Type of antipsychotic medication

Question 1

How do antipsychotics work
What are the 2 classes
-how do they differ

Answer 1

Block dopamine receptors (occasionally seretonin receptors)
-decrease positive symptoms of psychosis

1st gen ones act on D receptors in many areas => worsen negative symptoms

• lack of emotions, withdrawal
• social withdrawal

2nd gen ones act on D2 and seretonin receptos in mesocortical pathway => reduces negative symptoms

Question 2

When are they used

Answer 2

Psychosis associated with

• acute mania
• bipolar disorder
• anxiety, depression
• OCD

Question 3

What are the side effects of high potency, 1st gen antipsychotics

• name some common ones
• how would you manage tardive dyskinesia

Answer 3

Extrapyramidal symptoms/drug induced movement disorders

• akathisia - movements associated with restlessness
• dystonia - involuntary painful muscle contractions
• parkinsonism
• tardive dyskinesia - uncontrollable facial movements

Neuroleptic malignant syndrome
-high fever, confusion, rigid muscle

Haloperidol, trifluoperazine, fluphenazine

Short term procyclidine, stop antipsychotic

Question 4

What are the side effects of low potency 1st gen psychotics

-name some common ones

Answer 4

Dry mouth
Sedation
Constipation
Dizziness

Thioridazine
Chlorpromazine

Question 5

What are the side effects of 2nd generation antipsychotics

-name some common ones

Answer 5

Weight gain
Drug induced T2DM
Tiredness
Agranulocytosis - low WCC
HyperPRL
HypoNa

Clozapine - agranulocytosis, myocarditis
Olanzapine
Paliperidone
Aripiprazole
Risperidone

Question 6

When should you avoid using antipsychotics

Answer 6

PD
Heart, liver disease
Low WCC

Question 7

Monitoring needed

Answer 7

Baseline measurements

• BMI
• U&E, FBC, lipids, HbA1c, LFTs
• BP, HR
• ECG - QT prolongation => increased arrythmia risk
• PRL