Schizophrenia

Question 1

Antipsychotics

Answer 1

Potent antagonists of DA receptors acting through the mesolimbic pathway
Causes: psychomotor slowing, emotional quieting, affective indifference, inhibition of aggression

Question 2

Antipsychotic AE

Answer 2

Nigrostriatal AE:
Extrapyramidal symptoms, motor disturbances (DRUG-INDUCED PARKINSONISM)

Tuberohypophyseal AE:
DA antagonists = increased prolactin release = gynaecomastia, amenorrhoea

Other:
Akathisia, drug-induced Parkinsonism, dystonia, tardive dyskinesia, gynaecomastia, amenorrhoea

Sedation, postural hypotension, dry mouth/blurred vision, constipation, weight gain, metabolic effects

Question 3

Chlorpromazine MoA

Answer 3

DA receptor antagonist -> inhibition of positive symptoms of psychosis

Question 4

Chlorpromazine AE

Answer 4

Less extrapyramidal effects (due to less potency at D2 receptors), higher potency at ACh receptors (more sedation and orthostatic hypotension), weight gain, breast engorgement, galactorrhoea, amenorrhoea, loss of libido, osteoporosis

Question 5

Haloperidol MoA

Answer 5

DA receptor antagonist -> inhibits the positive symptoms of psychosis

Question 6

Haloperidol AE

Answer 6

Higher potency at D2 receptors than chlorpromazine (more extrapyramidal effects), lower potency at ACh receptors than haloperidol (less sedation and orthostatic hypotension)

Question 7

Risperidone MoA

Answer 7

DA receptor antagonist -> inhibition of positive symptoms + 5HT2A receptor antagonist -> inhibition of negative symptoms

Question 8

Risperidone AE

Answer 8

Orthostatic hypotension, reflex tachycardia, prolactin release (prolactinoma, T2DM exacerbation), weight gain, insomnia, akathisia, headache, rhinitis, incontinence, sexual dysfunction, sedation

Question 9

Olanzapine MoA

Answer 9

Same as risperidone

Question 10

Olanzapine AE

Answer 10

Little/no extrapyramidal side effects, weight gain, peripheral oedema, hyperglycaemia, dyslipidaemia, increased T2DM risk, orthostatic hypotension, dry mouth, constipation, sedation

Question 11

Clozapine MoA

Answer 11

Same as risperidone

Question 12

Clozapine indications

Answer 12

Resistant schizophrenia, patients who develop extrapyramidal side effects

Question 13

Clozapine AE

Answer 13

Little/no extrapyramidal effects, fatal agranulocytosis, orthostatic hypotension, reflex tachycardia, delayed ejaculation, priapism, GIT hypomotility, seizures, resp. depression, hypersalivation, urinary continence, hyperglycaemia, weight gain, dyslipidaemia, increased T2DM risk

Question 14

Quetiapine MoA

Answer 14

Same as risperidone

Question 15

Quetiapine AE

Answer 15

Same as others - little/no extrapyramidal effects