Psychosis and Mania

Question 1

_____ generation antipsychotics predominantly block D2 receptors

Answer 1

1st generation

Question 2

______ generation antipsychotics are more likley to cause EPSEs

Answer 2

1st generation

Question 3

True or false: Risperidone and Aripiprazole are 1st generation antipsychotics

Answer 3

FALSE - they are 2nd generation (atypicals)

Question 4

What are the four types of EPSEs?

Answer 4

1. Parkinsonian symptoms
2. Dystonia
3. Akathisia
4. Tardive dyskinesia

Question 5

Symptoms of ______ include: hyperthermia, fluctuation consciousness, muscle rigidity, autonomic dysfunction, labile BP

Answer 5

Neuroleptic malignant syndrome

Question 6

True or false: antipsychotics can cause QT prolongation

Answer 6

TRUE

Question 7

If a clozapine dose has been missed for _______ the dose will need to be re-titrated

Answer 7

> 48 hours

Question 8

True or false: clozapine can be used in Parkinson’s disease

Answer 8

TRUE - it is indicated for psychosis in Parkinson’s disease

Question 9

True or false: Carbamazepine can be used for prophylaxis of bipolar disorder

Answer 9

TRUE

Should be used under specialist supervision

Question 10

True or false:

When given to the elderly, reduce the initial antipsychotic dose to half the normal adult dose

Answer 10

TRUE

The elderly are more susceptible to side effects

Question 11

True or false: Aripiprazole increases prolactin causing hyperprolactinaemia

Answer 11

FALSE

Aripiprazole actually reduces prolactin levels because it is a dopamine receptor PARTIAL agonist
(Unlike other antipsychotics that are DA antagonists)

Question 12

How do antipsychotics cause hyperprolactinaemia ?

Answer 12

DA inhibits prolactin release

DA receptor blockade by antipsychotics prevents inhibition = more prolactin released

Question 13

Which antipsychotic is less likely to prolong the QT interval

Answer 13

Aripiprazole

BNF

Question 14

How long should an antipsychotic be tried for before it is deemed ineffective?

Answer 14

4-6 weeks

Question 15

True or false:
Amisulpride and aripiprazole have a low risk of causing diabetes and weight compared to other second generation antipsychotics

Answer 15

TRUE

Question 16

Which 1st generation Antipsychotic drugs are least likely to cause weight gain
(2 points)

Answer 16

sulpiride
trifluoperazine

NB: there are other drugs also but they are not used as often

Question 17

Clozapine monitoring schedule ? (For white cell count)

Answer 17

Weekly for 18 weeks

Fortnightly for up to 1 year

Then monthly

Question 18

Which antipsychotic is known to cause hypersalivation

Answer 18

Clozapine

Treat with antimuscarinics e.g. glycopyrronium

Question 19

What drug is used to treat hypersalivation caused by clozapine

Answer 19

Hyoscine hydrobromide

Question 20

Clozapine dose has to be retitrated if a dose is missed for _____

Answer 20

48 hours

Question 21

Difference between dyskinesia and tardive dyskinesia

Answer 21

Dykinesia is the general term for involuntary movements

Tardive dyskinesia occurs after treatment with antipsychotics and affects the lips, tongue, face and jaw

Question 22

Antipsychotics used for treatment of mania in bipolar disorder?
(4 points)

Answer 22

1. Haloperidol
2. Olanzapine
3. Quetiapine
4. Risperidone

Question 23

Treatment options for depressive episodes associated with bipolar disorder?
(4 points)

Answer 23

1. Fluoxetine AND Olanzapine
2. Olanzapine alone
3. Lamotrigine
4. Quetiapine

Question 24

Which antipsychotics do not require monitoring of prolactin levels
(4 points)

Answer 24

Olanzapine
Aripiprazole
Clozapine
Quetiapine