Podcast
Questions and Answers
Antipsychotic drugs are primarily used to treat anxiety disorders.
Antipsychotic drugs are primarily used to treat anxiety disorders.
False
The term 'neuroleptic' refers to the therapeutic effects of antipsychotic drugs.
The term 'neuroleptic' refers to the therapeutic effects of antipsychotic drugs.
False
The discovery of antipsychotic drugs led to a decline in the treatment of schizophrenia.
The discovery of antipsychotic drugs led to a decline in the treatment of schizophrenia.
False
Antipsychotic drugs work by blocking serotonin receptors.
Antipsychotic drugs work by blocking serotonin receptors.
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The potency of antipsychotic drugs in blocking dopaminergic receptors in vitro has no relationship to their therapeutic strength.
The potency of antipsychotic drugs in blocking dopaminergic receptors in vitro has no relationship to their therapeutic strength.
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Antipsychotic drugs are only used to treat schizophrenia.
Antipsychotic drugs are only used to treat schizophrenia.
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The term 'major tranquillizer' accurately describes the therapeutic effects of antipsychotic drugs.
The term 'major tranquillizer' accurately describes the therapeutic effects of antipsychotic drugs.
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Antipsychotic drugs are only used to treat acute symptoms of psychosis.
Antipsychotic drugs are only used to treat acute symptoms of psychosis.
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Chlorpromazine was introduced in the 1960s.
Chlorpromazine was introduced in the 1960s.
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The British National Formulary uses the term 'neuroleptic' to describe antipsychotic drugs.
The British National Formulary uses the term 'neuroleptic' to describe antipsychotic drugs.
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The term atypical antipsychotic agent was introduced to distinguish the newer antipsychotic drugs from conventional typical agents, such as risperidone and olanzapine.
The term atypical antipsychotic agent was introduced to distinguish the newer antipsychotic drugs from conventional typical agents, such as risperidone and olanzapine.
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The D1 receptor is critical for antipsychotic action.
The D1 receptor is critical for antipsychotic action.
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PET studies suggest that an antipsychotic effect is obtained when D2-receptor occupancy lies in the range 80–90%.
PET studies suggest that an antipsychotic effect is obtained when D2-receptor occupancy lies in the range 80–90%.
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Low-potency conventional antipsychotic drugs such as haloperidol have a high risk of producing extrapyramidal symptoms.
Low-potency conventional antipsychotic drugs such as haloperidol have a high risk of producing extrapyramidal symptoms.
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The risk of tardive dyskinesia is higher with the newer antipsychotic drugs.
The risk of tardive dyskinesia is higher with the newer antipsychotic drugs.
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Clozapine has proven efficacy against negative or cognitive symptoms.
Clozapine has proven efficacy against negative or cognitive symptoms.
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Most authorities believe that the terms ‘atypical’ and ‘typical’ antipsychotic are still useful.
Most authorities believe that the terms ‘atypical’ and ‘typical’ antipsychotic are still useful.
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Chlorpromazine antagonizes β2-adrenoceptors, histamine H2-receptors, and muscarinic cholinergic receptors.
Chlorpromazine antagonizes β2-adrenoceptors, histamine H2-receptors, and muscarinic cholinergic receptors.
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α1-adrenoceptor blockade by chlorpromazine causes hypertension.
α1-adrenoceptor blockade by chlorpromazine causes hypertension.
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Histamine H1-receptor blockade by chlorpromazine gives it a stimulating profile.
Histamine H1-receptor blockade by chlorpromazine gives it a stimulating profile.
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Thioxanthenes and butyrophenones are potent dopamine-receptor antagonists, with few effects at other neurotransmitter receptors and are sedating.
Thioxanthenes and butyrophenones are potent dopamine-receptor antagonists, with few effects at other neurotransmitter receptors and are sedating.
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Atypical antipsychotic drugs such as sulpiride and amisulpride are highly selective D1-receptor antagonists.
Atypical antipsychotic drugs such as sulpiride and amisulpride are highly selective D1-receptor antagonists.
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Risperidone is a potent antagonist at both 5-HT1 receptors and dopamine D1 receptors.
Risperidone is a potent antagonist at both 5-HT1 receptors and dopamine D1 receptors.
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Olanzapine has a low propensity to cause movement disorders and is less sedating than quetiapine.
Olanzapine has a low propensity to cause movement disorders and is less sedating than quetiapine.
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Lurasidone is a weak 5-HT2 and D2 receptor antagonist.
Lurasidone is a weak 5-HT2 and D2 receptor antagonist.
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Asenapine binds potently to D2 receptors but weakly to 5-HT2 receptors.
Asenapine binds potently to D2 receptors but weakly to 5-HT2 receptors.
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Sertindole is a weak 5-HT2-receptor antagonist with potent D2-receptor-antagonist effects.
Sertindole is a weak 5-HT2-receptor antagonist with potent D2-receptor-antagonist effects.
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Ziprasidone is another 5-HT1 and D1-receptor antagonist.
Ziprasidone is another 5-HT1 and D1-receptor antagonist.
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Piperazine compounds such as trifluoperazine and fluphenazine are less selective dopamine-receptor antagonists.
Piperazine compounds such as trifluoperazine and fluphenazine are less selective dopamine-receptor antagonists.
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Thioxanthenes are similar in structure to the butyrophenones.
Thioxanthenes are similar in structure to the butyrophenones.
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Butyrophenones are potent dopamine-receptor antagonists, with few effects at other neurotransmitter receptors and have a low propensity to cause extrapyramidal side effects.
Butyrophenones are potent dopamine-receptor antagonists, with few effects at other neurotransmitter receptors and have a low propensity to cause extrapyramidal side effects.
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Substituted benzamides such as sulpiride and amisulpride are highly selective D1-receptor antagonists.
Substituted benzamides such as sulpiride and amisulpride are highly selective D1-receptor antagonists.
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Risperidone is a potent antagonist at both 5-HT1 receptors and dopamine D2 receptors.
Risperidone is a potent antagonist at both 5-HT1 receptors and dopamine D2 receptors.
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Paliperidone is an active metabolite of olanzapine and has very similar pharmacological properties when given orally.
Paliperidone is an active metabolite of olanzapine and has very similar pharmacological properties when given orally.
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Olanzapine has a higher potency of dopamine D2-receptor blockade than risperidone.
Olanzapine has a higher potency of dopamine D2-receptor blockade than risperidone.
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Lurasidone is a potent 5-HT2 and D2 receptor antagonist.
Lurasidone is a potent 5-HT2 and D2 receptor antagonist.
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The risk of tardive dyskinesia is lower with the newer antipsychotic drugs.
The risk of tardive dyskinesia is lower with the newer antipsychotic drugs.
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Asenapine binds potently to D2 receptors but weakly to 5-HT1 receptors.
Asenapine binds potently to D2 receptors but weakly to 5-HT1 receptors.
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Chlorpromazine antagonizes α1-adrenoceptors, histamine H1-receptors, and muscarinic cholinergic receptors.
Chlorpromazine antagonizes α1-adrenoceptors, histamine H1-receptors, and muscarinic cholinergic receptors.
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Sertindole is a potent 5-HT2-receptor antagonist with weak D2-receptor-antagonist effects.
Sertindole is a potent 5-HT2-receptor antagonist with weak D2-receptor-antagonist effects.
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Quetiapine is a potent 5-HT2 and D2 receptor antagonist.
Quetiapine is a potent 5-HT2 and D2 receptor antagonist.
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Asenapine binds potently to D2 receptors and has a significant effect on weight gain and sedation.
Asenapine binds potently to D2 receptors and has a significant effect on weight gain and sedation.
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Antipsychotic drugs are absorbed mainly from the duodenum when taken by mouth
Antipsychotic drugs are absorbed mainly from the duodenum when taken by mouth
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Sertindole is a potent 5-HT2-receptor antagonist with strong D2-receptor-antagonist effects.
Sertindole is a potent 5-HT2-receptor antagonist with strong D2-receptor-antagonist effects.
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Ziprasidone is a potent 5-HT2 and D2 receptor antagonist with a high liability to cause weight gain and sedation.
Ziprasidone is a potent 5-HT2 and D2 receptor antagonist with a high liability to cause weight gain and sedation.
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Antipsychotic drugs are not highly protein-bound
Antipsychotic drugs are not highly protein-bound
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The plasma half-life of most antipsychotic drugs is around 3 hours
The plasma half-life of most antipsychotic drugs is around 3 hours
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Aripiprazole is a potent 5-HT2-receptor antagonist with a high propensity to cause weight gain and sedation.
Aripiprazole is a potent 5-HT2-receptor antagonist with a high propensity to cause weight gain and sedation.
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Quetiapine has a half-life of around 20 hours and can be dosed once daily
Quetiapine has a half-life of around 20 hours and can be dosed once daily
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Clozapine is a potent dopamine D2-receptor antagonist with a high affinity for 5-HT2 receptors and a low liability to cause movement disorders.
Clozapine is a potent dopamine D2-receptor antagonist with a high affinity for 5-HT2 receptors and a low liability to cause movement disorders.
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The therapeutic plasma range for clozapine is 600–1000 μg/l.
The therapeutic plasma range for clozapine is 600–1000 μg/l.
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Depot preparations of antipsychotic drugs have a similar pharmacokinetic profile to standard preparations
Depot preparations of antipsychotic drugs have a similar pharmacokinetic profile to standard preparations
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The majority of antipsychotic drugs are excreted unchanged by the kidney
The majority of antipsychotic drugs are excreted unchanged by the kidney
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Zuclopenthixol acetate is used for the long-term maintenance of psychotic patients.
Zuclopenthixol acetate is used for the long-term maintenance of psychotic patients.
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Risperidone, paliperidone, aripiprazole, and olanzapine are conventional antipsychotic drugs.
Risperidone, paliperidone, aripiprazole, and olanzapine are conventional antipsychotic drugs.
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The plasma concentrations of antipsychotic drugs are commonly used in everyday clinical work to monitor treatment
The plasma concentrations of antipsychotic drugs are commonly used in everyday clinical work to monitor treatment
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Chlorpromazine is metabolized to produce only a few active and inactive metabolites
Chlorpromazine is metabolized to produce only a few active and inactive metabolites
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Depot antipsychotic drugs are used for patients who respond well to antipsychotic medication but can take it regularly.
Depot antipsychotic drugs are used for patients who respond well to antipsychotic medication but can take it regularly.
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Zuclopenthixol acetate is an exception to the depot preparations in terms of pharmacokinetic profile
Zuclopenthixol acetate is an exception to the depot preparations in terms of pharmacokinetic profile
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regarding depot -Relapse after treatment discontinuation is likely to occur immediately
regarding depot -Relapse after treatment discontinuation is likely to occur immediately
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Tardive dyskinesia is a disorder that improves immediately after stopping the drug.
Tardive dyskinesia is a disorder that improves immediately after stopping the drug.
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Clozapine is the most effective atypical agent in treating tardive dyskinesia but is best reserved for patients who respond to other atypicals.
Clozapine is the most effective atypical agent in treating tardive dyskinesia but is best reserved for patients who respond to other atypicals.
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Vitamin E is a well-established treatment for tardive dyskinesia.
Vitamin E is a well-established treatment for tardive dyskinesia.
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Tetrabenazine is a dopamine-enhancing agent used to treat tardive dyskinesia.
Tetrabenazine is a dopamine-enhancing agent used to treat tardive dyskinesia.
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Anticholinergic drugs are effective in treating tardive dystonia.
Anticholinergic drugs are effective in treating tardive dystonia.
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Clozapine has been reported to be useful in treating tardive dystonia.
Clozapine has been reported to be useful in treating tardive dystonia.
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Local injection of botulinum toxin into the affected muscle group is not a treatment option for tardive dystonia.
Local injection of botulinum toxin into the affected muscle group is not a treatment option for tardive dystonia.
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Antipsychotic drugs are associated with a decreased risk of venous thrombosis and pulmonary embolus.
Antipsychotic drugs are associated with a decreased risk of venous thrombosis and pulmonary embolus.
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Chlorpromazine is not associated with weight gain due to its histamine H1-receptor antagonism.
Chlorpromazine is not associated with weight gain due to its histamine H1-receptor antagonism.
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Depression is a rare side effect of antipsychotic drugs.
Depression is a rare side effect of antipsychotic drugs.
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Akathisia is a feeling of physical restlessness and a need to move that is reliably controlled by antiparkinsonian drugs.
Akathisia is a feeling of physical restlessness and a need to move that is reliably controlled by antiparkinsonian drugs.
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Antipsychotic-induced parkinsonism is characterized by akinesia, an expressionless face, and lack of associated movements when walking.
Antipsychotic-induced parkinsonism is characterized by akinesia, an expressionless face, and lack of associated movements when walking.
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Tardive dyskinesia is more common among men, the young, and patients who have localized brain pathology.
Tardive dyskinesia is more common among men, the young, and patients who have localized brain pathology.
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The incidence of tardive dyskinesia is higher with atypical antipsychotic agents such as clozapine, olanzapine, and risperidone than with haloperidol.
The incidence of tardive dyskinesia is higher with atypical antipsychotic agents such as clozapine, olanzapine, and risperidone than with haloperidol.
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The cause of tardive dyskinesia is due to a decrease in dopamine levels as a result of prolonged dopaminergic blockade.
The cause of tardive dyskinesia is due to a decrease in dopamine levels as a result of prolonged dopaminergic blockade.
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Antipsychotic drugs should be prescribed prophylactically to prevent tardive dyskinesia.
Antipsychotic drugs should be prescribed prophylactically to prevent tardive dyskinesia.
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Tardive dyskinesia always recovers when the antipsychotic drug is stopped.
Tardive dyskinesia always recovers when the antipsychotic drug is stopped.
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Antipsychotic-induced parkinsonism usually appears within the first few days of treatment with antipsychotic drugs.
Antipsychotic-induced parkinsonism usually appears within the first few days of treatment with antipsychotic drugs.
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Akathisia is characterized by chewing and sucking movements, grimacing, and choreoathetoid movements.
Akathisia is characterized by chewing and sucking movements, grimacing, and choreoathetoid movements.
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The symptoms of antipsychotic-induced parkinsonism can be controlled with anticholinergic drugs.
The symptoms of antipsychotic-induced parkinsonism can be controlled with anticholinergic drugs.
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Weight gain due to antipsychotic drugs is not associated with an increased risk of type 2 diabetes.
Weight gain due to antipsychotic drugs is not associated with an increased risk of type 2 diabetes.
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Antipsychotic drugs such as haloperidol, amisulpride, aripiprazole, and lurasidone are associated with increased lipid levels.
Antipsychotic drugs such as haloperidol, amisulpride, aripiprazole, and lurasidone are associated with increased lipid levels.
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The presence of the metabolic syndrome in patients taking antipsychotic drugs does not significantly increase the risk of cardiovascular disease.
The presence of the metabolic syndrome in patients taking antipsychotic drugs does not significantly increase the risk of cardiovascular disease.
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Schizophrenia itself is not associated with an increased risk of diabetes.
Schizophrenia itself is not associated with an increased risk of diabetes.
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Antipsychotic drugs do not increase the risk of cardiovascular disease through mechanisms independent of weight gain.
Antipsychotic drugs do not increase the risk of cardiovascular disease through mechanisms independent of weight gain.
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The majority of patients taking antipsychotic drugs do not have the metabolic syndrome.
The majority of patients taking antipsychotic drugs do not have the metabolic syndrome.
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Antipsychotic drugs do not contribute to the increase in overall mortality seen in patients with schizophrenia.
Antipsychotic drugs do not contribute to the increase in overall mortality seen in patients with schizophrenia.
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Weight gain is the most likely problem with haloperidol, amisulpride, aripiprazole, and lurasidone.
Weight gain is the most likely problem with haloperidol, amisulpride, aripiprazole, and lurasidone.
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The risk of cardiovascular disease is not increased in patients with schizophrenia taking antipsychotic drugs.
The risk of cardiovascular disease is not increased in patients with schizophrenia taking antipsychotic drugs.
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Antipsychotic drugs do not have any negative effects on glucose metabolism.
Antipsychotic drugs do not have any negative effects on glucose metabolism.
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Clozapine should be given with carbamazepine to potentiate its therapeutic effect.
Clozapine should be given with carbamazepine to potentiate its therapeutic effect.
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Fluoxetine and paroxetine increase the hepatic metabolism of antipsychotic drugs like haloperidol and risperidone.
Fluoxetine and paroxetine increase the hepatic metabolism of antipsychotic drugs like haloperidol and risperidone.
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Acute dystonia is more commonly observed in elderly women.
Acute dystonia is more commonly observed in elderly women.
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Butyrophenones are associated with a low risk of extrapyramidal side effects.
Butyrophenones are associated with a low risk of extrapyramidal side effects.
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The therapeutic effects of antipsychotic drugs are mainly related to their anticholinergic properties.
The therapeutic effects of antipsychotic drugs are mainly related to their anticholinergic properties.
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Antipsychotic drugs are absorbed mainly from the small intestine when taken by mouth.
Antipsychotic drugs are absorbed mainly from the small intestine when taken by mouth.
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Torticollis is a common feature of acute dystonia.
Torticollis is a common feature of acute dystonia.
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Piperazine compounds, such as trifluoperazine and fluphenazine, are highly selective dopamine-receptor antagonists.
Piperazine compounds, such as trifluoperazine and fluphenazine, are highly selective dopamine-receptor antagonists.
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The British National Formulary is a reference guide for antipsychotic drugs.
The British National Formulary is a reference guide for antipsychotic drugs.
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Antipsychotic drugs are only used to treat positive symptoms of psychosis.
Antipsychotic drugs are only used to treat positive symptoms of psychosis.
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Antipsychotic drugs can increase the risk of osteoporosis in some patients.
Antipsychotic drugs can increase the risk of osteoporosis in some patients.
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Chlorpromazine is not associated with photosensitivity and skin pigmentation.
Chlorpromazine is not associated with photosensitivity and skin pigmentation.
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Phenothiazines are not associated with cholestatic jaundice.
Phenothiazines are not associated with cholestatic jaundice.
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Antipsychotic drugs do not lower the seizure threshold in epileptic patients.
Antipsychotic drugs do not lower the seizure threshold in epileptic patients.
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Hypothermia is not a significant unwanted effect in the elderly.
Hypothermia is not a significant unwanted effect in the elderly.
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Galactorrhoea and amenorrhoea are not induced in some women by high prolactin levels.
Galactorrhoea and amenorrhoea are not induced in some women by high prolactin levels.
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The treatment of the NMS involves the use of a specific antidote.
The treatment of the NMS involves the use of a specific antidote.
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Blood cell dyscrasias are a common side effect of antipsychotic drugs.
Blood cell dyscrasias are a common side effect of antipsychotic drugs.
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Skin rashes are not a side effect of antipsychotic drugs.
Skin rashes are not a side effect of antipsychotic drugs.
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Dantrolene is a drug that is commonly used to treat malignant hyperthermia.
Dantrolene is a drug that is commonly used to treat malignant hyperthermia.
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Bromocriptine is a dopamine antagonist that is used to treat the syndrome.
Bromocriptine is a dopamine antagonist that is used to treat the syndrome.
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Antipsychotic drugs are not associated with metabolic changes affecting general health.
Antipsychotic drugs are not associated with metabolic changes affecting general health.
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Low-libido and sexual dysfunction are not side effects of antipsychotic drugs.
Low-libido and sexual dysfunction are not side effects of antipsychotic drugs.
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Support in an intensive care unit is usually necessary for patients who develop the syndrome.
Support in an intensive care unit is usually necessary for patients who develop the syndrome.
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Patients who have developed the syndrome can never be given the same drug again.
Patients who have developed the syndrome can never be given the same drug again.
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At least 1 week should elapse before antipsychotic drug treatment is reinstated.
At least 1 week should elapse before antipsychotic drug treatment is reinstated.
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The syndrome is usually treated with antipsychotic drugs.
The syndrome is usually treated with antipsychotic drugs.
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Diazepam is a drug that is commonly used to treat muscle stiffness in the syndrome.
Diazepam is a drug that is commonly used to treat muscle stiffness in the syndrome.
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The syndrome is more common in patients who are treated with atypical antipsychotic drugs.
The syndrome is more common in patients who are treated with atypical antipsychotic drugs.
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If an antipsychotic drug has to be used again, it is recommended to restart treatment with a typical agent.
If an antipsychotic drug has to be used again, it is recommended to restart treatment with a typical agent.
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Clozapine is associated with a significant risk of agranulocytosis.
Clozapine is associated with a significant risk of agranulocytosis.
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Weekly blood counts are mandatory for the first year of treatment with clozapine.
Weekly blood counts are mandatory for the first year of treatment with clozapine.
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The concomitant use of carbamazepine with clozapine is generally recommended.
The concomitant use of carbamazepine with clozapine is generally recommended.
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Clozapine is likely to cause extrapyramidal movement disorders, including tardive dyskinesia.
Clozapine is likely to cause extrapyramidal movement disorders, including tardive dyskinesia.
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Seizures are a common side effect of clozapine at any dose.
Seizures are a common side effect of clozapine at any dose.
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Clozapine is associated with an increased risk of myocarditis and myopathy.
Clozapine is associated with an increased risk of myocarditis and myopathy.
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The neuroleptic malignant syndrome is a common side effect of antipsychotic drugs.
The neuroleptic malignant syndrome is a common side effect of antipsychotic drugs.
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The mortality rate of neuroleptic malignant syndrome is typically around 1%.
The mortality rate of neuroleptic malignant syndrome is typically around 1%.
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Patients who survive neuroleptic malignant syndrome usually have residual disability.
Patients who survive neuroleptic malignant syndrome usually have residual disability.
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Clozapine has been reported to cause neuroleptic malignant syndrome.
Clozapine has been reported to cause neuroleptic malignant syndrome.
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Antipsychotic drugs are contraindicated in patients with myasthenia gravis.
Antipsychotic drugs are contraindicated in patients with myasthenia gravis.
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Chlorpromazine can be safely used in patients with liver disease.
Chlorpromazine can be safely used in patients with liver disease.
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Antipsychotic drugs can increase the risk of stroke in elderly patients with pre-existing cerebrovascular disease.
Antipsychotic drugs can increase the risk of stroke in elderly patients with pre-existing cerebrovascular disease.
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Clozapine is recommended for patients with Parkinson's disease.
Clozapine is recommended for patients with Parkinson's disease.
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Antipsychotic drugs can produce movement disorders in patients with dementia.
Antipsychotic drugs can produce movement disorders in patients with dementia.
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Renal disease is not a contraindication to antipsychotic medication.
Renal disease is not a contraindication to antipsychotic medication.
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Glaucoma is a contraindication to antipsychotic medication if the drug has significant anticholinergic activity.
Glaucoma is a contraindication to antipsychotic medication if the drug has significant anticholinergic activity.
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Addison's disease is not a contraindication to antipsychotic medication.
Addison's disease is not a contraindication to antipsychotic medication.
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Antipsychotic drugs should be used with caution in patients with epilepsy.
Antipsychotic drugs should be used with caution in patients with epilepsy.
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The British National Formulary is not a reference guide for antipsychotic drugs.
The British National Formulary is not a reference guide for antipsychotic drugs.
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Adequate dopamine D2-receptor blockade can be obtained with high doses of conventional antipsychotic drugs.
Adequate dopamine D2-receptor blockade can be obtained with high doses of conventional antipsychotic drugs.
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Higher doses of antipsychotic drugs are associated with a lower risk of cardiac arrhythmias.
Higher doses of antipsychotic drugs are associated with a lower risk of cardiac arrhythmias.
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Combining antipsychotic drugs with a benzodiazepine is not a safer and more effective means of producing rapid sedation than high doses of antipsychotic drugs.
Combining antipsychotic drugs with a benzodiazepine is not a safer and more effective means of producing rapid sedation than high doses of antipsychotic drugs.
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Antipsychotic drugs do not alter cardiac conduction.
Antipsychotic drugs do not alter cardiac conduction.
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The increased risk of sudden death in patients taking antipsychotic drugs is related to decreasing dose.
The increased risk of sudden death in patients taking antipsychotic drugs is related to decreasing dose.
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PET data are not usually available to allow clear dosage recommendations for newer antipsychotic drugs.
PET data are not usually available to allow clear dosage recommendations for newer antipsychotic drugs.
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Lower recommended doses of antipsychotic drugs do not produce an adequate antipsychotic effect in the majority of patients.
Lower recommended doses of antipsychotic drugs do not produce an adequate antipsychotic effect in the majority of patients.
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The dosage of individual drugs can be found in the manufacturer’s literature or a comparable work of reference, but not in the British National Formulary.
The dosage of individual drugs can be found in the manufacturer’s literature or a comparable work of reference, but not in the British National Formulary.
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Doses should not be lower for the elderly, patients with brain damage or epilepsy, and the physically ill.
Doses should not be lower for the elderly, patients with brain damage or epilepsy, and the physically ill.
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There has been a trend towards the recommendation of higher doses of typical antipsychotic drugs such as haloperidol.
There has been a trend towards the recommendation of higher doses of typical antipsychotic drugs such as haloperidol.
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Haloperidol is available as an oral preparation only.
Haloperidol is available as an oral preparation only.
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Aripiprazole is less effective than olanzapine in emergency situations.
Aripiprazole is less effective than olanzapine in emergency situations.
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Intramuscular olanzapine should be given with parenteral benzodiazepines.
Intramuscular olanzapine should be given with parenteral benzodiazepines.
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Respiratory depression is a concern primarily in children.
Respiratory depression is a concern primarily in children.
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Flumazenil is used to treat respiratory depression.
Flumazenil is used to treat respiratory depression.
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Hypoglycaemia is a medical condition that should not be considered in the differential diagnosis of disturbed behaviour.
Hypoglycaemia is a medical condition that should not be considered in the differential diagnosis of disturbed behaviour.
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Antipsychotic drugs can be safely used in patients with a history of head injury.
Antipsychotic drugs can be safely used in patients with a history of head injury.
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Alcohol consumption does not potentiate the sedative effects of antipsychotic drugs and benzodiazepines.
Alcohol consumption does not potentiate the sedative effects of antipsychotic drugs and benzodiazepines.
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Postepileptic states are not a consideration in the differential diagnosis of disturbed behaviour.
Postepileptic states are not a consideration in the differential diagnosis of disturbed behaviour.
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Antipsychotic drugs and benzodiazepines are used to control psychomotor excitement, hostility, and other abnormal behavior resulting from anxiety disorders.
Antipsychotic drugs and benzodiazepines are used to control psychomotor excitement, hostility, and other abnormal behavior resulting from anxiety disorders.
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The addition of olanzapine (10 mg) can be helpful if the patient is already taking an antipsychotic drug.
The addition of olanzapine (10 mg) can be helpful if the patient is already taking an antipsychotic drug.
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Risperidone (1–2 mg) is not recommended for use in controlling acute behavioral disturbance.
Risperidone (1–2 mg) is not recommended for use in controlling acute behavioral disturbance.
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Haloperidol (5 mg) is recommended for use without pre-treatment ECG monitoring in an emergency situation.
Haloperidol (5 mg) is recommended for use without pre-treatment ECG monitoring in an emergency situation.
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Psychological or behavioral approaches should be used before drug treatment to control acute behavioral disturbance.
Psychological or behavioral approaches should be used before drug treatment to control acute behavioral disturbance.
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Quetiapine (100–200 mg) is not a suitable option for controlling acute behavioral disturbance.
Quetiapine (100–200 mg) is not a suitable option for controlling acute behavioral disturbance.
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Antipsychotic drugs are used to treat acute behavioral disturbance resulting from chronic psychosis.
Antipsychotic drugs are used to treat acute behavioral disturbance resulting from chronic psychosis.
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Lorazepam (1–2 mg) is used to treat chronic behavioral disturbance.
Lorazepam (1–2 mg) is used to treat chronic behavioral disturbance.
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The goal of drug treatment in acute behavioral disturbance is to sedate the patient as quickly as possible.
The goal of drug treatment in acute behavioral disturbance is to sedate the patient as quickly as possible.
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Promethazine (25 mg) is not used in combination with haloperidol (5 mg) to control acute behavioral disturbance.
Promethazine (25 mg) is not used in combination with haloperidol (5 mg) to control acute behavioral disturbance.
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Phenothiazines are a type of antipsychotic drug that includes Chlorpromazine and Trifluoperazine.
Phenothiazines are a type of antipsychotic drug that includes Chlorpromazine and Trifluoperazine.
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Dibenzothiazepine is a type of antipsychotic drug that includes Risperidone and Quetiapine.
Dibenzothiazepine is a type of antipsychotic drug that includes Risperidone and Quetiapine.
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Olanzapine is a type of Butyrophenones antipsychotic drug.
Olanzapine is a type of Butyrophenones antipsychotic drug.
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Aripiprazole is a type of Quinolinone antipsychotic drug.
Aripiprazole is a type of Quinolinone antipsychotic drug.
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Sulpiride is a type of Substituted benzamides antipsychotic drug.
Sulpiride is a type of Substituted benzamides antipsychotic drug.
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Which antipsychotic drug is least associated with weight gain?
Which antipsychotic drug is least associated with weight gain?
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Which of the following antipsychotic drugs has the highest propensity to cause prolactin elevation?
Which of the following antipsychotic drugs has the highest propensity to cause prolactin elevation?
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Which antipsychotic drug has been associated with agranulocytosis?
Which antipsychotic drug has been associated with agranulocytosis?
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Which of the following antipsychotic drugs is associated with a low risk of extrapyramidal symptoms?
Which of the following antipsychotic drugs is associated with a low risk of extrapyramidal symptoms?
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Which antipsychotic drug is associated with a higher risk of QT prolongation?
Which antipsychotic drug is associated with a higher risk of QT prolongation?
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Which of the following antipsychotic drugs has been associated with a higher risk of insomnia and agitation?
Which of the following antipsychotic drugs has been associated with a higher risk of insomnia and agitation?
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What is the time to peak plasma for Flupenthixol decanoate?
What is the time to peak plasma for Flupenthixol decanoate?
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Which depot antipsychotic drug has a time to steady state of 2 weeks?
Which depot antipsychotic drug has a time to steady state of 2 weeks?
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What is the typical clinical dose of Haloperidol decanoate?
What is the typical clinical dose of Haloperidol decanoate?
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Which depot antipsychotic drug has a licensed dosing interval of 1 month?
Which depot antipsychotic drug has a licensed dosing interval of 1 month?
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What is the time to peak plasma for Pipotiazine palmitate?
What is the time to peak plasma for Pipotiazine palmitate?
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Fluphenazine decanoate takes 1-2 days to reach peak plasma concentration.
Fluphenazine decanoate takes 1-2 days to reach peak plasma concentration.
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The typical clinical dose of Zuclopenthixol decanoate is 50 mg.
The typical clinical dose of Zuclopenthixol decanoate is 50 mg.
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Risperidone microspheres have a time to peak plasma concentration of 2-4 days.
Risperidone microspheres have a time to peak plasma concentration of 2-4 days.
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Paliperidone palmitate has a licensed dosing interval of 4 weeks.
Paliperidone palmitate has a licensed dosing interval of 4 weeks.
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Aripiprazole has a time to peak plasma concentration of 7 days and a licensed dosing interval of monthly.
Aripiprazole has a time to peak plasma concentration of 7 days and a licensed dosing interval of monthly.
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What is a common anticholinergic effect of antipsychotic drugs?
What is a common anticholinergic effect of antipsychotic drugs?
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Which of the following effects is associated with antihistaminic effects of antipsychotic drugs?
Which of the following effects is associated with antihistaminic effects of antipsychotic drugs?
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What is a possible antiadrenergic effect of antipsychotic drugs?
What is a possible antiadrenergic effect of antipsychotic drugs?
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What is a possible movement disorder associated with antipsychotic drugs?
What is a possible movement disorder associated with antipsychotic drugs?
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What is a metabolic effect associated with antipsychotic drugs?
What is a metabolic effect associated with antipsychotic drugs?
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What is the frequency of monitoring body mass index for patients taking antipsychotic drugs?
What is the frequency of monitoring body mass index for patients taking antipsychotic drugs?
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What is an alternative intervention for patients who have experienced weight gain while taking antipsychotic drugs?
What is an alternative intervention for patients who have experienced weight gain while taking antipsychotic drugs?
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What is the recommended frequency of blood glucose monitoring for patients taking antipsychotic drugs?
What is the recommended frequency of blood glucose monitoring for patients taking antipsychotic drugs?
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What is the recommended management for patients who have developed diabetes, dyslipidaemia, or hypertension while taking antipsychotic drugs?
What is the recommended management for patients who have developed diabetes, dyslipidaemia, or hypertension while taking antipsychotic drugs?
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What is the purpose of enquiring about tobacco smoking and alcohol use at each visit?
What is the purpose of enquiring about tobacco smoking and alcohol use at each visit?
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What is the relative dose of Chlorpromazine?
What is the relative dose of Chlorpromazine?
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What is the D2-receptor occupancy in vivo of Trifluoperazine?
What is the D2-receptor occupancy in vivo of Trifluoperazine?
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What is the maximum BNF dose of Haloperidol?
What is the maximum BNF dose of Haloperidol?
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What is the relative dose of Clozapine?
What is the relative dose of Clozapine?
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What is the D2-receptor occupancy in vivo of Sulpiride?
What is the D2-receptor occupancy in vivo of Sulpiride?
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Study Notes
Antipsychotic Drugs
- Phenothiazines:
- Chlorpromazine (prototypic phenothiazine)
- Antagonizes α1-adrenoceptors, histamine H1-receptors, and muscarinic cholinergic receptors
- Causes sedation, hypotension, and anticholinergic effects
- Thioxanthenes:
- Flupenthixol and clopenthixol
- Similar in structure to phenothiazines
- Therapeutic effects similar to piperazine group
- Butyrophenones:
- Haloperidol
- Potent dopamine-receptor antagonists
- Few effects at other neurotransmitter receptors
- Not sedating, but high propensity to cause extrapyramidal side effects
- Atypical Antipsychotic Drugs:
- Selective D2-receptor antagonists:
- Substituted benzamides (sulpiride and amisulpride)
- Highly selective D2-receptor antagonists
- Less likely to produce extrapyramidal movement disorders
- Lack sedative and anticholinergic properties
- 5-HT2-D2-receptor antagonists:
- Risperidone, paliperidone, olanzapine, quetiapine, lurasidone, asenapine, ziprasidone, and aripiprazole
- Differ significantly in potency of dopamine D2-receptor blockade and other aspects
- Selective D2-receptor antagonists:
Pharmacology of Antipsychotic Drugs
- Block dopamine receptors, especially D2 receptors
- 60-70% D2-receptor occupancy associated with antipsychotic effect
- Higher levels associated with extrapyramidal side effects and hyperprolactinaemia
- Other side effects attributable to binding to various receptors (anticholinergic, antiadrenergic, etc.)
Depot Antipsychotic Drugs
- Slow-release preparations used for patients who cannot rely on taking medication regularly
- Include fluphenazine decanoate, flupenthixol decanoate, zuclopenthixol decanoate, haloperidol decanoate, and pipotiazine palmitate
- Given intramuscularly in an oily medium
- Zuclopenthixol acetate reaches peak plasma levels within 1-2 days and has a shorter duration of action
- Slow-release injections of atypical antipsychotic drugs (risperidone, paliperidone, aripiprazole, and olanzapine) also available
Pharmacokinetics of Antipsychotic Drugs
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Well-absorbed from the jejunum
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Subject to first-pass metabolism in the liver
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Highly protein-bound
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Extensively metabolized by the liver to produce active and inactive metabolites
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Half-life of most antipsychotic drugs around 20 hours, allowing for once-daily dosing
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Quetiapine has a shorter half-life (around 3 hours) and requires twice-daily dosing### Antipsychotic Drug Side Effects
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Weight gain associated with antipsychotic drugs can lead to obesity, increasing the risk of type 2 diabetes, and schizophrenia itself is also linked to an increased risk of diabetes.
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The risk of diabetes is likely increased by antipsychotic drugs, partly through weight gain and partly through other pharmacological properties, such as blockade of peripheral M3 muscarinic receptors.
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Newer antipsychotic drugs like olanzapine, clozapine, and quetiapine are associated with increased lipid levels, which can contribute to the risk of cardiovascular disease and mortality.
Metabolic Syndrome
- Approximately one-third of patients taking antipsychotic drugs have the 'metabolic syndrome', which significantly increases the risk of cardiovascular disease, including myocardial infarction and stroke.
- The metabolic syndrome is a combination of central obesity with two or more of the following: hypertension, raised fasting glucose, low HDL cholesterol, and raised triglycerides.
Tardive Dyskinesia
- Tardive dyskinesia is a serious side effect that may not improve after stopping antipsychotic drugs, characterized by chewing and sucking movements, grimacing, and choreoathetoid movements.
- It is more common among women, the elderly, and patients with diffuse brain pathology, and a diagnosis of mood disorder is also a risk factor.
- In about 50% of cases, tardive dyskinesia disappears when the antipsychotic drug is stopped, but the incidence is lower with atypical antipsychotic agents like clozapine, olanzapine, and risperidone.
Extrapyramidal Effects
- Extrapyramidal effects are related to the antidopaminergic action of antipsychotic drugs on the basal ganglia, and can be divided into four groups:
- Acute dystonia
- Parkinsonian syndrome
- Tardive dyskinesia
- Akathisia
Akathisia
- Akathisia is an unpleasant feeling of physical restlessness and a need to move, leading to an inability to keep still, and may be mistaken for a worsening of psychosis.
- It usually occurs during the first two weeks of treatment with antipsychotic drugs, but may begin only after several months, and is not reliably controlled by antiparkinsonian drugs.
Parkinsonian Syndrome
- Antipsychotic-induced parkinsonism is characterized by akinesia, an expressionless face, and lack of associated movements when walking, together with rigidity, coarse tremor, stooped posture, and, in severe cases, a festinant gait.
- The symptoms can be controlled with antiparkinsonian drugs, but it is not good practice to prescribe them prophylactically as a routine.
Anticholinergic and Antihistaminic Effects
- Anticholinergic effects of antipsychotic drugs include dry mouth, urinary hesitancy and retention, constipation, reduced sweating, blurred vision, and, rarely, the precipitation of glaucoma.
- Antihistaminic effects cause sedation and increased appetite, leading to excessive weight gain and contributing to the development of the metabolic syndrome and type 2 diabetes.
Cardiovascular Effects
- Cardiac conduction defects, including cardiac arrhythmias, are sometimes reported, and ECG changes are more common, particularly prolongation of the QT interval and T-wave changes.
- Antipsychotic drugs are also associated with an increased risk of venous thrombosis and pulmonary embolus, which appears to be greater with newer agents and in those who have started treatment more recently.
Other Side Effects
- Depression of mood has been reported, but it is difficult to evaluate, and may be related to excessive dopamine-receptor blockade in the mesolimbic forebrain.
- Other side effects include sedation, postural hypotension, nasal congestion, and inhibition of ejaculation.
Clozapine
- Clozapine is associated with a significant risk of leucopenia, which can progress to agranulocytosis, and requires intensive monitoring of white blood cell counts.
- It is also associated with hypersalivation, drowsiness, postural hypotension, weight gain, and hyperthermia, and may cause seizures, particularly at higher doses.### Dosage of Antipsychotic Drugs
- Doses should be lower for the elderly, patients with brain damage or epilepsy, and the physically ill
- Dosage of individual drugs can be found in the British National Formulary or the manufacturer's literature
- PET imaging studies suggest that lower doses of typical antipsychotic drugs like haloperidol can be effective
Antipsychotic Drugs and Sudden Death
- Antipsychotic drug treatment is associated with a higher risk of sudden unexplained death
- Patients with schizophrenia taking antipsychotic drugs have higher rates of cardiac arrest and ventricular arrhythmias
- The risk of sudden death is related to increasing dose and may be due to the drugs' effect on cardiac conduction
Pharmacological Treatment of Acute Behavioural Disturbance
- Antipsychotic drugs and benzodiazepines are used to control psychomotor excitement and abnormal behaviour
- The goal is to bring behaviour under control quickly and safely
- Psychological or behavioural approaches should be tried first, followed by drug treatment if necessary
- Combination therapy with lorazepam or promethazine can be helpful
Medications Used in Acute Behavioural Disturbance
- Olanzapine (10 mg), quetiapine (100-200 mg), risperidone (1-2 mg), and haloperidol (5 mg) can be used orally
- Parenteral preparations of lorazepam (2 mg), promethazine (50 mg), and olanzapine (10 mg) are available for emergency use
- Aripiprazole (9.75 mg) is licensed for emergency use and may be less likely to cause hypotension
Practical Considerations
- Check for possible respiratory depression, particularly in the elderly and those with concomitant physical illness
- Benzodiazepine antagonist flumazenil should be available
- Differentiate between mania and schizophrenia, and consider medical conditions such as postepileptic states and hypoglycaemia
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Description
This quiz covers the definition and characteristics of antipsychotic medications, including neuroleptics and major tranquillizers. Learn about the therapeutic and side effects of these drugs. Assess your knowledge of their clinical actions and uses.
