Schizophrenia

Question 1

What are antipsychotics used for?

Answer 1

Used to calm disturbed patients

Used to stabilise mood aswell

Question 2

Positive and negative symptoms

Answer 2

Positive - thought disorder, hallucinations, delusions

Negative - Social withdrawal, Apathy (lack of enthusiasm)

Question 3

Time frame for deeming antipsychotics effective

Answer 3

4 to 6 weeks

Question 4

1st generation and 2nd generation side effects

Answer 4

1st -
- Act mainly by blocking D2 receptors
- Cause a range of SE, especially EPSE and elevated prolactin

2nd - Act on a variety of receptors, hence less typical side effects- more metabolic side effects
- Better at treating negative symptoms of schizophrenia

Question 5

What do 1st generations end in

Answer 5

Azines/ol

Question 6

What do 2nd generations end in

Answer 6

Apine/one

Question 7

What can 2 or more schizophrenic drugs lead to

Answer 7

QT prolongation, cardiac issues - use ECG to rule out issues

Question 8

What is the dosage like for emergency IM

Answer 8

lower dose as no first pass metabolism

Question 9

What can it lead to in elderly patients?

Answer 9

Postural hypotension

Question 10

What is used in last resort

Answer 10

Clozapine

Question 11

If people are not compliant, what can be used

Answer 11

Depot

Question 12

What are some side effects of 1st generation

Answer 12

Acute psuedoparkinsonism (tremors, rigidity) - give antimuscarinics like procyclidine

Acute dystonia = procyclidine

Acute akathisia (inner restlessness) - discontinue

Chronic tardive dyskinesia (rhythmic involuntary movements) - switch to an alternative

Question 13

Side effects of 2nd generation - hyperprolactinemia

Answer 13

Risperidone, amisulpride (RA)

Question 14

Side effects of 2nd generation - sexual dysfunction

Answer 14

Haloperidol, olanzapine, riperidone (HOR)

Question 15

Side effects of 2nd generation - hyperglycaemia

Answer 15

Clozapine, olanzapine, quetiapine, risperidone

(COQR)

Question 16

Side effects of 2nd generation - postural hypotension

Answer 16

Clozapine, chlorpromazine, quetiapine (CQC)

Question 17

What are some monitoring required with antipsychotics

Answer 17

Full blood count and U+Es - at the start then annually

Blood lipids + weight - baseline, at 3 months then yearly

Fasting blood glucose at baseline- 4-6 months, then yearly

Blood pressure and ECG

Prolactin - baseline, 6 months, yearly

Question 18

What is the main thing with pimozide

Answer 18

ECG required - real risk of sudden death and QTC prolongation

Question 19

Main points with chlorpromazine

Answer 19

Risk of acute dystonic reactions like facial and skeletal muscle spasms

Contact sensitisation - tablets should be handled with care and avoid direct contact

Question 20

Main points with clozapine

Answer 20

Agranulocytosis - blood

Keep eye out for infections

Intestinal obstruction

Hypersalivation (kwells)

Keep an eye out if stop smoking

Question 21

Main points with olanzapine

Answer 21

Weight gain

CNS and respiratory depression

Question 22

What should be monitored with olanzapine IM

Answer 22

BP, pulse and respiratory rate should be monitored for at least 4 hours after IM