Antipsychotics - Second generation

Question 1

What are examples of second generation antipsychotics?

Answer 1

• Quitiepine
• Olanzapine
• Risperidone
• Clozapine

Question 2

What is the mechanism of action of second generation?

Answer 2

• 5HT2A receptor antagonism and D2 receptor antagonism but also interaction with several other receptors (i.e., D3, D4, α-adrenergic, and H1 receptors)

Question 3

Why do second generation antipsychotics have less extrapyramidal side effects?

Answer 3

The greater affinity to 5HT2A receptors and the reduced D2 receptor antagonism, along with the interaction with other receptors, decreases the likelihood of extrapyramidal effects

Question 4

What are side effects of second generation antipsychotics?

Answer 4

• Sedation
• Extrapyramidal side effects
• Weight gain
• Diabetes
• Lipid changes
• Prolonged QT
• Agranulocytosis
• Hyperprolactinaemia

Question 5

What are specific side effects of clozapine?

Answer 5

• Agranulocytosis (usually within the first 4 months of therapy)
• Metabolic syndrome
• Hyperglycemia
• Hypercholesterolemia
• Weight gain
• Decreased risk of EPS compared to typical antipsychotics

Question 6

What are side effeects of olanzapine?

Answer 6

• Metabolic syndrome
• Hyperglycemia
• Dyslipidemia
• Weight gain
• Asymptomatic increase of liver enzymes
• Anticholinergic side effects: dry mouth, constipation
• Orthostatic hypotension (due to α1-adrenergic blockade)

Question 7

What monitoring would you do for second generation antipsychotics?

Answer 7

At regular intervals - Blood tests - full blood count, renal and liver profiles

Question 8

Why do you need to be particularly strict with performing routine bloods with individuals on clozapine?

Answer 8

Risk of agranulocytosis

Question 9

What must you inform people on clozapine to be aware of?

Answer 9

Symptoms of infection