Typical (1st generation) antipsychotics

Question 1

What is the main role of antipsychotic drugs?

Answer 1

Act as dopamine antagonists

Question 2

What diseases are antipsychotic drugs mainly used for?

Answer 2

Bipolar affective disorder and schizophrenia

Question 3

Examples of typical (1st gen) antipsychotics?

Answer 3

haloperidol, chlorpromazine

haloperidol commonly used in delirium or psychosis

Question 4

Mechanism of action for 1st gen antipsychotics?

Answer 4

Non-selectively block D2 and other receptors.

Reduce positive schizophrenia symptoms (i.e. delusions, hallucinations etc)

Question 5

Adverse effects of typical antipsychotics?

Answer 5

Worsen negative schizophrenia symptoms (reduced social contact, lack of motivation, lack of pleasure, poor attention etc).

Extra-pyramidal side-effects
~ Increased muscle tone
~ Parkinsonism – resting tremor, bradykinesia (slow movement) and rigidity

Neuroleptic malignant syndrome

Question 6

What is neuroleptic malignant syndrome?

Answer 6

a rare but life-threatening reaction that can occur in response to neuroleptic or antipsychotic medication.

Symptoms include fever and muscle stiffness - affecting hypothalamic pathway

Onset over 24-72 hours

Investigations: creatine kinase

Question 7

Apart from EPSE and potential neuroleptic malignant syndrome, what other adverse effects are associated with 1st gen antipsychotics?

Answer 7

Anticholinergic side effects: tachycardia, blurred vision, dry mouth, constipation, urinary retention

Question 8

What is the cause of neuroleptic malignant syndrome?

Answer 8

Syndrome resulting from the use of high potency anti-psychotic medications such as haloperidol.

Question 9

What are the main characteristics of neuroleptic malignant syndrome?

Answer 9

Hyperpyrexia (high fever)

Autonomic dysfunction

Rigidity

Altered conscious state

Raised creatine phosphokinase

Question 10

Treatment of neuroleptic malignant syndrome?

Answer 10

Stop the neuroleptic medication and cool the patient. Can also use medications such as bromocriptine, dantrolene and benzodiazepine.

Question 11

What is neuroleptic malignant syndrome?

Answer 11

A rare but potentially life threatening adverse reaction to antipsychotics including haloperidol.

Question 12

Symptoms of NMS?

Answer 12

Increased sweating and fever

Rigidity

Confusion

Fluctuating consciousness

Fluctuating blood pressure

Tachycardia

Question 13

What does NMS involve and what would this show on a blood test?

Answer 13

NMS involves the breakdown of muscle tissue and raised creatine kinase levels are used as diagnostic criteria.