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Roomies Collab Deck 2: Endocrinology and NeuroPsych > Psychoses and related disorders > Flashcards

Psychoses and related disorders Flashcards

1
Q

Antipsychotic drugs, formerly called ‘(?)’, are also known as neuroleptics

A

major tranquillisers

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2
Q

Antipsychotic drugs, formerly called ‘major tranquillisers’, are also known as (?)

A

neuroleptics

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3
Q

An oral antipsychotic drug should be used in combination with (?) in patients with schizophrenia?

A

Psychological therapy

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4
Q

When choosing an antipsychotic drug to treat schizophrenia, what factors do you need to consider? (5)

A
  1. The potential to cause extrapyramidal symptoms (including akathisia)
  2. Cardiovascular adverse effects
  3. Metabolic adverse effects (including weight gain and diabetes)
  4. Hormonal adverse effects (including increase in prolactin concentration)
  5. Patient and carer preference
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5
Q

How long should a patient receive an antipsychotic drug at an optimal dose before it is deemed ineffective?

A

4-6 weeks

Clozapine: 8-10 weeks

Doses should be started low and slowly titrated up to the minimum effective dose according to patient response and tolerability (optimal dose)

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6
Q

Should you prescribe more than one antipsychotic drug at a time?

A

NO
except in exceptional circumstances (e.g. clozapine augmentation or when changing medication during titration)

Due to increased risk of adverse effects such as extrapyramidal symptoms, QT interval prolongation and sudden cardiac death

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7
Q

Which drug should be offered if schizophrenia is not controlled despite the sequential use of at least 2 different antipsychotic drugs (one of which should be a second-generation antipsychotic drug), each for an adequate duration?

A

Clozapine

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8
Q

When should clozapine be offered to patients with schizophrenia?

A

If not controlled despite the sequential use of at least 2 different antipsychotic drugs (one of which should be a second-generation antipsychotic drug), each for an adequate duration

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9
Q

When should long-acting depot injectable antipsychotic drugs be considered for patients with psychosis and schizophrenia?

A

When it is a clinical priority to avoid non-adherence

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10
Q

The (?)-generation antipsychotic drugs (also known as typical or conventional) act predominantly by blocking dopamine D2 receptors in the brain.

A

first

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11
Q

The first-generation antipsychotic drugs (also known as (?) or conventional) act predominantly by blocking dopamine D2 receptors in the brain.

A

typical

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12
Q

The first-generation antipsychotic drugs (also known as typical or (?)) act predominantly by blocking dopamine D2 receptors in the brain.

A

conventional

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13
Q

The first-generation antipsychotic drugs (also known as typical or conventional) act predominantly by blocking (?) receptors in the brain.

A

dopamine D2

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14
Q

Which generation of antipsychotics is more likely to cause acute extrapyramidal symptoms as a side effect?

A

First-generation

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15
Q

Which generation of antipsychotics is more likely to cause hyperprolactinaemia as a side effect?

A

Frist-generation

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16
Q

First-generation antipsychotic drugs include what 5 subtypes?

A 
Penothiazine derivatives
Butyrophenones
Thioxanthenes 
Diphenylbutylpiperidines
Substituted benzamides
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17
Q

Phenothiazine derivatives are first-generation antipsychotics. Name 7 drugs that fall under this category?

A 
Chlorpromazine hydrochloride
Fluphenazine decanoate
Levomepromazine 
Pericyazine
Prochlorperazine
Promazine hydrochloride
Trifluoperazine
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18
Q

Butyrophenones are first-generation antipsychotics. Name 2 drugs that fall under this category?

A

Benperidol

Haloperidol

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19
Q

Thioxanthenes are first-generation antipsychotics. Name 2 drugs that fall under this category?

A

Flupentixol

Zuclopenthixol

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20
Q

Diphenylbutylpiperidines are first-generation antipsychotics. Name one drug that falls under this category?

A

Pimozide

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21
Q

Substituted benzamides are first-generation antipsychotics. Name one drug that falls under this category?

A

Sulpiride

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22
Q

The (?)-generation antipsychotic drugs (also referred to as atypical) act on a range of receptors in comparison to first-generation antipsychotic drugs

A

second

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23
Q

The second-generation antipsychotic drugs (also referred to as (?)) act on a range of receptors in comparison to first-generation antipsychotic drugs

A

atypical

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24
Q

Which generation of antipsychotic drugs are more associated with side effects such as weight gain and glucose intolerance?

A

Second-generation

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25
Q

Is chlorpromazine hydrochloride a first- or second-generation antipsychotic?

A

First-generation

Subtype: phenothiazine derivative

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26
Q

Is fluphenazine decanoate a first- or second-generation antipsychotic?

A

First-generation

Subtype: phenothiazine derivative

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27
Q

Is levomepromazine a first- or second-generation antipsychotic?

A

First-generation

Subtype: phenothiazine derivative

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28
Q

Is pericyazine a first- or second-generation antipsychotic?

A

First-generation

Subtype: phenothiazine derivative

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29
Q

Is prochlorperazine a first- or second-generation antipsychotic?

A

First-generation

Subtype: phenothiazine derivative

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30
Q

Is promazine hydrochloride a first- or second-generation antipsychotic?

A

First-generation

Subtype: phenothiazine derivative

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31
Q

Is trifluoperazine a first- or second-generation antipsychotic?

A

First-generation

Subtype: phenothiazine derivative

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32
Q

Is benperidol a first- or second-generation antipsychotic?

A

First-generation

Subtype: butyrophenones

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33
Q

Is haloperidol a first- or second-generation antipsychotic?

A

First-generation

Subtype: butyrophenones

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34
Q

Is flupentixol a first- or second-generation antipsychotic?

A

First-generation

Subtype: thioxanthenes

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35
Q

Is zuclophenthixol a first- or second-generation antipsychotic?

A

First-generation

Subtype: thioxanthenes

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36
Q

Is pimozide a first- or second-generation antipsychotic?

A

First-generation

Subtype: diphenylbutylpiperidines

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37
Q

Is sulpiride a first- or second-generation antipsychotic?

A

First-generation

Subtype: substituted benzamides

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38
Q

Is amisulpride a first- or second-generation antipsychotic?

A

Second-generation

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39
Q

Is aripiprazole a first- or second-generation antipsychotic?

A

Second-generation

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40
Q

Is asenapine a first- or second-generation antipsychotic?

A

Second-generation

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41
Q

Is cariprazine a first- or second-generation antipsychotic?

A

Second-generation

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42
Q

Is clozapine a first- or second-generation antipsychotic?

A

Second-generation

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43
Q

Is lurasidone hydrochloride a first- or second-generation antipsychotic?

A

Second-generation

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44
Q

Is olanzapine a first- or second-generation antipsychotic?

A

Second-generation

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45
Q

Is paliperidone a first- or second-generation antipsychotic?

A

Second-generation

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46
Q

Is quetiapine a first- or second-generation antipsychotic?

A

Second-generation

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47
Q

Is risperidone a first- or second-generation antipsychotic?

A

Second-generation

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48
Q

What is the definition of high-dose antipsychotic? (2)

A
  1. Total daily dose of a single antipsychotic drug which exceeds the maximum licensed dose with respect to the age of the patient and the indication being treated
    OR
  2. A total daily dose of two or more antipsychotic drugs which exceeds the maximum licensed dose using the percentage method
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49
Q

Is there robust evidence that high doses of antipsychotic drug treatment is more effective than standard doses for the treatment of schizophrenia?

A

NO

The majority of adverse effects are dose-related and there is clear evidence for a greater side-effect burden with high-dose antipsychotic drug use

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50
Q

The majority of adverse effects associated with antipsychotic treatment are (?)-related

A

dose

There is clear evidence for a greater side-effect burden with high-dose antipsychotic drug use

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51
Q

Antipsychotic polypharmacy and ‘when required’ antipsychotic drug treatment are strongly associated with (?) prescribing

A

high-dose

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52
Q

What is the aim of treatment when prescribing an antipsychotic drug for administration in an emergency situation (e.g. rapid tranquillisation)?

A

To calm and sedate the patient WITHOUT inducing sleep

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53
Q

If you prescribe an antipsychotic drug for administration in an emergency situation (e.g. for rapid tranquillisation) what monitor of the patient is required?

A

Monitor for side-effects and vital signs at least every hour until there are no further concerns about their physical health status

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54
Q

What monitoring is required if a high-dose antipsychotic drug has been given?

A

Monitor the patient every 15 minutes

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55
Q

In elderly patients with dementia, the use of antipsychotic drugs are associated with a small increased risk of (1?) and an increased risk of (2?) or (3?)

A
  1. Mortality
  2. Stroke
  3. Transient ischaemic attack

Elderly patients are also particularly susceptible to postural hypotension

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56
Q

It is recommended that antipsychotic drugs should not be used in elderly patient with dementia, unless they are at risk of (1?) themselves or others, or experiencing (2?), (3?) or (4?) that are causing them severe distress

A
  1. harming
  2. agitation
  3. hallucinations
  4. delusions
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57
Q

How often should treatment be reviewed in an elderly patient with dementia taking an antipsychotic drug?

A

At least every 6 weeks (earlier for in-patients)

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58
Q

Which generation of antipsychotic drugs are most commonly associated with extrapyramidal side effects?

A

First generation

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59
Q

Extrapyramidal side effects of antipsychotic drugs are (?)-related

A

Dose

  • Most likely to occur with high doses of high-potency first-generation antipsychotic drugs
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60
Q

Name 4 types of extrapyramidal side effects of antipsychotic drugs?

A
  • Parkinsonian symptoms
  • Dystonia
  • Akathisia
  • Tardive dyskinesia
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61
Q

Which patients taking antipsychotic drugs do parkinsonian symptoms (including bradykinesia, tremor) most commonly occur in? (2)

A
  • Elderly females

- Those with pre-existing neurological damage (e.g. stroke)

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62
Q

Which patients taking antipsychotic drugs most commonly get dystonia as an extrapyramidal side effect?

A

Young males

Dystonic = uncontrolled muscle spasm in any part of the body

Acute dystonia can appear within hours of starting antipsychotics

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63
Q

Acute dystonia can appear within (?) of starting antipsychotics

A

hours

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64
Q

Akathisia characteristically occurs within (?) to (?) of starting antipsychotic treatment or on dose increase

A

hours to weeks

May be mistaken for psychotic agitation

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65
Q

What is tardive dyskinesia?

A

Abnormal involuntary movements of lips, tongue, face, and jaw

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66
Q

Tardive dyskinesia can develop on (1?)-term or (2?)-dose antipsychotic therapy, or even after (3?)

A
  1. long
  2. high
  3. discontinuation
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67
Q

In some patients tardive dyskinesia can be (reversible/irreversible?)

A

Irreversible

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68
Q

What is the aim of treatment when parkinsonian symptoms are identified in a patient taking an antipsychotic drug?

A

Reduce exposure to high-dose and high-potency antipsychotic drugs

Anti-muscarinic drugs can relieve symptom burden

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69
Q

What class of drugs can be prescribed to relieve symptom burden of parkinsonian symptoms in patients taking antipsychotic drugs?

A

Anti-muscarinic drugs

But they should NOT be routinely prescribed for prophylaxis with antipsychotic drugs

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70
Q

Tardive dyskinesia most commonly occurs in (?) taking antipsychotic drugs

A

elderly females

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71
Q

What is the most serious manifestation of late-onset extrapyramidal side effects from antipsychotic drugs that has no satisfactory treatment?

A

Tardive dyskinesia

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72
Q

Why is hyperprolactinaemia a side effect of most antipsychotic drugs?

A

Dopamine inhibits prolactin release

Antipsychotic drugs block dopamine receptors –> increase in prolactin

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73
Q

Which antipsychotic drug reduced prolactin concentration in a dose-dependent manner because it is a dopamine-receptor partial agonist?

A

Aripiprazole

Second-generation antipsychotic drug used in schizophrenia.

Aripiprazole is a dopamine D2 partial agonist with weak 5-HT1a partial agonism and 5-HT2A receptor antagonism.

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74
Q

Which antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia? (4)

A

Risperidone
Amisulpride
Sulpiride
First-generation antipsychotic drugs

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75
Q

Which antipsychotic drugs is hyperprolactinaemia a very RARE side effect? (6)

A 
Aripiprazole
Asenapine
Cariprazine
Clozapine
Quetiapine
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76
Q

What are the clinical symptoms of hyperprolactinaemia? (6)

A
  • Sexual dysfunction
  • Reduced bone mineral density
  • Menstrual disturbances
  • Breast enlargement
  • Galactorrhoea
  • Increased risk of breast cancer
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77
Q

What are the mechanisms of antipychotic-induced sexual dysfunction:

  • Reduced (1?) transmission and (2?) decrease libido
  • Antimuscarinic effects can cause disorders of arousal
  • Alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men
A
  1. Dopamine

2. Hyperprolactinaemia

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78
Q

What are the mechanisms of antipychotic-induced sexual dysfunction:

  • Reduced dopamine transmission and hyperprolactinaemia decrease (?)
  • Antimuscarinic effects can cause disorders of arousal
  • Alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men
A

libido

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79
Q

What are the mechanisms of antipychotic-induced sexual dysfunction:

  • Reduced dopamine transmission and hyperprolactinaemia decrease libido
  • (?) effects can cause disorders of arousal
  • Alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men
A

Antimuscarinic

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80
Q

What are the mechanisms of antipychotic-induced sexual dysfunction:

  • Reduced dopamine transmission and hyperprolactinaemia decrease libido
  • Antimuscarinic effects can cause disorders of (?)
  • Alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men
A

arousal

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81
Q

What are the mechanisms of antipychotic-induced sexual dysfunction:

  • Reduced dopamine transmission and hyperprolactinaemia decrease libido
  • Antimuscarinic effects can cause disorders of arousal
  • (?) antagonists are associated with erection and ejaculation problems in men
A

Alpha1-adrenoceptor

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82
Q

What are the mechanisms of antipychotic-induced sexual dysfunction:

  • Reduced dopamine transmission and hyperprolactinaemia decrease libido
  • Antimuscarinic effects can cause disorders of arousal
  • Alpha1-adrenoceptor antagonists are associated with (1?) and (2?) problems in men
A
  1. erection

2. ejaculation

83
Q

All antipsychotics can cause sexual dysfunction, but which three antipsychotic drugs have a higher prevalence to cause sexual dysfunction?

A

Risperidone
Haloperidol
Olanzapine

84
Q

All antipsychotics can cause sexual dysfunction, but which two antipsychotic drugs have the lowest risk of cause sexual dysfunction?

A

Aripiprazole

Quetiapine

85
Q

Antipsychotic drugs are associated with cardiovascular side effects such as (1?), (2?), and (3?)

A
  1. tachycardia
  2. arrhythmias
  3. hypotension

QT-interval prolongation is a particular concern with pimozide

86
Q

With which antipsychotic drug is QT-interval prolongation a particular concern?

87
Q

The risk of QT-interval prolongation is higher in which mode of administration of antipsychotic drugs?

A

IV

Overall risk is probably dose-related but there is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum.

88
Q

Which antipsychotic drugs have a low tendency to prolong the QT interval? (11)

A
  1. Aripiprazole
  2. Asenapine
  3. Clozapine
  4. Flupentixol
  5. Fluphenazine decanoate
  6. loxapine
  7. Olanzapine
  8. Paliperidone
  9. Prochlorperazine
  10. Risperidone
  11. Sulpiride
89
Q

Postural hypotension is a common cardia side-effect of antipsychotic drugs, when does it usually occur?

A

Acutely during the initial dose titration

But it can also be a chronic problem

90
Q

Which second-generation antipsychotics are most likely to cause postural hypotension? (2)

A

Clozapine

Quetiapine

91
Q

What can you do to minimise the risk of postural hypotension when starting a patient on antipsychotic drugs?

A

Slow dose titration

92
Q

Which metabolic disorder is associated with schizophrenia?

A

Insulin resistance and diabetes

The risk of diabetes is probably increased in all patients with schizophrenia who take antipsychotic drugs

93
Q

Which generation of antipsychotic drugs is more likely to cause diabetes?

A

Second-generation

Some evidence suggests first-generation antipsychotic drugs are less likely to cause diabetes than second-generation antipsychotic drugs.

94
Q

Which first-generation antipsychotic drugs have the lowest risk of causing diabetes? (2)

A

Fluphenazine decanoate

Haloperidol

95
Q

Which second-generation antipsychotic drugs have the lowest risk of causing diabetes? (2)

A

Amisulpride

Aripiprazole

96
Q

Which antipsychotic drugs most commonly cause weight gain? (2)

A

Clozapine

Olanzapine

97
Q

Which antipsychotic drugs are least likely to cause weight gain? (7)

A
  1. Amisulpride
  2. Asenapine
  3. Cariprazine
  4. Haloperidol
  5. Lurasidone hydrochloride
  6. Sulpiride
  7. Trifluoperazine
98
Q

What is a rare but potentially fatal side-effect of all antipsychotic drugs?

A

Neuroleptic malignant syndrome

99
Q

What are the signs and symptoms of neuroleptic malignant syndrome? (7)

A
  1. Hyperthermia
  2. Fluctuating levels of consciousness
  3. Muscle rigidity
  4. Fever
  5. Tachycardia
  6. Labile blood pressure
  7. Sweating
100
Q

Name two drugs that have been used for the treatment of neuroleptic malignant syndrome?

A

Bromocriptine

Dantrolene

101
Q

When should weight be measured when a patient begins treatment with antipsychotic drugs?

A
  1. Baseline
  2. Weekly for 6 weeks
  3. At 12 weeks
  4. At 1 year
  5. Yearly
102
Q

When should fasting blood glucose be measures when a patient begins on antipsychotic drugs?

A
  1. Baseline
  2. 12 weeks
  3. 1 year
  4. Yearly
103
Q

When should HbA1c be measured in a patient that begins on antipsychotic drugs?

A
  1. Baseline
  2. 12 weeks
  3. 1 year
  4. Yearly
104
Q

When should blood lipid concentrations be measured in a patient starting on antipsychotic drugs?

A
  1. Baseline
  2. 12 weeks
  3. 1 year
  4. Yearly
105
Q

When should prolactin concentrations be measured in a patient starting on antipsychotic drugs?

106
Q

What investigation may be required prior to initiating antipsychotic drugs if physical examination identifies cardiovascular risk factors, if personal history of cardiovascular disease, or if the patient is being admitted as an inpatient?

107
Q

When should blood pressure be measured in a patient starting on antipsychotic drugs?

A
  1. Baseline
  2. 12 weeks
  3. 1 year
  4. Yearly
108
Q

Prior to starting a patient on antipsychotic drugs, what needs to be measured? (10)

A
  1. Weight
  2. Fasting blood glucose
  3. HbA1c
  4. Blood lipid concentration
  5. Prolactin concentration
  6. Blood pressure
  7. ECG (may be required)
  8. FBC
  9. Urea and electrolytes
  10. LFTs
109
Q

What needs to be measured yearly in patients taking antipsychotic drugs? (9)

A
  1. Weight
  2. Fasting blood glucose
  3. HbA1c
  4. Blood lipid concentration
  5. Prolactin concentration
  6. Blood pressure
  7. FBC
  8. Urea and electrolytes
  9. LFTs
110
Q

Which generation of antipsychotic depot injections give rise to a higher incidence of adverse-effects such as extrapyramidal reactions?

A

First-generation antipsychotic depot injections

111
Q

Name 4 second-generation antipsychotic depot injections in which extrapyramidal reactions occur less frequently?

A

Aripiprazole
Paliperidone
Risperidone
Olanzapine embonate

112
Q

Which first-generation antipsychotic depot injection may be more effective in preventing relapses than other first-generation antipsychotic depot preparations?

A

Zuclopenthixol decanoate

113
Q

Second-generation antipsychotic drug:

(drug?) is a selective dopamine receptor antagonist with high affinity for mesolimbic D2 and D3 receptors

A

Amisulpride

114
Q

Second-generation antipsychotic drug:

Amisulpride is a selective (?) receptor antagonist with high affinity for mesolimbic D2 and D3 receptors

115
Q

Second-generation antipsychotic drug:

Amisulpride is a selective dopamine receptor (?) with high affinity for mesolimbic D2 and D3 receptors

A

antagonist

116
Q

Second-generation antipsychotic drug:

Amisulpride is a selective dopamine receptor antagonist with high affinity for (?) D2 and D3 receptors

A

mesolimbic

117
Q

Second-generation antipsychotic drug:

Amisulpride is a selective dopamine receptor antagonist with high affinity for mesolimbic (?) and (?) receptors

118
Q

What are the indications for the use of the second-generation antipsychotic drug amisulpride? (2)

A
  1. Acute psychotic episode in schizophrenia

2. Schizophrenia with predominantly negative symptoms

119
Q

What are the contraindications to the use of the second-generation antipsychotic drug amisulpride? (4)

A
  1. CNS depression
  2. Comatose states
  3. Phaeochromocytoma
  4. Prolactin-dependent tumours
120
Q

Second-generation antipsychotic drug:

(?) is a dopamine D2 partial agonist with weak 5-HT1a partial agonism and 5-HT2A receptor antagonism

A

Aripiprazole

121
Q

Second-generation antipsychotic drug:

Aripiprazole is a (?) partial agonist with weak 5-HT1a partial agonism and 5-HT2A receptor antagonism

A

dopamine D2

122
Q

Second-generation antipsychotic drug:

Aripiprazole is a dopamine D2 partial agonist with weak (?) partial agonism and 5-HT2A receptor antagonism

123
Q

Second-generation antipsychotic drug:

Aripiprazole is a dopamine D2 partial agonist with weak 5-HT1a partial agonism and (?) receptor antagonism

124
Q

Doses of aripiprazole (second-generation antipsychotic) should be (?) if concurrent use of potent inducers of CYP3A4

125
Q

Doses of aripiprazole (second-generation antipsychotic) should be (?) if concurrent use of potent inhibitors of CYP3A4 or CYP2D6

126
Q

Doses of aripiprazole (second-generation antipsychotic) should be doubled if concurrent use of potent (?) of CYP3A4

127
Q

Doses of aripiprazole (second-generation antipsychotic) should be inhibitors if concurrent use of potent (?) of CYP3A4 or CYP2D6

A

inhibitors

128
Q

What is the indication for the use of the second-generation antipsychotic drug asenapine?

A

Moderate to severe manic episodes associated with bipolar disorder, as monotherapy or combination therapy
- Sublingual administration: 5 mg twice daily, increased if necessary to 10 mg twice daily, adjusted according to response

129
Q

What is the indication for the use of the first-generation antipsychotic drug benperidol?

A

Control of deviant antisocial sexual behaviour

130
Q

What are the contraindications for the use of the first-generation antipsychotic drug benperidol? (3)

A

CNS depression
Comatose states
Phaechromocytoma

131
Q

What is the indication for the use of the second-generation antipsychotic drug cariprazine?

A

Schizophrenia

- Oral: 1.5 mg once daily, increased in steps of 1.5 mg if required; maximum 6 mg per day

132
Q

Which lifestyle change may require a dose adjustment of the first-generation antipsychotic drug chlorpromazine hydrochloride?

A

Smoking (starting or stopping during treatment)

133
Q

What are 4 common side effects of the first-generation antipsychotic drug chlorpromazine hydrochloride?

A

Anxiety
Glucose tolerance impaired
Mood altered
Muscle tone increased

134
Q

What are the indications for the use of the first-generation antipsychotic drug chlorpromazine hydrochloride? (7)

A
  1. Schizophrenia and other psychoses
  2. Mania
  3. Short-term adjunctive management of severe anxiety
  4. Psychomotor agitation, excitement, and violent or dangerously impulsive behaviour
  5. Intractable hiccup
  6. Relief of acute symptoms of psychoses (under expert supervision)
  7. Nausea and vomiting in palliative care (where other drugs have failed or are not available)
135
Q

Second-generation antipsychotic drug:

(?) is a dopamine D1, dopamine D2, 5-HT2A, alpha1-adrenoceptor, and muscarinic-receptor antagonist

136
Q

Second-generation antipsychotic drug:

Clozapine is a (1?), (2?), (3?), (4?), and (5?) antagonist

A
  1. Dopamine D1
  2. Dopamine D2
  3. 5-HT2A
  4. Alpha1-adrenoceptor
  5. Muscarinic-receptor
137
Q

Second-generation antipsychotic drug:

Clozapine is a dopamine D1, dopamine D2, 5-HT2A, alpha1-adrenoceptor, and muscarinic-receptor (?)

A

antagonist

138
Q

What are the 2 indications for the use of the second-generation antipsychotic drug clozapine?

A
  1. Schizophrenia in patients unresponsive to, or intolerant of, conventional antipsychotic drugs
  2. Psychosis in Parkinson’s disease
139
Q

What is the concern if patients taking the second-generation antipsychotic drug clozapine develop constipation?

A

Impairment of intestinal peristalsis

140
Q

In which clinical situations should you monitor blood concentrations of clozapine for toxicity in patients taking this second-generation antipsychotic drug?

A
  1. Patient stops smoking or switches to an e-cigarette
  2. Concomitant medicines may interact to increase blood clozapine levels
  3. A patient has pneumonia or other serious infection
  4. Reduced clozapine metabolism is suspected
  5. Toxicity is suspected
141
Q

What are the contraindications to the use of clozapine (second-generation antipsychotic drug)? (11)

A
  1. Alcoholic and toxic psychoses
  2. Bone-marrow disorders
  3. Coma
  4. Drug intoxication
  5. History of agranulocytosis
  6. History of circulatory collapse
  7. History of neutropenia
  8. Paralytic ileus
  9. Severe cardiac disorders (e.g. myocarditis)
  10. Severe CNS depression
  11. Uncontrolled epilepsy
142
Q

Why must you closely monitor leucocyte and differential blood counts in patients taking clozapine (second-generation antipsychotic drug)?

A

Risk of neutropenia and agranulocytosis

143
Q

When should leucocyte and differential blood counts be monitored in patients taking clozapine (second-generation antipsychotic drug)? (5)

A
  1. Prior to starting (must be normal)
  2. Every week for 18 weeks
  3. Then at least every 2 weeks
  4. If continued and blood count stable after 1 year - at least every 4 weeks
  5. 4 weeks after discontinuation
144
Q

Discontinue clozapine (second-generation antipsychotic drug) if leucocyte count below (1?)/mm^3 or if absolute neutrophil count below (2?)/mm^3

A
  1. Leucocyte count below 3000/mm^3

2. Absolute neutrophil count below 1500/mm^3

145
Q

In patients taking clozapine (second-generation antipsychotic drug) when does the side effect of fatal myocarditis most commonly occur?

A

In the first 2 months

146
Q

Which lifestyle change may require a dose adjustment of the second-generation antipsychotic drug clozapine?

A

Smoking (starting or stopping during treatment)

147
Q

What needs to be monitored regularly in patients taking clozapine (second-generation antipsychotic drug)? (5)

A
  1. Leucocyte and differential blood counts
  2. Blood lipids
  3. Weight
  4. Fasting blood glucose
  5. Prolactin (for all antipsychotics)
148
Q

Why do we not abruptly withdraw clozapine?

A

Risk of rebound psychosis

On planned withdrawal reduce dose over 1-2 weeks to avoid rebound psychosis

149
Q

What are the indications for the use of the first-generation antipsychotic drug flupentixol? (2)

A
  1. Schizophrenia and other psychoses, particularly with apathy and withdrawal but not mania or psychomotor hyperactivity
  2. Depressive illness
150
Q

For a patient with schizophrenia or other psychoses, which symptoms may they have that you would consider treatment with flupentixol (first-generation antipsychotic drug)?

A

Apathy
Withdrawal

NOT mania or psychomotor hyperactivity

151
Q

Second-generation antipsychotic drug:

(?) is a dopamine D1, D2, D4, 5-HT2, histamine-1, and muscarinic-receptor antagonist

A

Olanzapine

152
Q

Second-generation antipsychotic drug:

Olanzapine is a (1?), (2?), (3?), and (4?)-receptor antagonist

A
  1. Dopamine D1, D2, D4
  2. 5-HT2
  3. Histamine-1
  4. Muscarinic
153
Q

Second-generation antipsychotic drug:

Olanzapine is a dopamine D1, D2, D4, 5-HT2, histamine-1, and muscarinic-receptor (?)

A

antagonist

154
Q

What are the indications for the use of olanzapine (second-generation antipsychotic drug)? (5)

A
  1. Schizophrenia
  2. Combination therapy for mania
  3. Preventing recurrence in bipolar disorder
  4. Monotherapy for mania
  5. Control of agitation and disturbed behaviour in schizophrenia or mania
155
Q

Which lifestyle change may require a dose adjustment of the second-generation antipsychotic drug olanzapine?

A

Smoking (starting or stopping during treatment)

156
Q

What needs to be monitored regularly in a patient taking the second-generation antipsychotic drug olanzapine? (4)

A
  1. Blood lipids
  2. Weight
  3. Fasting blood glucose
  4. Prolactin (for all antipsychotic drugs)
157
Q

(?) (deep IM injection) is used for maintenance in schizophrenia in patients tolerant to olanzapine by mouth

A

Olanzapine embonate

158
Q

Olanzapine embonate ((mode of administration?)) is used for maintenance in schizophrenia in patients tolerant to olanzapine by mouth

A

deep IM injection

159
Q

Olanzapine embonate (deep IM injection) is used for maintenance in schizophrenia in patients (tolerant/intolerant?) to olanzapine by mouth

160
Q

What are the risks when olanzapine is used during the third trimester of pregnancy? (3)

A

Neonatal lethargy
Tremor
Hypertonia

Olanzapine can only be used during pregnancy if benefit outweights risk

161
Q

After a patient has a deep IM injection of olanzapine embonate (second-generation antipsychotic depot preparation), how long do you need to monitor the patient for?

A

At least 3 hours after injection

162
Q

Second-generation antipsychotic drug:

(?) is a metabolite of risperidone

A

Paliperidone

163
Q

Second-generation antipsychotic drug:

Paliperidone is a metabolite of (?)

A

Risperidone

164
Q

What are the indications for use of the second-generation antipsychotic drug paliperidone? (2)

A
  1. Schizophrenia

2. Psychotic or manic symptoms of schizoaffective disorder

165
Q

What are the two mode of administrations of the second-generation antipsychotic drug paliperidone?

A
  1. Oral

2. Deep IM injection (second-generation antipsychotic depot preparation)

166
Q

What are the indications for the use of the first-generation antipsychotic drug pericyazine? (3)

A
  1. Schizophrenia
  2. Psychoses
  3. Short-term adjunctive management of severe anxiety, psychomotor agitation, and violent or dangerously impulse behaviour
167
Q

What are the three contraindications to the use of the first-generation antipsychotic drug pericyazine?

A
  1. CNS depression
  2. Comatose states
  3. Phaeochromocytoma
168
Q

What are the indications of the first-generation antipsychotic drug pimozide? (3)

A
  1. Schizophrenia
  2. Monosymptomatic hypochondriacal psychosis
  3. Paranoid psychosis
169
Q

What are the contraindications to the use of the first-generation antipsychotic drug pimozide? (5)

A
  1. CNS depression
  2. Comatose states
  3. History of arrhythmias
  4. History or family history of congenital QT prolongation
  5. Phaeochromocytoma
170
Q

What are the common side effects of the first-generation antipsychotic drug pimozide? (9)

A
  1. Appetite decreased
  2. Depression
  3. Headache
  4. Hyperhidrosis
  5. Hypersalivation
  6. Restlessness
  7. Sebaceous gland overactivity
  8. Urinary disorders
  9. Vision blurred
171
Q

What needs to be monitored in patients taking pimozide (first-generation antipsychotic drug) due to reports of sudden unexplained death?

172
Q

What seen on an ECG would make you review, withdraw or dose reduce the first-generation antipsychotic drug pimozide?

A

QT interval prolongation

173
Q

Can the first-generation antipsychotic drug pimozide be used in combination with other antipsychotic drugs (including depot preparations)?

A

NO

Due to risk of QT interval prolongation

174
Q

Can the first-generation antipsychotic drug pimozide be used in combination with a tricyclic antidepressant?

A

NO

Due to risk of QT interval prolongation

175
Q

What are the indications for the use of first-generation antipsychotic drug prochlorperazine?

A
  1. Schizophrenia and other psychoses
  2. Mania
  3. Short-term adjunctive management of severe anxiety
  4. Nausea and vomiting, acute attack
  5. Nausea and vomiting, prevention
  6. Labyrinthine disorders
  7. Nausea and vomiting in previously diagnosed migraine
  8. Acute migraine
176
Q

First-generation antipsychotic drug:

1 mg prochlorperazine (1?) is approximate to 1 mg prochlorperazine (2?)

A
  1. Maleate
  2. Mesilate

Doses are expressed as prochlorperazine maleate or mesilate

177
Q

First-generation antipsychotic drug:

(?) mg prochlorperazine maleate is approximate to 1 mg prochlorperazine mesilate

A

1

Doses are expressed as prochlorperazine maleate or mesilate

178
Q

First-generation antipsychotic drug:

1 mg prochlorperazine maleate is approximate to (?) mg prochlorperazine mesilate

A

1

Doses are expressed as prochlorperazine maleate or mesilate

179
Q

What are the contraindications of the first-generation antipsychotic drug prochlorperazine? (4)

A
  1. Avoid oral route in child under 10 kg
  2. CNS depression
  3. Comatose states
  4. Phaeochromocytoma
180
Q

What are the indications for the use of the first-generation antipsychotic drug promazine hydrochloride? (2)

A
  1. Short-term adjunctive management of psychomotor agitation

2. Agitation and restlessness in elderly

181
Q

What are the contraindications to the use of the first-generation antipsychotic drug promazine hydrochloride? (3)

A

CNS depression
Comatase states
Phaeochromocytoma

182
Q

Second-generation antipsychotic drug:

(?) is a dopamine D1, dopamine D2, 5-HT2, alpha1-adrenoceptor, and histamine-1 receptor antagonist

A

Quetiapine

183
Q

Second-generation antipsychotic drug:

Quetiapine is a (1?), (2?), (3?), (4?), and (5?) receptor antagonist

A
  1. Dopamine D1
  2. Dopamine D2
  3. 5-HT2
  4. Alpha1-adrenoceptor
  5. Histamine-1
184
Q

Second-generation antipsychotic drug:

Quetiapine is a dopamine D1, dopamine D2, 5-HT2, alpha1-adrenoceptor, and histamine-1 receptor (?)

A

Antagonist

185
Q

What are the indications for the use of the second-generation antipsychotic drug quetiapine? (5)

A
  1. Schizophrenia
  2. Treatment of mania in bipolar disorder
  3. Treatment of depression in bipolar disorder
  4. Prevention of mania and depression in bipolar disorder
  5. Adjunctive treatment of major depression
186
Q

Second-generation antipsychotic drug:

(?) is a dopamine D2, 5-HT2A, alpha1-adrenoceptor, and histamine-1 receptor antagonist

A

Risperidone

187
Q

Second-generation antipsychotic drug:

Risperidone is a (1?), (2?), (3?), and (3?) receptor antagonist

A
  1. Dopamine D2
  2. 5-HT2A
  3. Alpha1-adrenoceptor
  4. Histamine-1
188
Q

Second-generation antipsychotic drug:

Risperidone is a dopamine D2, 5-HT2A, alpha1-adrenoceptor, and histamine-1 receptor (?)

A

antagonist

189
Q

What are the indications for the use of the second-generation antipsychotic drug risperidone?

A
  1. Schizophrenia and other psychoses
  2. Acute and chronic psychosis
  3. Mania
  4. Short-term treatment (up to 6 weeks) of persistent aggression in patients with moderate to severe Alzheimer’s dementia unresponsive to non-pharmacological interventions and when there is a risk of harm to self or others
190
Q

What are the two modes of administration of risperidone (second-generation antipsychotic drug)?

A
  1. Oral

2. Deep IM injection

191
Q

What is the duration that risperidone (second-generation antipsychotic drug) can be used for treatment of persistent aggression in patients with moderate to severe Alzheimer’s dementia unresponsive to non-pharmacological interventions and when there is a risk of harm to self or others?

A

Up to 6 weeks

192
Q

What are the indications for the use of the first-generation antipsychotic drug sulpiride? (2)

A
  1. Schizophrenia with predominantly negative symptoms

2. Schizophrenia with mainly positive symptoms

193
Q

What are the contraindications for the first-generation antipsychotic drug sulpiride? (3)

A

CNS depression
Comatase states
Phaeochromocytoma

194
Q

(?) (first-generaton antipsychotic drug) may aggravate symptoms of aggression, agitation and excitation (even in low doses)

195
Q

Sulpiride (first-generaton antipsychotic drug) may aggravate symptoms of (?), (?) and (?) (even in low doses)

A

aggression
agitation
excitation

196
Q

Do you need to monitor blood pressure in patients taking sulpiride (first-generation antipsychotic drug)?

A

NO

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

197
Q

What are the indications for the use of the first-generation antipsychotic drug trifluoperazine?

A
  1. Schizophrenia and other psychoses
  2. Short-term adjunctive management of psychomotor agitation, excitement, and other violent or dangerously impulsive behaviour
  3. Short-term adjunctive management of severe anxiety
  4. Severe nausea and vomiting
198
Q

What are the contraindications to the use of the first-generation antipsychotic drug trifluoperazine? (3)

A

CNS depression
Comatose states
Phaeochromocytoma

199
Q

Do you need to regularly monitor BP in a patient taking trifluoperazine (first-generation antipsychotic drug)?

A

NO

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

200
Q

What are the indications for the use of the first-generation antipsychotic drug zuclopenthixol? (1)

A

Schizophrenia and other psychoses

201
Q

What are the contraindicatons for the use of the first-generation antipsychotic drug zuclopenthixol? (5)

A
  1. Apathetic states
  2. CNS depression
  3. Comatose states
  4. Phaeochromocytoma
  5. Withdrawn states
202
Q

What is the indication for the use of the first-generation antipsychotic depot preparation zuclopenthixol decanoate?

A

Maintenance in schizophrenia and paranoid psychoses

- deep IM injection

203
Q

Which subtype of the first-generation antipsychotics less depression of consciousness and respiration than other sedatives following an overdose?

A

Phenothiazines

  • chlorpromazine hydrochloride
  • fluphenazine decanoate
  • levomepromazine
  • pericyazine
  • prochlorperazine
  • promazine hydrochloride
  • trifluoperazne

Roomies Collab Deck 2: Endocrinology and NeuroPsych (49 decks)

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