Typical (1st Generation) anti-psychotics

Question 1

The mesocortical pathway, which is responsible for regulating emotions and cognitive functions. Is there increases or a decrease in dopamine in schizophrenia?

Answer 1

• decreased dopamine
• responsible for negative symptoms (low affect, low motivation, social withdrawal)

Question 2

In the mesolimbic pathway, which is responsible for motivation and desire, is there an increases or a decrease in dopamine in schizophrenia?

Answer 2

• increased dopamine
• responsible for positive symptoms (delusions, hallucination, disorganised thought)

Question 3

When we talk about anti-psychotics we talk about drugs that can treat conditions such as schizophrenia and psychosis. Too much dopamine is heavily involved and is part of 4 main pathways. Which of these 2 pathways are generally affected, causing positive and negative symptoms in schizophrenia?

1 - mesolimbic pathway (motivation and desire)
2 - mesocortical pathway (emotions)
3 - nigrostriatal pathway (involuntary movements and coordination)
4 - tuberoinfundibular pathway

Answer 3

1 - mesolimbic pathway (motivation and desire)
2 - mesocortical pathway (emotions)

Question 4

There are typical and atypical antipsychotics. Which of the following are the 2 core typical drugs we need to know about?

1 - Haloperidol
2 - Clozapine
3 - Risperidone
4 - Chlorpromazine

Answer 4

1 - Haloperidol
4 - Chlorpromazine

Question 5

Haloperidol and Chlorpromazine are the 2 typical antipsychotics we need to know about. These drugs are indicated in which of the following?

1 - rapid tranquillisation
2 - depression
3 - anxiety
4 - sleep disorder

Answer 5

1 - rapid tranquillisation
- used in patients with severe psychomotor agitation and who are dangerous

• reduce dopamine and therefore the positive symptoms
• Haloperidol is the 1st choice for this

Question 6

Haloperidol and Chlorpromazine are the 2 typical antipsychotics we need to know about. These drugs are indicated for use in treating patients with schizophrenia. Atypical antipsychotics are preferred, but Haloperidol and Chlorpromazine can be used if what side effects of atypical antipsychotics are problematic?

1 - dry eyes
2 - metabolic effects
3 - sexual dysfunction
4 - sleep disorder

Answer 6

2 - metabolic effects

• olanzapine and clozapine cause significant weight gain, dyslipidaemia

Question 7

Haloperidol and Chlorpromazine is indicated in nausea and vomiting, especially in palliative care. How do these drugs reduce nausea and vomiting?

1 - serotonin antagonist on pre synapse
2 - serotonin agonist on pre synapse of chemoreceptor trigger zone (CTZ)
3 - dopamine D2 receptor partial agonist
4 - dopamine D2 antagonist on post synapse of chemoreceptor trigger zone (CTZ)

Answer 7

4 - dopamine D2 antagonist on post synapse of chemoreceptor trigger zone (CTZ)

• CTZ is an area of the medulla oblongata that receives inputs from blood-borne drugs or hormones, and communicates with other structures in the vomiting centre to initiate vomiting.

Question 8

Haloperidol and Chlorpromazine are the 2 typical antipsychotics we need to know about. These 2 drugs are indicated in the treatment of bipolar disorder which is a spectrum. Which 2 stages of this spectrum are these medications particularly useful for?

1 - cycolthymia
2 - severe depression
3 - mania
4 - hypomania

Answer 8

3 - mania
4 - hypomania

Question 9

There are 4 key indications for the use of typical (1st generation) anti-psychotics. Which of the following is NOT one of these 4 key indicators?

1 - rapid tranquillisation
2 - schizophrenia
3 - dementia
4 - bipolar disorder
5 - nausea and vomiting

Answer 9

3 - dementia

• rapid tranquillisation if patient is aggressive or examination is required
  2 - schizophrenia - especially if the patient has the metabolic risks associated with atypical medications
  4 - bipolar disorder - in acute mania or hypomania
  5 - nausea and vomiting - mainly in palliative care

Question 10

Haloperidol and Chlorpromazine are the 2 typical antipsychotics we need to know about. What is the mechanism of action of these drugs?

1 - serotonin antagonist on pre synapse
2 - serotonin agonist on pre synapse
3 - dopamine D2 receptor partial agonist
4 - dopamine D2 antagonist on post synapse

Answer 10

4 - dopamine D2 antagonist on post synapse

• good for treating positive psychotic episodes

Question 11

Haloperidol and Chlorpromazine are the 2 key core typical drugs we need to be aware of. Why are extra-pyramidal (abnormal movements) effects a common side effect of these drugs?

1 - increase dopamine in the nigrostriatal pathway
2 - decrease dopamine in the nigrostriatal pathway
3 - increase dopamine in the mesolimbic pathway
4 - increase dopamine in the mesocortical pathway

Answer 11

2 - decrease dopamine in the nigrostriatal pathway

Question 12

Haloperidol and Chlorpromazine are the 2 key core typical drugs we need to be aware of. Extra-pyramidal (abnormal movements) effects is a common side effect of these drugs, which can present in a variety of ways. Which of the following match this description: involuntary parkinsonian or spasms

1 - acute dystonic reactions
2 - neuroleptic malignant syndrome
3 - tardive dyskinesia
4 - akathisia

Answer 12

1 - acute dystonic reactions
- involuntary muscle spasms and contractions
- dys = dysfunction
- tonia = contraction
- typically occurs early in treatment

Question 13

Haloperidol and Chlorpromazine are the 2 key core typical drugs we need to be aware of. Extra-pyramidal (abnormal movements) effects is a common side effect of these drugs, which can present in a variety of ways. Which of the following match this description: a state of inner restlessness.

1 - acute dystonic reactions
2 - neuroleptic malignant syndrome
3 - tardive dyskinesia
4 - akathisia

Answer 13

4 - akathisia
- Greek for never sit still/down
- patient feels that they need to move
- typically occurs early in treatment

Question 14

Haloperidol and Chlorpromazine are the 2 key core typical drugs we need to be aware of. Extra-pyramidal (abnormal movements) effects is a common side effect of these drugs, which can present in a variety of ways. Which of the following match this description: life threatening rigidity, confusion, autonomic dysregulation and pyrexia

1 - acute dystonic reactions
2 - neuroleptic malignant syndrome
3 - tardive dyskinesia
4 - akathisia

Answer 14

2 - neuroleptic malignant syndrome

• typically occurs early in treatment

Question 15

Haloperidol and Chlorpromazine are the 2 key core typical drugs we need to be aware of. Extra-pyramidal (abnormal movements) effects is a common side effect of these drugs, which can present in a variety of ways. Which of the following match this description: pointless, involuntary and repetitive.

1 - acute dystonic reactions
2 - neuroleptic malignant syndrome
3 - tardive dyskinesia
4 - akathisia

Answer 15

3 - tardive dyskinesia

• typically occurs late in treatment, normally months or years following treatment

Question 16

Haloperidol and Chlorpromazine are the 2 key core typical drugs we need to be aware of. Patients taking these medications can experience hyperprolactinaemia. How does this occur?

1 - increase dopamine in the nigrostriatal pathway
2 - decrease dopamine in the tuberohypophyseal pathway
3 - increase dopamine in the mesolimbic pathway
4 - increase dopamine in the mesocortical pathway

Answer 16

2 - decrease dopamine in the tuberohypophyseal pathway

• normally the release of dopamine in this pathway inhibits the release of prolactin
• so less dopamine means more prolactin is released

Question 17

Hyperprolactinaemia is an adverse event of atypical antipsychotics. How often should prolactin be monitored once people start these medications?

1 - weekly then annually
2 - at start, weekly then monthly
3 - annually
4 - start of treatment, 6 months and then annually

Answer 17

4 - start of treatment, 6 months and then annually

Question 18

The main side effects of haloperidol and chlorpromazine, 2 key core typical drugs we need to be aware of is extra-pyramidal (abnormal movements). These drugs can also cause other adverse events. Which of the following is NOT an adverse event?

1 - hypotension
2 - erectile dysfunction
3 - drowsiness
4 - QT prolongation
5 - hypertension

Answer 18

5 - hypertension

• hypotension caused by inhibition of alpha receptors
• drowsiness caused by inhibiting histamine H1 receptors
• erectile dysfunction caused by inhibiting muscarinic receptors

Question 19

Which group of patients should typical antipsychotics be avoided in, or at least start in very low doses?

1 - younger patients
2 - 30-50 y/o
3 - immunocompromised
4 - older patients

Answer 19

4 - older patients

• should be avoided in dementia as well due to extra-pyramidal effects

Question 20

Although the BNF provides an extensive list of drug interactions. Why should amiodarone and macrolids specifally be avoided due to interactions with typical anti-psychotics?

1 - hyperkalaemia
2 - QT prolongation
3 - hyperkalaemia
4 - QT shortening

Answer 20

2 - QT prolongation

• typical anti-psychotics, amiodarone and macrolids all cause QT prolongation
• prolonged QT interval can cause delayed ventricular repolarisation, can lead to arrhythmias and sudden cardiac death

Question 21

Haloperidol and Chlorpromazine are the 2 typical antipsychotics we need to know about. How are these drugs typically administered?

1 - IV
2 - oral
3 - SC
4 - IM

Answer 21

2 - oral
- BUT if patient cannot or will not it can be given via IM