrasia
-venous thromboembolism 
FUNCTIONAL 
-drowsiness / irritation / apathy / excitment / confusion / insomnia / headache / dizzyness 
DERMATOLOGICAL 
-photosensitivity
-contact sensitivity
-rash
-jaundice
-purple pigmentation
-opacification of cornea and lens

Question 13

Serious SE of anti-psychotics

Answer 13

Neuroleptic Malignant Syndrome

Question 14

Baseline tests before initiating anti-psychotic therapy

Answer 14

U&E, 
LFT
FBC - monthly
Lipids
HbA1c - repeat at 6 months

BMI
ECG

Question 15

Annual follow up

Answer 15

U&E, LFT, Lipids, HbA1c, BMI,
+
Prolactin

Question 16

What is Neuroleptic Malignant Syndrome ?

Answer 16

Severe and life threatening reaction to anti-psychotics
0.02% patients
Central D2 Blockade
-> Dopamine depletion in hypothalamus & nigrostriatum
-> impaired Homeostasis
-> muscle breakdown, matabolic acidosis and Leukocytosis

Question 17

Symptoms of NMS?

Answer 17

Hyperthermia >38
Lead pipe rigidity
Altered conciousness
Autonomic dysfunction
-SWEAT
-PALLOR
-TACHY
-LABILE BP
-URINARY INCONTINENCE
-TREMOR

Question 18

Management of NMS

Answer 18

Discontinue drug 
DANTROLENE IV
Supportive measures 
-cooling
-intubate / ventilate
-IVI
-Dialysis 
Measure response in CK, Urinary myoglobin, U&E, ABG, FBC, and coagulation and support for at least 7/7