adverse reactions/ side effects

Question 1

what are side effects

Answer 1

any action that occurs other than the desired effect of the drug

Question 2

SE with antipsychotics ( nervous system)

Answer 2

nervous system because its a dopamine antagonist ( block dopamine from binding)

Question 3

SE with antipsychotics (endocrine system)

Answer 3

endocrine because blockade of muscarinic cholinergic receptors

Question 4

SE with antipsychotics ( cardiovascular system)

Answer 4

cardiovascular system due to blockade of histamine receptors

Question 5

SE with antipsychotics exocrine system

Answer 5

blockade of adrenergic receptors

Question 6

what are the 9 nervous system side effects

Answer 6

Extrapyramidal Side Effects
Tardive Dyskinesia
Anticholinergic Side Effects
Neuroleptic Malignant Syndrome
Sedation
Confusion
Headaches
Seizures
Sleep Disturbances

Question 7

extrapyramidal symptoms / side effects epse

Answer 7

akanthasia
akinesia
pseudo Parkinsonism
dystonia

they’re group of motor disturbances caused by dopamine being blocked in the nigrrostrital pathway. its reported in 17-19% of clients that have started antipsychotic meds

Question 8

what type of antipsychotics are most likely to cause EPS

Answer 8

high potency typical antipsychotics because they’re potent dopamine (D2) antagonist

Question 9

how can you control EPS

Answer 9

with antiparkinsonian meds

Question 10

akanthasia

Answer 10

most common EPS
5-60 days of starting drug therapy

its motor-restlessness state of motion/ inability to sit still and it is outside of voluntary control

improves with reducing meds or adding benzodiazepine or propranolol

Question 11

akinesia/ bradykinesia

Answer 11

state of being without movement or slowed movements.

Question 12

pseudo Parkinsonism

Answer 12

onset of is the first week after initiating drug therapy
- mask like face
-stooped posture
- cogwheel rigidity in arms and shoulder
- resting temor
- shuffling gait
- bradykinesia anikensia: slowed movements

Question 13

acute dystonic reactions

Answer 13

onset: very sudden, 1-5 days of initiation or increase of drug therapy
- sudden uncoordinated prolonged abnormal tonic contractions of muscle groups
1) torticollis or retrocollis
2) opisthotonos or pleuthotonous ( pisa sign)
3) oculogyric crisis
4) thickening or protrusion of the tongue

Question 14

risk factors for acute dystonic reactions

Answer 14

IM route
high potency antipsychotics
high dose meds
males under 30 years old especially indigenous ones
previous dystonic reaction

children and youth are at greater risk of oculogyric crisis and opisthotonos

Question 15

signs of tardive dyskinesia

Answer 15

eye: rapid eye blinking
mouth: jaw clenching, constant chewing, lip smacking, tongue movements
body: twitching and jerking of limbs, arms and legs

Question 15

Tardive Dyskinesia (TD)

Answer 15

onset is in late psychopharmacological treatment , prominent with high potency and high doses of typical antipsych

cause: chronic exposure to dopamine receptor blocking agents in the nigrostriatal pathway

Question 15

how do you monitor symptoms of tar dive dyskinesia

Answer 15

through AIMS, abnormal involuntary movement scale but test it when pt is fully awake around mid afternoon

Question 15

Anticholinergic side effects

Answer 15

in the nigrostriatal pathway, dopamine blocks cholinergic receptors. Dopamine is blocked at the D2 receptor sites causing an increase stimulation of acetylcholine release

there’s two types: peripheral and central anticholinergic SE

Question 16

tardive dyskinesia treatment

Answer 16

usually irreversible, and has no effective treatment.

Question 17

peripheral anticholinergic side effects

Answer 17

dry mouth
constipation
urinary retention
bowel obstruction
dilated pupils
blurred vision
increased heart rate
decreased sweating

Question 18

central anticholinergic side effects

Answer 18

impaired concentration
confusion
attention deficit
disorientation
memory impairment

Question 19

neuroleptic malignant syndrome

Answer 19

onset occurs hours to months after initial start of drug therapy
hypodopaminergic state ( severe low dopamine)
extremely rare ( 1% of people) can be fatal

Question 20

risk factors of neuroleptic malignant syndrome

Answer 20

initiation or increase of antipsychotic meds
dehydration
physical exhaustion
malnutrition
clients with underlying brain damage and dementia
higher dose of antipsychotics or use of multiple antipsychotics

Question 21

Treatment is

Answer 21

discontinue immediately
Physician may prescribe a dopamine AGONIST (Bromocriptine)
Supportive treatment is required (fluids, electrolytes)

Question 22

symptoms of NMS

Answer 22

eps (muscle rigidity)
increased body temp ( diaphoresis)
Change in consciousness (delirium, confusion, coma)
Fluctuating BP, Tachycardia, decrease respirations
Elevated CPK and myoglobin (causes damage to the liver and kidneys)
Tremor
progress over days to weeks if untreated

Question 23

sedation

Answer 23

related to the anti-histaminic action of antipsychotics

Question 24

confusion

Answer 24

difficulty with concentration, disorientation

Question 25

headaches

Question 26

seizures

Answer 26

be careful with pts with seizure disorder and disorders like dementia. Antipsych meds lower seizure threshold all can do this except clozapine ( unless dose is above 600mg) which is the worst. Seroquel and respiridol are lower risk

Question 27

sleep difficulties

Answer 27

vivid dreams and nightmares

Question 28

what occurs 2 things occur in the endocrine system

Answer 28

metabolism and sexual hormone dysregulation

Question 29

metabolism

Answer 29

metabolic issues stems from undesirable blockage of histamine receptors

antipsychotic can cause weight gain, increased appetite
risk for diabetes T2DM and metabolic syndrome with anti psychs

Question 30

metabolic monitoring includes

Answer 30

weigh
fasting blood work ( blood sugar, triglycerides, cholesterol)
waist circumference
vital signs

Question 31

what two drugs have higher risk of metabolic SE

Answer 31

olanzapine and clozapine

Question 32

predictors of increased weight gain

Answer 32

younger age at treatment initiation
first exposure to antipsychotics
non-smoking status
female sex
family history of high BMI