psychomotor agitiation

Question 1

typical antipsychotics - name them

Answer 1

haloperidol
chropromazine
prochloperazine

Question 2

indications for typical antipsychotics

Answer 2

• urgent treatment for psychomotor agitation= dangerous or violent behaviour
  2. schizophrenia especially if SE of 2nd gens going to be a problem
  3. Bipolar - acute mania or hypomania
  4. N and V - esp in palliative care setting

Question 3

MOA typical antipsychotics

Answer 3

block d2 receptors.
mesolimbic and mesocortical block = antipsychotic.
nigostriatal path and tuberohyophyseal = SE.

d2r also in chemoreceptor trigger zone so help with N and V.

most sedating. most severe sedation = chlorpromazine.

Question 4

SE typical aantipsychotics

Answer 4

• EP effects; acute dystonia; involuntary parkinson movements

akithusia - inner restlesness

neuroleptic malignant syndrome.

above = early SE

late SE; tardice dyskinesia - repetitive mvoements

other SE

• hypotension
• drowsy
• long QT
• Erectile dysfunction
• hyperprolactinaemia

Question 5

who should you alter the dose of typical antipsychotics for

Answer 5

• elderly
• avoid in dementia
• avoid in parkinsons if possible

Question 6

common interactions with typical antipsychotics -

Answer 6

drugs prolonging QT - amiodarone

- macrolides. can cause torsades du pointes

Question 7

who can prescribe typical antipsychotics for schizophrenia

Answer 7

psychiatrists

Question 8

what typical antipsychotic is most commonly used for intractable hiccups

Answer 8

chlropromazine

Question 9

name atypical antipsychotics

Answer 9

quietapine, olanzapine, risperidone, clozapine

Question 10

indications for atypical antipsychotics

Answer 10

1. urgen psychomotor agitiation
2. schizophrenia if SE from typical too much
3. BP disorder

Question 11

MOA of typical antipsychotics

Answer 11

block d2r as for typicals. but also target negative symptoms due to higher affinity for 5ht2a receptors and looser binsing to d2r (clozapine and quietiapine for looser binding)

Question 12

SE atypical antipsychotics

Answer 12

• sedation
• EP effects but less than first gen.
• metabolic disturbance - weight gain, DM, Lipid changes.
• prolonged QTc = arrhythmias
• risperidone effects tubohypophyseal path = gynaecomastia and sexual dysfunction in men and women.

clozapine - agranulocytosis and rare = myocarditis

Question 13

who should you use atypical antopsychotics carefully in

Answer 13

-CVD patients.

Question 14

who do you not give clozapine to

Answer 14

• severe heart disease

- history of neutropenia

Question 15

interactions of atypicals

Answer 15

• dopamine blocking antiemetics

- drugs that prolong QTC