Antipsychotics Overview
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What is the primary purpose of antipsychotic drugs?

  • To enhance cognitive function
  • To induce sleep
  • To reduce hallucinations and delusions⁸ (correct)
  • To treat depression

    • What D2-receptor occupancy range is typically associated with the antipsychotic effect?

  • 60-70% (correct)
  • 70-80%
  • 40-50%
  • 80-90%

    • Which of the following is a first-generation antipsychotic?

  • Quetiapine
  • Aripiprazole
  • Clozapine
  • Haloperidol (correct)

    • Which atypical antipsychotic is associated with a risk of agranulocytosis?

    <p>Clozapine</p> Signup and view all the answers

    Which antipsychotic is least likely to cause extrapyramidal side effects?

    <p>Clozapine</p> Signup and view all the answers

    What common adverse effect is linked to Olanzapine?

    <p>QT prolongation</p> Signup and view all the answers

    Which of the following characteristics is NOT typical of atypical antipsychotics?

    <p>Can cause tardive dyskinesia</p> Signup and view all the answers

    Which antipsychotic drug has the shortest half-life?

    <p>Quetiapine</p> Signup and view all the answers

    What is a common adverse effect associated with antipsychotic drugs?

    <p>Constipation</p> Signup and view all the answers

    Which drug is a 5-HT2-D2 receptor antagonist?

    <p>Risperidone</p> Signup and view all the answers

    What is a common adverse effect of Quetiapine?

    <p>Somnolence</p> Signup and view all the answers

    How long does it typically take to reach steady-state drug levels of most antipsychotic drugs?

    <p>Several weeks</p> Signup and view all the answers

    What type of side effects is Risperidone most likely to cause?

    <p>Extrapyramidal side effects</p> Signup and view all the answers

    What is the licensed dosing interval for Haloperidol decanoate?

    <p>4 weeks</p> Signup and view all the answers

    Which of the following side effects is categorized under antidopaminergic movement effects?

    <p>Acute dystonia</p> Signup and view all the answers

    What is the time to peak plasma level for Fluphenazine decanoate?

    <p>1-2 days</p> Signup and view all the answers

    Which of the following side effects is primarily associated with antihistaminic effects of antipsychotic drugs?

    <p>Sedation</p> Signup and view all the answers

    What is the typical clinical dose for Risperidone microspheres?

    <p>37.5 mg</p> Signup and view all the answers

    What is a prominent motor symptom observed in the clinical picture described?

    <p>Generalized muscular hypertonicity</p> Signup and view all the answers

    Which medication is used specifically to treat malignant hyperthermia?

    <p>Dantrolene</p> Signup and view all the answers

    Which of the following conditions is a contraindication for the use of Bromocriptine?

    <p>Myasthenia gravis</p> Signup and view all the answers

    What symptom is associated with autonomic disturbances in this condition?

    <p>Tachycardia</p> Signup and view all the answers

    Which medication should not be administered with parenteral benzodiazepines?

    <p>Olanzapine</p> Signup and view all the answers

    What is one of the side effects characterized by an expressionless face, lack of movement, and rigidity after months of antipsychotic treatment?

    <p>Parkinsonian syndrome</p> Signup and view all the answers

    Which drug is commonly used to control Parkinsonian syndrome resulting from antipsychotic medication?

    <p>Procyclidine</p> Signup and view all the answers

    Which statement about tardive dyskinesia is correct?

    <p>It can occur in patients taking metoclopramide.</p> Signup and view all the answers

    What are the specific movements associated with tardive dyskinesia?

    <p>Grimacing and choreoathetoid movements</p> Signup and view all the answers

    Which complication is associated with antihistaminic effects from antipsychotic medications?

    <p>Increased appetite and weight gain</p> Signup and view all the answers

    What is a consequence of excessive dopamine-receptor blockade in patients treated with antipsychotics?

    <p>Mood depression and anhedonia</p> Signup and view all the answers

    Which side effect is categorized as an anticholinergic effect of antipsychotics?

    <p>Dry mouth and constipation</p> Signup and view all the answers

    What is the recommended monitoring for potential cardiac issues arising from antipsychotic use?

    <p>ECG monitoring for arrhythmias</p> Signup and view all the answers

    What is the primary concern associated with obesity in patients taking certain antipsychotic medications?

    <p>Increased risk of developing type 2 diabetes</p> Signup and view all the answers

    Which specific antipsychotic medications are noted for significantly increasing lipid levels?

    <p>Olanzapine, clozapine, and quetiapine</p> Signup and view all the answers

    Which combination constitutes metabolic syndrome?

    <p>Central obesity, high fasting glucose, low HDL cholesterol, high triglycerides</p> Signup and view all the answers

    What is a recommended monitoring frequency for body mass index in patients on antipsychotic drugs?

    <p>Once every 4 weeks for 12 weeks, then at least biannually</p> Signup and view all the answers

    What is a side effect associated with clozapine that requires regular monitoring?

    <p>Leucopenia requiring blood count</p> Signup and view all the answers

    Which lifestyle intervention is recommended for patients on antipsychotic medication to mitigate weight gain?

    <p>Diet and exercise adjustments</p> Signup and view all the answers

    What is the rare serious condition that can occur in a small minority of patients treated with high potency antipsychotics?

    <p>Neuroleptic malignant syndrome</p> Signup and view all the answers

    What type of change can high prolactin levels cause in patients?

    <p>Galactorrhoea and amenorrhoea</p> Signup and view all the answers

    Study Notes

    Antipsychotic Drug Overview

    • Antipsychotics reduce hallucinations, delusions, agitation, and psychomotor excitement in conditions like schizophrenia and mania.
    • Effective treatment occurs when D2-receptor occupancy is between 60-70%.

    Types of Antipsychotics

    • Conventional Antipsychotics (First Generation)

      • Examples: chlorpromazine, haloperidol.
      • Function primarily as dopamine-receptor antagonists.

    • Atypical Antipsychotics (Second Generation)

      • Produce effects with fewer extrapyramidal side effects.
      • Higher risk of tardive dyskinesia is not common except with risperidone.

    Common Antipsychotic Agents

    • Phenothiazines:
      • Chlorpromazine, Trifluoperazine.
    • Thioxanthenes:
      • Flupenthixol, Clopenthixol.
    • Butyrophenones:
      • Haloperidol.
    • Dibenzodiazepines:
      • Clozapine, Olanzapine.
    • Dibenzothiazepine:
      • Quetiapine.
    • Substituted Benzamides:
      • Sulpiride, Amisulpride.
    • Benzisoxazole:
      • Risperidone.
    • Quinolinone:
      • Aripiprazole.

    Side Effects of Atypical Antipsychotics

    • Amisulpride: EPS, prolactin elevation, weight gain. Side effects include insomnia and QT prolongation.
    • Sulpiride: Similar profile to amisulpride.
    • Clozapine: Zero EPS or prolactin elevation, significant weight gain potential, and associated with agranulocytosis.
    • Olanzapine: Variable EPS, high weight gain. Side effects include somnolence and diabetes.
    • Quetiapine: No EPS or prolactin elevation. Monitor for somnolence and metabolic effects.
    • Risperidone: Higher risk of EPS and prolactin elevation. Side effects include insomnia and anxiety.

    Pharmacology Highlights

    • Atypical antipsychotics act as 5-HT2-D2-receptor antagonists.
    • Most are metabolized by the liver; exceptions include sulpiride and amisulpride excreted unchanged by the kidneys.
    • Typical half-life of antipsychotics is around 20 hours; quetiapine requires twice-daily dosing.
    • Steady-state drug levels achieved after several weeks.

    Common Side Effects

    • Antidopaminergic Effects: Acute dystonia, akathisia, parkinsonism, tardive dyskinesia.
    • Other Effects: Weight gain, sedation, cardiac arrhythmias, metabolic syndrome, endocrine changes (e.g., galactorrhea).
    • Serious Risks: Neuroleptic malignant syndrome (NMS), especially with high-potency compounds.

    Tardive Dyskinesia

    • Characterized by involuntary movements primarily of the face, increased susceptibility in women and elderly.
    • Lower occurrence in atypical agents like clozapine and olanzapine compared to haloperidol.
    • Possible treatment includes clozapine or clonazepam.

    Depot Antipsychotic Administration

    • Infrequently used antipsychotics available in depot forms for long-term treatment.
    • Includes agents like flupenthixol decanoate, haloperidol decanoate, and risperidone microspheres.
    • Various dosing intervals and clinical dosages, emphasizing monitoring.

    Clinical Monitoring and Intervention

    • Regular monitoring of body mass index, blood glucose, lipid profile, and blood pressure.
    • Recommend lifestyle interventions and potential switching to drugs with a better side effect profile.
    • Metformin may assist with weight management.

    Clozapine Monitoring

    • Requires weekly blood counts at initiation due to risk of leukopenia, transitioning to bi-weekly then monthly.
    • Potential side effects include drowsiness, weight gain, and seizures at higher doses.

    Contraindications

    • Avoid in conditions like myasthenia gravis, Addison’s disease, and glaucoma.
    • Increased risk of severe movement disorders in dementia patients.
    • Caution with liver diseases and potential cardiac risks associated with certain medications.

    Treatment of Acute Behavioral Disturbances

    • Medications like lorazepam, olanzapine, or haloperidol are commonly used for rapid tranquillization.
    • ECG monitoring is advised prior to administration of parenteral antipsychotics.

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    Description

    This quiz covers the fundamental aspects of antipsychotic drugs, including their purpose in treating conditions like schizophrenia and the different types of antipsychotics. Understand the mechanisms of action and the therapeutic effects associated with both conventional and atypical agents. Test your knowledge on the pharmacology of these important medications.

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