Antipsychotic drugs side effects Flashcards
Patients with schizophrenia, how often physical health monitoring and cardiovascular assessment be undertaken ?
every year
With which antipsychotic drugs extrapyramidal symptoms are most likely to occur ?
butyrophenones, group 3 phenothiazines and first generation depot preparations.
Name extrapyramidal symptoms ?
Parkinsonism Dystonia Akathisia Dyskinesia Tardive dyskinesia
Explain Parkinsonism symptoms ?
Tremors, more common in adults and elderly
Explain Dystonia ?
abnormal face and body movement , more common in children and young adults. Appears after a few doses
What is Akathisia ?
inner restlessness, usually after large initial doses
Explain tardive dyskinesia ?
Tardive means late
rhythmic involuntary movements of tongue, face, jaw. Most serious manifestation; can be irreversible
More common in the elderly
Usually appears after long term treatment or high doses
what is the first sign of tardive dyskinesia ?
fine vermicular movements of tongue
With which antipsychotics hyperprolactinaemia is more likely to occur ?
rispderidone, amisulrpide and first generation
What are the symptoms of hyperprolactinaemia and monitoring requirements ?
- Breast symptoms: enlargement, pain, galactorrhea
- Reduced bone mineral density
- menstrual irregularities
- sexual dysfunction = reduced libido
Monitor prolactin levels at the start, 6 months and yearly
Monitor endocrine function in children: weight, height, menstrual function, sexual maturation
There is only one antipsychotic that doesn’t cause hyperporlactinaemia, because it is a partial dopamine agonist ?
Aripiprazole
What are the metabolic side effects that most likely occur with second generation antipsychotics ?
- hyperglycaemia and sometimes diabetes: most likely with clozapine, risperidone, olanzapine, quetiapine
- weight gain: commonly with olanzapine and clozapine
- lipid changes: dyslipidaemia
Which antipsychotics are most likely to cause sexual dysfunction ?
haloperidol and risperidone
Antipsychotic drugs are associated with what type of cardiovascular side effects ?
tachycardia, arrythmias, hypotension , QT interval prolongation
Which antipsychotics have the most risk of causing QT prolongation ?
pimozide, haloperidol. And IV antipsychotics also doses above maximum limit.
aripirprazole has negligible effect on QT interval
Of what side effects particularly elderly patients are at risk when given antipsychotic ?
hypotension and interference with temperature regulation thus elderly are particularly at risk of falls, hypothermia and hyperthermia ( dose related s/e)
Should elderly with mild to moderate symptoms of schizophrenia should be given antipsychotic , yes or no and why ?
No and initial dose for elderly should be half of the adult does. It is because there is a risk of hypotension and hypo/hyperthermia
Which antipsychotics can cause postural hypotension ?
clozapine, chlorpromazine, lurasidone, quetiapine
What are the symptoms of NMS?
muscle rigidity
fluctuating consciousness
hyperthermia and autonomic dysfunction with pallor, tachycardia, sweating, urinary incontinence, labile BP
Which dopamine receptor agonists have been used to reverse NMS?
bromocriptine and dantrolene
How long NMS syndrome last after stopping antipsychotics ?
lasts 5-7 days, but longer with depot preparations
What are other important side effects of antipsychotics ?
antimuscarinic side effects, blood dyscrasias, photosensitivity ( high doses ), jaundice ( including cholestatic ), sedation
Which antipsychotic can cause contact sensitisation and thus direct contact should be avoided ?
chlorpromazine
Pimozide has a high risk of which cardiac side effect?
Prolongs QT interval, cases of sudden death
Which drugs shouldn’t be give with pimozide due to risk of QT prolongation ?
TCAs, antipsychotics, antiarrhytmics
and those that cause hypokalaemia
Phenothiazine antipsychotics can cause what side effects?
hepatoxicity
Acute dystonic reactions: facial and skeletal muscle spasms and oculogyric crises.
At risk are especially girls, young women and children under < 10 kg
