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Anti Psychotics > Adverse Events > Flashcards

Adverse Events Flashcards

0
Q

What are the clinical features of hyperprolactinemia?

A
  1. Menstrual irregularity
  2. Gynaecomastia
  3. Galactorrhea
  4. Decreased libido
  5. Sexual dysfunction
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1
Q

What are 3 endocrine adverse effects of antipsychotics?

A
  1. Hyperprolactinemia
  2. Weight gain
  3. Diabetes
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2
Q

What is defined as significant weight gain?

A

7% increase in weight in one year

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3
Q

What is the american diabetes association guidelines on weight gain on antipsychotics?

A

To consider changing antipsychotics if a 5% or more increase in weight has occurred after starting the drug.

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4
Q

What antipsychotic is most diabetiogenic?

A

Olanazapine

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5
Q

What are three cardiovascular adverse events caused by antipsychotics?

A
  1. Postural hypotension
  2. Ecg changes -including qt interval prolongation
  3. Sudden death
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6
Q

What is the mechanism of postural hypotension by antipsychotics?

A

Alpha adrenergic blocking

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7
Q

Describe potential ECG changes associated with antipsychotics?

A
  1. qt prolongation
  2. Sinus tachycardia secondary to reflex tachycardia caused by alpha adrenergic blockage, 3. st depression
  3. flattened t waves
  4. Sinus tachycardia
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8
Q

At what qtc should one stop an antipsychotic?

A

500 msec

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9
Q

What is the increase rate in sudden death in patients taking antipsychotics?

A

Two fold compared with patients not on antipsychotics

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10
Q

Which antipsychotic has the potential to cause metabolic syndrome the most?

A

Olanzapine (CATIE trial)

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12
Q

What the neurological complications of antipsychotics?

A
  1. Tardiness dyskinesia
  2. Akathisia
  3. Dystonia
  4. Pseudoparkinsons
  5. Seizures
  6. Neuroleptic malignant syndrome
  7. Thermoregulation problems
  8. Sedation and cognition
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13
Q

What are the autonomic effects of antipsychotics?

A

Dry mouth, constipation, blurred vision, impaired ejaculation, tachycardia and memory impairment.

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14
Q

Describe dystonic reactions, usual time of onset, types of clinical presentations, risk factors and incidence?

A
  1. Defined as prolonged tonic contractions rapid onset usually within 24-96 hrs from initiation of the drug
  2. Pharyngeal- laryngeal (life threatening), glossospasm, tongue protrusion, trismus, blepharospasm, oculogyric crisis, torticollis, retrocollis.
  3. Risk factors younger patients esp male, high dose, high potency agents
  4. Incidence upto 64% with FGAs
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15
Q

How do you treat dystonic reactions?

A
  1. Bentropine 2mg
  2. Diphenhydramine (Benadryl) 50 mg
  3. Diazepam 5-10 iv slow push or lorazepam 1-2 mg im

Im 15-20 mins
Iv 5 mins

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16
Q

Define akathisia?

A

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.

17
Q

What is the treatment for akathisia?

A

It responds poorly to anticholinergics
Reducing dose or using low potency antipsychotics
Benzodiazepines
Beta blockers

18
Q

What are the treatments options for pseudo-Parkinson’s caused by antipsychotics?

A
  1. Benztropine
  2. Dihyphendramine
  3. Amantadine less problems with memory
19
Q

What is tardive dyskinesia?what are some examples of tardive dyskinetic movements?

A

Defined as involuntary movements.

Tongue movement, lip smacking, rocking, hand movement, jaw movements.

20
Q

What are some risk factors for developing tardive dyskinesia?

A
  1. Acute eps
  2. Total dose
  3. Cumulative dose
  4. Increasing age
  5. Diabetes
  6. Female sex
  7. Duration of dosing
    Overall mortality and morbidity is increased!
21
Q

What are some treatment options for tardive dyskinesia?

A
  1. Regular monitoring
  2. If on a fga change to a sga
  3. Change to clozapine
22
Q

What are the factors that might increase the risk of seizures with antipsychotics?

A
  1. Previous seizures
  2. Organic brain injury head trauma
  3. Previous drug induced seizures
  4. Higher doses
  5. Increasing dose rapidly
23
Q

What is the treatment for antipsychotic induced seizures?

A

Reduction of dose
No need for antiepileptics
Consider changing to lower seizure causing antipsychotics haloperidol, resperidone

24
Q

What is the incidence of NMS with FGAs?

A

0.5-1%

25
Q

What are the clinical features of NMS?

A 
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

26
Q

What are the differential diagnosis for NMS?

A
  1. Lethal Catatonia
  2. Heat stroke
  3. Anticholinergic toxicity
  4. Anaesthetic Induced hyperthermia
  5. Monoamine oxidase interactions
27
Q

What is the treatment for NMS?

A

Discontinue antipsychotic
Dantrolene
Bromocriptine
Amantadine

28
Q

What are some psychiatric se of antipsychotics?

A

Apathy
Delirium
Psychosis

29
Q

What eye disease could be worsened by antipsychotics?

A

Narrow angle glaucoma due to anticholinergic effect

30
Q

What are the genitourinary effects of antipsychotics?

A

Urinary retention
Urinary incontinence
Decreased sexual drive

31
Q

What antipsychotics have the greatest potential for leukopenia?

A

Clozapine
Chloroperazine
Resperidone

32
Q

At what wcc and neutrophil counts should antipsychotics be withheld?

A

Wcc less than 3 and neutrophil count less than 1

33
Q

What is incidence of agranulocytosis with clozapine?

A

0.8 - 3%

34
Q

What is the most studied antipsychotic in pregnancy?

A

Haloperidol

Anti Psychotics (2 decks)

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