Adverse reactions of antipsychotics and their treatment Flashcards
anti-alpha1 adrenergic symptoms
orthostatic hypotension, lightheadedness, sedation and sexual dysfunction
anti-histamine symptoms
sedation, weight gain and fatigue
central anti-cholinergic symptoms
severe agitation, disorientation, hallucinations, seizure, high fever, dilated pupils, stupor/coma, EKG changes
peripheral anti-cholinergic symptoms
dry mouth, dry nose, blurred vision, constipation, urinary retention
treatment of anti-cholinergic symptoms
oral water/ice, sugarless gum, neostigmine, stool softeners, change med
for acute delirium: withdrawal plus close medical supervision (EKG) and physostigmine (Antilirium)
dopamine blockade
extrapyramidal symptoms (acute dystolic reaction, akathisia, parkinsonian symptoms, tardive dyskinesia)
acute dystonic reaction
involuntary sustained contraction of skeletal muscle
commonly the jaw muscles (lock jaw), torticollis, carpopedal spasm, oculogyric crisis (rotation of eyeballs), opisthotonus (resting on head and hells in hyperextension)
often suddenly appears in the first couple days of treatment
more common in men under 30 and with high potency agents
treatment of acute dystonic reactions
IV/IM anti-parkinsonian agents (benztropine (cogentin))
Benadryl
consider changing agent
prophylaxis agent against further episodes with oral anticholinergic (benztropine)
if it continues after d/c of benztropine, longer prophylaxis needed
akathisia reaction
fidgety, constantly moving hands and feet, rock from the waist, shift from foot to foot, typically also dysphoric
commonly middle aged women
treatment of akathisia
decrease neuroleptic dose if possible,
trial of benztropine, propranolol or klonopin
consider changing to lower potency typical or to an atypical
parkinsonian symptoms
pill-rolling tremor, cogwheel rigidity, masked facies
3 sx may occur together or individually, usually 1-4 weeks of treatment
highest risk in elderly females
treatment of parkinsonian symptoms
decrease dose
use antiparkinsonian agent (benztropine, benadryl or amatadine)
consider changing to lower potency typical or atypical
tremor treated with propranolol
tardive dyskinesia symptoms
slow choreiform or tic-like movements, usually of the tongue and facial muscles but occasionally upper extremities
risk increases with age, females, high dose meds, use of several neuroleptics and long duration of treatment
generally develops over months/years of use and follows a stable, benign, long term course for most
treatment of TD
“drug holidays” may make symptoms worse
no acceptable treatment other than to d/c agent if possible
can quantify degree of neuroleptic dysfxn with abnormal involuntary movements scale (AIMS)
consider switching to an atypical (risperdal)
neuroleptic malignant syndrome
potentially FATAL, can occur at ANY TIME
extreme hyperthermia, severe muscular rigidity, dystonia, confusion, agitation, CV collapse
symptoms evolve over 24-72 hrs and sometimes mistaken for worsening psychosis
