Antipsychotics

Question 1

Chlorpromazine

Answer 1

1st gen antipsychotic

Question 2

Trifluoperazine

Answer 2

1st gen antipsychotic

Question 3

Flupentixol

Answer 3

1st gen antipsychotic

Question 4

Fluphenazine

Answer 4

1st gen antipsychotic

Question 5

Sulpride

Answer 5

1st gen antipsychotic

Question 6

Haloperidol

Answer 6

1st gen antipsychotic

Question 7

Olanzapine

Answer 7

2nd gen antipsychotic

Question 8

Risperidone

Answer 8

2nd gen antipsychotic

Question 9

Amisulpride

Answer 9

2nd gen antipsychotic

Question 10

Quetiapine

Answer 10

2nd gen antipsychotic

Question 11

Aripiprazole

Answer 11

2nd gen antipsychotic

Question 12

Zotepine

Answer 12

2nd gen antipsychotic

Question 13

Clozapine

Answer 13

2nd gen antipsychotic

Question 14

SEs of 1st gen antipsychotics compared to 2nd gen

Answer 14

• more likely to cause EPSEs

- more likely to cause prolactinaemia

Question 15

EPSEs

Answer 15

• acute dystonia
• akathisia
• parkinsonism
• tardive dyskinesia

Question 16

Anticholinergic SEs

Answer 16

‘Can’t see, can’t pee, can’t shit, can’t spit… also tachycardia’

• blurred vision
• urinary retention
• constipation
• dry mouth
• tachycardia

Question 17

Effects of prolactinaemia

Answer 17

• galactorrhoea, amenorrhoea, gynaecomastia, hypogonadism
• sexual dysfunction
• increased risk osteoporosis

Question 18

SEs of antipsychotics

Answer 18

• EPSEs
• anticholinergic SEs
• hyperprolactinaemia
• sexual dysfunction
• weight gain
• DM
• cardiovascular effects
• seizure threshold lowered

Question 19

What effect does smoking have on antipsychotics?

Answer 19

induces metabolism so DECREASES plasma AP levels (need higher dose)

Question 20

When is clozapine used?

Answer 20

treatment resistant schizophrenia where 2 other APs (at least 1 being 2nd generation) have failed

Question 21

Serious SEs of clozapine

Answer 21

• Agranulocytosis (typically neutropenia)
• Myocarditis and cardiomyopathy
• Intestinal obstruction
• Seizures

Think: ‘All Medicine Is Shit’

Question 22

What level should clozapine be maintained at?

Answer 22

350-500 micrograms

Question 23

Neuroleptic Malignant Syndrome (NMS) - mneumonic etc.

Answer 23

'FALTER'
Fever
Altered mental state (/delirium)
Leukocytosis
Tremors
Elevated CK (rhabdomyolosis)
Rigidity (lead-pipe)

• hyperthermia
• tachycardia/unstable HR
• tachypnoea
• unstable BP

Question 24

Neuroleptic malignant syndrome - Cause

Answer 24

SE of antipsychotics, usually triggered by new AP or dose increase, or withdrawal of dopaminergic drugs in PD

Question 25

Neuroleptic malignant syndrome - Mx

Answer 25

- stop APs immediately - urgent medical Mx: admit, supportive Mx, often ICU - treat rhabdomyolysis - admit

Question 26

What medications to consider for LBD/PD hallucinations

Answer 26

- anticholinesterase inhibitors (dementia drugs) 1st line - low dose quetiapine - very low dose clozapine

Question 27

1st line rapid tranquillization

Answer 27

take into account any advance statements Offer oral Mx - if already on AP: lorazepam or promethazine (avoids risks of combining APs) - if not already on AP: olanzapine, quetiapine, risperidone or haloperidol - repeat after 45-60 mins

Question 28

2nd line rapid tranquillization and when it is indicated

Answer 28

- if 2 doses (1t line) fail, or if patient is placing themselves or others at significant risk - consider IM Mx - consider patient's legal status, contact seniors - lorazepam IM diluted with water (have flumazenil (antidote) to hand incase of respiratory depression) - promethazine IM (useful in benzo-tolerant patient; can be repeated) - olanzapine IM (NOT with IM benzo) - haloperidol last choice as high risk of acute dystonia (ensure IM procyclidine to hand); can be repeated

Question 29

Best AP to avoid hyperprolactinaemia

Answer 29

Aripiprazole

Question 30

What drug(s) are used to treat tardive dyskinesia?

Answer 30

tetrabenazine

Question 31

What drug(s) are used to treat akathisia?

Answer 31

propranolol

Question 32

What drug(s) are used to treat acute dystonia?

Answer 32

procyclidine and benztropine