What is the method of action of Typical antipsychotics?

Dopamine D2 receptor antagonists, blocking dopaminergic transmission in the mesolimbic pathways

What are the main adverse effects of Typical antipsychotics?

Extrapyramidal side-effects and hyperprolactinaemia common

What is the method of action of Atypical antipsychotics?

Act on a variety of receptors (D2, D3, D4, 5-HT)

What are the main adverse effects of Atypical antipsychotics?

• Extrapyramidal side-effects and hyperprolactinaemia less common than typical antipsychotics
• weight gain

What are some examples of Typical antipsychotics?

• Haloperidol
• Chlorpromazine

What are some examples of Atypical antipsychotics?

• Clozapine
• Risperidone
• Olanzapine

What are the symptoms of Extrapyramidal side-effects?

• Parkinsonism
• acute dystonia
• sustained muscle contraction (e.g. torticollis, oculogyric crisis)
• may be managed with procyclidine
• akathisia (severe restlessness)
• tardive dyskinesia (late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)

What additional risks are present when using antipsychotics are used in elderly patients?

• increased risk of stroke
• increased risk of venous thromboembolism

Which Antipsychotic has the highest risk of dyslipidemia and obesity?

olanzapine

Which Antipsychotic has a risk of agranulocytosis?

clozapine

For patients on Antipsychotics how often do they need a Cardiovascular risk assessment?

annually

For patients on Antipsychotics how often do they need a Electrocardiogram?

baseline

For patients on Antipsychotics how often do they need a Blood pressure check?

• baseline
• frequently during dose titration

For patients on Antipsychotics how often do they need a Fasting blood glucose, prolactin check?

• at the start of therapy
• at 6 months
• annually

For patients on Antipsychotics how often do they need a Fasting Lipids & weight checked?

• at the start of therapy
• at 3 months
• annually

For patients on Antipsychotics how often do they need a FBC, U&E and LFT checked?

• at the start of therapy
• annually