Psychopharmacology - Antipsychotics

Question 1

Classes of mood stabilisers

Answer 1

• Lithium
• Anticonvulsants
• Antipsychotics

Question 2

Lithium uses

Answer 2

• Bipolar disorder
• Mania

Question 3

Lithium side effects

Answer 3

• Common
  
  • Tremor
  • Dirrhoea
  • Increased appetite
• Those that require blood test monitoring
  
  • Nephrogenic diabetes insipidus
  • Hypothyroidism
• In overdose
  
  • Convulsions
  • Coma
  • Death
• Teratogenic
  
  • Ebstein’s abnormality
• Special points
  
  • Narrow therapeutic index
  • Monitor serum lithium concentration

Question 4

Anticonvulsants

Answer 4

• Valproic acid
• Carbamazepine
• Lamotrigine

Question 5

Valproic acid uses

Answer 5

• Valproic acid is as effective as lithium in mania prophylaxis but is not as effective in depressive prophalaxis
• Better tolerated than lithium

Question 6

What suppliment should be given with valproic acid?

Answer 6

Folic acid supplement in women as there is an increased risk of neural tube defect secondary to reduction in folic acid.

Question 7

Carbamazepine uses

Answer 7

• First line agent for acute mania and mania prophylaxis
• Indicated for rapid cyclers and mixed patients

Question 8

Side effect to look out for when taking lamotrigine.

Answer 8

If any rash develops stop use immediately.

A rash may indicate the most severe side effects: toxic epidermal necrolysis and Stevens Johnson Syndrome.

Question 9

Tuberofundibular:

• Pathway
• Side effects caused when dopamine levels reduced.

Answer 9

• From the hypothalamus to the anterior pituitary
• Hyperprolactinaemia - as dopamine inhibits prolactin release

Question 10

Nigrostriatal

1. Pathway
2. Pathway involved in:
3. Dopamine effect on acetylcholine activity:
4. Side effects of interfering with this pathway

Answer 10

1. Projects from the dopaminergic cell bodies in the substantia nigra to the basal ganglia
2. Movememt regulation
3. Dopamine supresses acetylcholine activity
4. Parkinsonian movements

Question 11

Mesocortical

1. Pathway
2. Associated symptoms
3. Dopamine problem in psychotic patient

Answer 11

1. Projects from the brain stem to the cerebral cortex
2. Negative symptoms and cognitive disorders
3. Too little dopamine

Question 12

Mesolimbic

1. Pathway
2. Problem associated
3. Dopamine problem in psychotic patients

Answer 12

1. Projects from the dopaminergic cell bodies in the ventral tegmentum to the limbic system
2. Positive symptoms
3. Too much dopamine

Question 13

What are the classes of antipsychotics?

Answer 13

• Typical
• Atypical

Question 14

Examples of typical antisychotics.

Answer 14

• Haloperidol
• Chlorpomazine
• Thioridazine

Question 15

Typical antipsychotics mechanism of action.

Answer 15

Blocks D2 receptors thereby increasing concentration of cAMP1.

Question 16

Typical antipsychotics uses

Answer 16

• Schizophrenia
• Psychosis
• Mania
• Tourette’s syndrome

Question 17

Typical antipsychotics side effects

Answer 17

• D2 receptors affect several pathways
  
  • Tuberoinfundibular pathway: galactorrhoea, ammenorrhoea, hyperprolactinaemia
  • Nigrostratial pathway: extrapyrimidal side effects (EPSE)
  • Mesocortical pathway: increases negative symptoms
  • Mesolimbic pathway: decreases positive symptoms
• alpha 2 antagonist (anti-adrenergic):
  
  • postural hypotension
• anti-muscarinic
  
  • dry mouth
  • constipation
  • memory deficits and potentially delirium
• anti-histaminergic
  
  • weight gain
  • drowsiness
• Neuroleptic malignant syndrome (NMS)
  
  • life threatening reaction that can be caused by antipsychotic drugs

Question 18

Extrapyramidal side effects

Answer 18

TRAP

• Tardive dyskinesia
• Restless lower limbs (akathesia)
• Acute dystonia
• Parkinsonisms

Question 19

Symptoms of NMS

Answer 19

• Fever
• Muscle rigidity
• Altered mental status
• Autonomic dysfunction

Question 20

Examples of atypical antipsychotics.

Answer 20

• Olanzapine
• Clozapine
• Quetiapine
• Risperidone
• Aripiprazole

Question 21

Atypical antipsychotic mechanism of action

Answer 21

Block D2 receptors thereby increasing concentration of cAMP1 receptors, but are also effective in blocking 5-HT2, alpha 1 and H1 receptors.

Question 22

Uses of atypical antipsychotics.

Answer 22

• Schizophrenia
• Olanzapine
  
  • anxiety disorders
  • OCD
  • mania
  • depression
  • Tourette’s syndromes

Question 23

Atypical antipsychotics side effects.

Answer 23

Similar to those of typical antipsychotics however there are fewer EPSE and anticholinergic side effects.

However they are more likely to cause weight gain and sedation.

Question 24

Treatment for extrapyramidal side effects

Answer 24

• Anticholinergics such as benztropine
• Dopamine facilitators such as Amantadine
• Beta-blockers such as propranolol

Question 25

Anxiolytic example

Answer 25

Buspirone

Question 26

Anxiolytic use

Answer 26

• Generalised anxiety disorder (often in combination with SSRI or SNRI)
• Substance related disorders and their withdrawal
• Insomnias and parasominas

Question 27

Anxiolytic cons

Answer 27

• Takes 2 weeks for patients to notice results
• Will not reduce anxiety in patients who are used to taking benzodiazapines as there is no sedative effect to take the edge off

Question 28

Benzodiazapine uses

Answer 28

• Anxiety disorders
• Insomnia and parasomnias
• Alcohol withdrawal

Question 29

Side effects of benzodiazapines

Answer 29

• Somnolence
• Cognitive deficits
• Amnesia
• Disinhibition
• Tolerance
• Dependence