Adverse Events Flashcards
What are the clinical features of hyperprolactinemia?
- Menstrual irregularity
- Gynaecomastia
- Galactorrhea
- Decreased libido
- Sexual dysfunction
What are 3 endocrine adverse effects of antipsychotics?
- Hyperprolactinemia
- Weight gain
- Diabetes
What is defined as significant weight gain?
7% increase in weight in one year
What is the american diabetes association guidelines on weight gain on antipsychotics?
To consider changing antipsychotics if a 5% or more increase in weight has occurred after starting the drug.
What antipsychotic is most diabetiogenic?
Olanazapine
What are three cardiovascular adverse events caused by antipsychotics?
- Postural hypotension
- Ecg changes -including qt interval prolongation
- Sudden death
What is the mechanism of postural hypotension by antipsychotics?
Alpha adrenergic blocking
Describe potential ECG changes associated with antipsychotics?
- qt prolongation
- Sinus tachycardia secondary to reflex tachycardia caused by alpha adrenergic blockage, 3. st depression
- flattened t waves
- Sinus tachycardia
At what qtc should one stop an antipsychotic?
500 msec
What is the increase rate in sudden death in patients taking antipsychotics?
Two fold compared with patients not on antipsychotics
Which antipsychotic has the potential to cause metabolic syndrome the most?
Olanzapine (CATIE trial)
What the neurological complications of antipsychotics?
- Tardiness dyskinesia
- Akathisia
- Dystonia
- Pseudoparkinsons
- Seizures
- Neuroleptic malignant syndrome
- Thermoregulation problems
- Sedation and cognition
What are the autonomic effects of antipsychotics?
Dry mouth, constipation, blurred vision, impaired ejaculation, tachycardia and memory impairment.
Describe dystonic reactions, usual time of onset, types of clinical presentations, risk factors and incidence?
- Defined as prolonged tonic contractions rapid onset usually within 24-96 hrs from initiation of the drug
- Pharyngeal- laryngeal (life threatening), glossospasm, tongue protrusion, trismus, blepharospasm, oculogyric crisis, torticollis, retrocollis.
- Risk factors younger patients esp male, high dose, high potency agents
- Incidence upto 64% with FGAs
How do you treat dystonic reactions?
- Bentropine 2mg
- Diphenhydramine (Benadryl) 50 mg
- Diazepam 5-10 iv slow push or lorazepam 1-2 mg im
Im 15-20 mins
Iv 5 mins
Define akathisia?
A feeling of restlessness and disquiet. Patient is unable to sit still and has motor restless. Subjective symptoms with objective evidence of pacing shifting, shuffling and tapping feet.
What is the treatment for akathisia?
It responds poorly to anticholinergics
Reducing dose or using low potency antipsychotics
Benzodiazepines
Beta blockers
What are the treatments options for pseudo-Parkinson’s caused by antipsychotics?
- Benztropine
- Dihyphendramine
- Amantadine less problems with memory
What is tardive dyskinesia?what are some examples of tardive dyskinetic movements?
Defined as involuntary movements.
Tongue movement, lip smacking, rocking, hand movement, jaw movements.
What are some risk factors for developing tardive dyskinesia?
- Acute eps
- Total dose
- Cumulative dose
- Increasing age
- Diabetes
- Female sex
- Duration of dosing
Overall mortality and morbidity is increased!
What are some treatment options for tardive dyskinesia?
- Regular monitoring
- If on a fga change to a sga
- Change to clozapine
What are the factors that might increase the risk of seizures with antipsychotics?
- Previous seizures
- Organic brain injury head trauma
- Previous drug induced seizures
- Higher doses
- Increasing dose rapidly
What is the treatment for antipsychotic induced seizures?
Reduction of dose
No need for antiepileptics
Consider changing to lower seizure causing antipsychotics haloperidol, resperidone
What is the incidence of NMS with FGAs?
0.5-1%
What are the clinical features of NMS?
Rapid onset usually within 24-72 hrs CAn occur when antipsychotics has been stopped Temperature 38 Ck rise Agitation Tachycardia Rigidity Altered conscious state
Faecal or urinary incontinence
What are the differential diagnosis for NMS?
- Lethal Catatonia
- Heat stroke
- Anticholinergic toxicity
- Anaesthetic Induced hyperthermia
- Monoamine oxidase interactions
What is the treatment for NMS?
Discontinue antipsychotic
Dantrolene
Bromocriptine
Amantadine
What are some psychiatric se of antipsychotics?
Apathy
Delirium
Psychosis
What eye disease could be worsened by antipsychotics?
Narrow angle glaucoma due to anticholinergic effect
What are the genitourinary effects of antipsychotics?
Urinary retention
Urinary incontinence
Decreased sexual drive
What antipsychotics have the greatest potential for leukopenia?
Clozapine
Chloroperazine
Resperidone
At what wcc and neutrophil counts should antipsychotics be withheld?
Wcc less than 3 and neutrophil count less than 1
What is incidence of agranulocytosis with clozapine?
0.8 - 3%
What is the most studied antipsychotic in pregnancy?
Haloperidol
