Antipsychotics

Question 1

What common property do all antipsychotics share?

Answer 1

they all reduce dopaminergic neurotransmission

Question 2

How do typical anti-Ps work?

Answer 2

ability to block dopamine (D2) receptors.

They also have in, varying degrees, M1, Alpha-1 and H1 receptor blockade.

Question 3

How do atypical anti-Ps work?

Answer 3

Combination of the relatively lower D2 antagonism with the 5HT2A antagonism.

Question 4

How does 5HT2A antagonism reduces EPSE

Answer 4

by increasing Dopamine in the nigrostriatal areas.

Question 5

How does 5HT2A antagonism reduce negative symptoms

Answer 5

by improving Dopamine in the prefrontal cortex

Question 6

How does 5HT2A antagonism have antidepressant effect

Answer 6

by increasing dopamine in the ventromedial prefrontal cortex.

Question 7

What does 5HT2A antagonism do to hyperprolactinaemia

Answer 7

reduce it

Question 8

Which phenothiazine has an aliphatic side chain

Answer 8

Chlorpromazine

Question 9

Which Phenothiazines have a PiperiDine side chain

Answer 9

Thioridazine, pipothiazine

Question 10

Which Phenothiazines have a PiperiZine side chain

Answer 10

Trifluoperazine, fluphenazine

Question 11

Name a Butyrophenone

Answer 11

Haloperidol

Question 12

Name a Thioxanthenes

Answer 12

Flupenthixol, zuclupenthixol

Question 13

Example of DiphenylbutylPiperidines

Answer 13

Pimozide

Question 14

Example of Dibenzodiazepines

Answer 14

Clozapine

Question 15

Example of Benzoxasoles

Answer 15

Risperidone

Question 16

Thienobenzodiazepines example?

Answer 16

Olanzapine

Question 17

Dibenzothiazepines example?

Answer 17

Quetiapine

Question 18

Examples of Substituted benzamides

Answer 18

Sulpiride, amisulpride

Question 19

Example of Arylpiperidylindole (quinolone)

Answer 19

Aripiprazole

Question 20

Which three atypicals are available in depot form

Answer 20

Risperidone (available as Risperdal Consta or Paliperidone)
Olanzapine
Aripiprazole (approved in the UK in Jan 2014)

Question 21

Which depot may be more effective in preventing relapses than others

Answer 21

zuclopenthixol

Question 22

When may post injection syndrome happen and what is risk of this

Answer 22

from accidental entry into a blood vessel on administration.The incidence of this is < 0.1% and almost all reactions occur within 1 hour of injection.

Question 23

Which depot must be given under supervision for three hours after the injection is given.

Answer 23

Olanzapine depots

Question 24

Symptoms of post injection syndrome

Answer 24

Sedation
Confusion, disorientation
Agitation, anxiety, aggression
Extrapyramidal symptoms, dysarthria, ataxia
Dizziness, weakness
Hypertension
Convulsion

Question 25

AntiPs with highest associated risk of diabetes?

Answer 25

Clozapine and olanzapine

Question 26

AntiPs recommended for patients with or with risk of developing diabetes?

Answer 26

Amisulpride, aripiprazole, and ziprasidone

Question 27

Half life and steady state of aripiprazole?

Answer 27

75 hours, 2 weeks

Question 28

Half life and steady state of olanzapine?

Answer 28

30 hours 1 week

Question 29

Half life and steady state of risperidone?

Answer 29

Risperidone 20 hours 2-3 days (oral)

Question 30

Half life and steady state of both amisulpride and clozapine?

Answer 30

12 hours 2-3 days

Question 31

Half life and steady state of zuprasidone and quetiapine?

Answer 31

6 hours 2-3 days

Question 32

Which antipsychotic shows most change to EEG of patients on it

Answer 32

Clozapine (47.1%)

Question 33

What is the term for the point at which the amount of drug administered each day is exactly counterbalanced by the amount eliminated.

Answer 33

steady state

Question 34

Which antipsychotics are least likely to cause postural hypotension?

Answer 34

Amisulpride Aripiprazole Haloperidol Sulpiride Trifluoperazine

Question 35

What scale can be used to ask about sexual symptoms prior to commencing AntiP

Answer 35

Arizona Sexual Experiences Scale (ASEX)

Question 36

What is propensity for antiPs to cause sexual side effects related to?

Answer 36

effect on prolactin

Question 37

Which antiP causes most sexual side effects and effect on prolactin

Answer 37

Risperidone, haloperidol

Question 38

Which antiP causes sexual side effects but not related to prolactin

Answer 38

clozapine

Question 39

Which antiP Causes a temporary increase in prolactin which then returns to normal within 6 weeks

Answer 39

olanzapine

Question 40

If sexual side effects can consider adding 5-10 mg of what as can normalise prolactin level?

Answer 40

aripiprazole

Question 41

The following are which type of side effects: Galactorrhoea, gynecomastia, menstrual disturbance, lowered sperm count, reduced libido, Parkinsonism, dystonia, akathisia, tardive dyskinesia

Answer 41

Antidopaminergic effects/antimuscarinic

Question 42

What type of SEs are Dry mouth, blurred vision, urinary retention, constipation

Answer 42

anticholinergic

Question 43

Which type of SEs are Postural hypotension, ejaculatory failure

Answer 43

Antiadrenergic effects

Question 44

What type of SE is Drowsiness

Answer 44

Histaminergic effects

Question 45

Which antiP has highest risk of sudden death and why

Answer 45

Thioridazine has pronounced effects on K+ channels and materially prolongs the QTc interval

Question 46

Which antiPs have moderate risk of weight gain

Answer 46

Chlorpromazine Quetiapine Risperidone Paliperidone

Question 47

Which antiPs have high risk of weight gain

Answer 47

clozapine, olanzapine

Question 48

Apart from switching antiP if weight gain present, which additional measures may be taken?

Answer 48

Aripiprazole augmentation (for clozapine and olanzapine induced weight gain) Metformin Orlistat Liraglutide (for clozapine induced weight gain) Topiramate