Antipsychotics

Question 1

what is the risk associated with the use of antipsychotics in elderly

Answer 1

increased risk of stroke and VTE

Question 2

how do antipsychotics work

Answer 2

block dopamine receptors therefore reduce pathological over-activity

Question 3

antipsychotics have antimuscarinic side effects - what are these

Answer 3

dry mouth
blurred vision
urinary retention
constipation

Question 4

haloperidol
chlorpromazine
thioridazine
fluphenazine 
zuclopenthixol 

are examples of what antipsychotics

Answer 4

typical

Question 5

what is the biggest concern with typical antipsychotics

Answer 5

extra pyramidal side effects

Question 6

what are EPSEs

Answer 6

acute dystonia
akathasia
parkinsonism
tardive dyskinesia

Question 7

what is acute dystonia

Answer 7

painful sustained contraction of muscles usually in the eyes, jaw or neck

Question 8

what is acute dystonia of the eyes called

Answer 8

oculogyric crisis

Question 9

what is acute dystonia of the neck called

Answer 9

torticollis

Question 10

how is acute dystonia reversed

Answer 10

procyclidine

Question 11

what is akathasia

Answer 11

feeling of restlessness and constant need to wander

Question 12

what are the features of parkinsonism seen in EPSE of typical antipsychotics

Answer 12

shuffling gait
tremor
reduced facial expression

Question 13

what is tardive dyskinesia

Answer 13

repetitive, uncontrollable contraction of the muscles of the face, tongue and upper body –> excessive blinking, lip smacking, jaw pouting, chewing, facial grimacing

Question 14

what endocrine disturbances can be seen with typical antipsychotics

Answer 14

hyperprolactinaemia

impaired glucose tolerance

Question 15

typical antipsychotics, particularly haloperidol cause what change on an ECG

Answer 15

QT prolongation

Question 16

True/False

Typical antipsychotics can cause sedation, increased appetite and weight gain

Answer 16

true

Question 17

Name some atypical antipsychotics

Answer 17

olanzapine
quetiapine
aripiprazole
risperidone 
amisulpride

Question 18

what is the main advantage in the use of atypical antipsychotics

Answer 18

reduction in EPSEs

Question 19

List some side effects of atypical antipsychotics

Answer 19

hyperprolactinaemia
impaired glucose tolerance (T2DM)
increased appetite and weight gain
drowsiness
sexual dysfunction

Question 20

atypical antipsychotics increase/decrease risk of seizure

Answer 20

increased risk of seizure by reducing seizure threshold

Question 21

which atypical antipsychotics is particularly good for prolactin elevation

Answer 21

aripiprazole

Question 22

weight gain is most pronounced with which atypical antipsychotic

Answer 22

olanzapine

clozapine

Question 23

what are the conditions for the use of clozapine

Answer 23

treatment resistant schizophrenia - when a patient has trialled 2 different antipsychotics for at least 6 weeks with no improvement, one of which is an atypical

Question 24

what are the 2 main concerning side effects of clozapine

Answer 24

myocarditis

agranulocytosis

Question 25

how are myocarditis and agranulocytosis avoided/monitored with clozapine use

Answer 25

ECG before starting regular blood testing to see FBC

Question 26

how often should a FBC be taken with someone on clozapine

Answer 26

weekly for the first 6 months | then every 2 weeks for next 6 months and then monthly thereafter

Question 27

when should FBC be done when stopping clozapine

Answer 27

1 month after

Question 28

how do you safety net a patient starting clozapine

Answer 28

say if they have a sore throat or any other kind of infection to immediately go to their GP to get FBC

Question 29

what are other side effects of clozapine

Answer 29

``` weight gain hypersalivation cardiomyopathy pulmonary embolism neutropenia reduced seizure threshold constipation ```

Question 30

how can you treat hypersalivation with clozapine use

Answer 30

hyocine hydrobromide

Question 31

what is the significance of smoking with regard to clozapine

Answer 31

smoking reduces clozapine levels so suddenly quitting smoking could dramatically increase blood levels