Chapter 4: Antipsychotics

Question 1

in schizo, what psychotic symptoms do antipyschotic drugs alleviate?
what symptoms does it have less effect on?

Answer 1

positive pyschotic symptoms:

• thought disorder
• hallucinations
• delusions

less effective on negative symptoms such as:

• apathy
• social withdrawal

Question 2

How do 1st gen antipsychotics work?

Answer 2

• Blocking DA d2 receptors in the brain.
• they are not selective for any of the 4 DA pathways in the brain so they cause a wide range of SEs,
• especially EPSE and raised prolactin.

Question 3

How many groups are the phenothiazines derivatives split into?

Answer 3

3 groups

Question 4

List the group 1 phenothiazines derivatives?

Answer 4

-Chlorpromazine, levomepromazine and promzine (CLP)

• PRONOUNCED sedatives effect
• Moderate: EPSE and antimuscarinics SEs

Question 5

List the group 2 phenothiazines derivatives

Answer 5

Pericyazine

• moderate sedative effects
• fewer EPSE effects than group 1 and 3.

Question 6

List group 3 phenothiazines derivatives

Answer 6

Fluphenazine, perphenazine, prochlorperazine, trifluoperazine

• FEWER sedative and antimuscarinics effects
• MORE EPSE than groups 1 and 2.

Question 7

What drugs are butyrophenones?

Answer 7

Haloperidol and benperidol.

-resemble group 3 in the clinical properties.

Question 8

List thioxanthenes

Answer 8

Flupentixol, zuclopenthixol

-MODERATE EPSE, sedative and antimuscarinics effects

Question 9

What effects does pimozide ad sulpiride have?

Answer 9

Reduced sedative, EPSE and antimuscarinics effects

Question 10

How do 2nd gen antipsychotics work?

Answer 10

Act on a range of receptors compared to 1st gen.

Has more of a distinct clinical profile, particularly in regards to side effects.

Question 11

Can antipsychotics be used to treat mild to moderate psychotic symptoms in the elderly? Why?

Answer 11

NO!

• Associated with a small increased risk of death and increased risk of stroke or TIA.
• elderly are more susceptible to postural hypotension and hyper/hypothermia in hot or cold weather.

Question 12

What should be done if antipsychotics have to be started in the elderly?

Answer 12

Initial doses should be half of the adult dose or less

Regularly review treatment

Question 13

What does extrapyramidal side effects (EPSE) consist of?

Answer 13

• Parkinsonian symptoms (including tremor): occurs more commonly in adults or elderly. Appear gradually.
• dystonia and dyskinesia: occurs commonly in children or young people. Appears after a few doses.
• akathisia: usually occurs after a high initial dose and may resemble an exacerbation of the condition being treated.
• tardive dyskinesia: MOST SERIOUS. Usually develops after long term therapy or with high doses. Short lived tardive dyskinesia may occur after withdrawal of the drug

Question 14

What does dystonia mean?

Answer 14

Abnormal face and body movements

Question 15

What does akathisia mean?

Answer 15

Restlessness

Question 16

What does tardive dyskinesia mean?

Answer 16

Rhythmic, involuntary movements of tongue, face and Jaw

Question 17

In children when is tardive dyskinesia more likely to happen?

Answer 17

When the antipsychotic is being withdrawn

Question 18

What drugs are more likely to cause hyperprolactinaemia?

Answer 18

• Aripiprazole (DA receptor partial agonist)

- risperidone, amisulpride and 1st gen antipsychotics.

Question 19

What drugs commonly use sexual dysfunction?

Answer 19

• Risperidone

- haloperidol