adverse reactions/ side effects Flashcards
what are side effects
any action that occurs other than the desired effect of the drug
SE with antipsychotics ( nervous system)
nervous system because its a dopamine antagonist ( block dopamine from binding)
SE with antipsychotics (endocrine system)
endocrine because blockade of muscarinic cholinergic receptors
SE with antipsychotics ( cardiovascular system)
cardiovascular system due to blockade of histamine receptors
SE with antipsychotics exocrine system
blockade of adrenergic receptors
what are the 9 nervous system side effects
Extrapyramidal Side Effects
Tardive Dyskinesia
Anticholinergic Side Effects
Neuroleptic Malignant Syndrome
Sedation
Confusion
Headaches
Seizures
Sleep Disturbances
extrapyramidal symptoms / side effects epse
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
what type of antipsychotics are most likely to cause EPS
high potency typical antipsychotics because they’re potent dopamine (D2) antagonist
how can you control EPS
with antiparkinsonian meds
akanthasia
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
akinesia/ bradykinesia
state of being without movement or slowed movements.
pseudo Parkinsonism
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
acute dystonic reactions
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
risk factors for acute dystonic reactions
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
signs of tardive dyskinesia
eye: rapid eye blinking
mouth: jaw clenching, constant chewing, lip smacking, tongue movements
body: twitching and jerking of limbs, arms and legs
Tardive Dyskinesia (TD)
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
how do you monitor symptoms of tar dive dyskinesia
through AIMS, abnormal involuntary movement scale but test it when pt is fully awake around mid afternoon
Anticholinergic side effects
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
tardive dyskinesia treatment
usually irreversible, and has no effective treatment.
peripheral anticholinergic side effects
dry mouth
constipation
urinary retention
bowel obstruction
dilated pupils
blurred vision
increased heart rate
decreased sweating
central anticholinergic side effects
impaired concentration
confusion
attention deficit
disorientation
memory impairment
neuroleptic malignant syndrome
onset occurs hours to months after initial start of drug therapy
hypodopaminergic state ( severe low dopamine)
extremely rare ( 1% of people) can be fatal
risk factors of neuroleptic malignant syndrome
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
Treatment is
discontinue immediately
Physician may prescribe a dopamine AGONIST (Bromocriptine)
Supportive treatment is required (fluids, electrolytes)
symptoms of NMS
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
sedation
related to the anti-histaminic action of antipsychotics
confusion
difficulty with concentration, disorientation
headaches
seizures
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
sleep difficulties
vivid dreams and nightmares
what occurs 2 things occur in the endocrine system
metabolism and sexual hormone dysregulation
metabolism
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
metabolic monitoring includes
weigh
fasting blood work ( blood sugar, triglycerides, cholesterol)
waist circumference
vital signs
what two drugs have higher risk of metabolic SE
olanzapine and clozapine
predictors of increased weight gain
younger age at treatment initiation
first exposure to antipsychotics
non-smoking status
female sex
family history of high BMI
