Lets Learn Schitzo

Question 1

There are two types of symptoms of schitzophrenia

Answer 1

positive symptoms and negative symptoms

Question 2

What are positive symptoms

Answer 2

positive symptoms = adding

halucinations
hearing things
though disorder

Question 3

what is a key medication in the management of schitzophrenia

Answer 3

antipsychotics

Question 3

what are negative symptoms

Answer 3

sociatial withdrawal

apathy

Question 4

what do antipsychotics help with in schitzophrenia

Answer 4

they can help to calm disturbed patients who may be suffering with

mania
delirium
agitated depression
severe anxiety

Question 5

name as many antipsychotics as you can

Answer 5

Chlorpromazine
Prochlorperazine
haloperidol
flupentixol
sulpiride
amisulpride
aripiprazole
clozapine
lurasidone
olanzapine
quetiapine
rispiridone

Question 6

name as many 1st gen antipsychotics as you can

Answer 6

can you think of any more

Chlorpromazine
Prochlorperazine
haloperidol
flupentixol
sulpiride

Question 7

name as many 2nd generation antipsychotics as you can

Answer 7

can you think of any more?

amisulpride
aripiprazole
clozapine
lurasidone
olanzapine
quetiapine
rispiridone

Question 8

What is an easy way to remember what antipsychotics are 1st gen vs 2nd gen

Answer 8

1st gens = azine are ol school

2nd gens = apines or one

Question 9

Why might a second generation antipsychotic be preferred over a first generation

Answer 9

less extrapyramidal side effects

Question 10

what are some examples of extra pyramidal side effects.

Answer 10

Parkinsoniam symptoms e.g. tremor

Involuntary contractions of muscle, face and neck (dystonia)

Akathisia (restlessness cant stay still)

rhythmic involuntary movements (tardive dyskinesia)

increased prolactin concs causing breast enlargement, sex dysfunction, reduced bone density.

Question 11

Is amisulpiride a 2nd or 1st gen

Answer 11

2nd

Question 12

is aripiprazole a 2nd gen or 1st gen

Answer 12

2nd

Question 13

is flupentixol a 2nd or 1st gen

Answer 13

1st

Question 14

is prochlorperazine a 2nd or 1st gen

Answer 14

1st

Question 15

is risperidone a 2nd or 1st gen

Answer 15

2nd gen

Question 16

is lurasidone a 2nd or 1st gen

Answer 16

2nd gen

Question 17

what group of antipsychotics in the first generation are most likely to cause extra pyramidal side effects

Answer 17

prochlorperazine
trifluroperazine
fluphenazine

group 3 derivates of azines

Question 18

which group is most associated with increased sedation

Answer 18

group 1

chlorpromazine
levopromazine
promazine

Question 19

what group has the least extra pyramidal side effects in the 1st generation

Answer 19

group 2

pericyazine
pipotiazine

Question 20

what non phenothiazines in the 1st generation are similar to the group 3

Answer 20

haloperidol
benperidol

Butyrophenones

Question 21

what is the difference in the targeting of 1st generation antipsychotics vs 2nd gen antipsychotics

Answer 21

1st gen are non selective and can target 4 of the dopamine pathways in the brain

2nd gen act on specific d receptors

Question 22

what can antipsychotics make someone who is elderly more susceptible too?

Answer 22

postural hypotension
hyperthermia
hypothermia

Question 23

If a patient has mild psychotic symptoms should we provide an antipsychotic

Answer 23

no look for an alternative

Question 24

what is a simple pnuemonic to help remember the extra pyramidal symptoms ADAPPT

Answer 24

Acute Dystonia Akathisia Parkisonism Prolactinaemia Tardive dyskinesia

Question 25

what are the main side effects aside from ADAPPT that antipsychotics have

Answer 25

weight gain diabetes / hyperglycaemia postural hypotension hyperprolactinaemia cardiac side effects decreased libido epse sexual dysfunction

Question 26

what antipsychotic should we avoid for weight gain

Answer 26

clozapine olanzapine

Question 27

what antipsychotics should we give if a patient is overweight

Answer 27

amisulpride aripriprazole haloperidol

Question 28

what antipsychotics should we avoid if a patient has hyperglycaemia

Answer 28

risperidone quetiapine clozapine olanzapine

Question 29

what antipsychotic should we give if a patient has hyperglycaemia

Answer 29

1st generation haloperidol fluphenazine

Question 30

what antipsychotics should we avoid if a patient suffers from postural hypotension

Answer 30

clozapine quetiapine

Question 31

what antipsychotic should we avoid if a patient suffers from hyperprolactinaemia

Answer 31

risperidone amisulpride sulphide and other gen 1s

Question 32

what antipsychotic is okay to give a patient to reduce the risk of them getting hyperprolactinaemia

Answer 32

aripiprazole clozapine quetiapine

Question 33

what is generally the best antipsychotic for side effects

Answer 33

aripiprazole

Question 34

what is the worst antipsychotic that may cause qt prolongation

Answer 34

pimozide!

Question 35

what antipsychotic can decrease libido

Answer 35

risperidone haloperidol

Question 36

what antipsychotic can decrease sex dysfunction

Answer 36

risperidone haloperidol olanzapine

Question 37

what things should we monitor in antipsychotics

Answer 37

fbc electrolyes lft bloods weight ECG prolactin

Question 38

in what period of time is relapse most likely to happen after stopping taking the meds

Answer 38

if a patient has only taken the meds for 1 - 2 years relapse may occur

Question 39

withdrawal after long term so needs to be weaned down

Answer 39

wean them down

Question 40

how long after should a patient be monitored??

Answer 40

2 years

Question 41

What does clozapine target (5)

Answer 41

D1 D2 5ht2a alpha 1 adrenoreceptor muscarinic receptor

Question 42

what is clozapines indication

Answer 42

schizophrenia in patients unresponsive to conventional antipsychotics and psychosis in parkinsons disease

Question 43

what antipsychotic has an mhra about causing constipation

Answer 43

clozapine can cause intestinal obstruction / faecal impaction and paralytic illeus

Question 44

If a patient on clozapine develops constipation what should they do before their dose

Answer 44

receive medical advise

Question 45

what are the two mhra warning with clozapine

Answer 45

monitor blood concs risk of constipation, paralytic illeus and faecal impaction

Question 46

is smoking an inducer or inhibitor

Answer 46

inducer

Question 47

if you stop smoking what is the effect on clozapine conc

Answer 47

may become toxic as it rises and you may need to change doses

Question 48

if you swap from smoking to e - cigarettes what is the effect on clozapine conc

Answer 48

similar to if stop smoking the levels will rise and you may need to reduce the dose.

Question 49

what are the contraindications of clozapine

Answer 49

bone marrow disorders agranulocytosis drug intox paralytic ileus