Antipsychotic drugs side effects

Question 1

Patients with schizophrenia, how often physical health monitoring and cardiovascular assessment be undertaken ?

Answer 1

every year

Question 2

With which antipsychotic drugs extrapyramidal symptoms are most likely to occur ?

Answer 2

butyrophenones, group 3 phenothiazines and first generation depot preparations.

Question 3

Name extrapyramidal symptoms ?

Answer 3

Parkinsonism
Dystonia
Akathisia
Dyskinesia
Tardive dyskinesia

Question 4

Explain Parkinsonism symptoms ?

Answer 4

Tremors, more common in adults and elderly

Question 5

Explain Dystonia ?

Answer 5

abnormal face and body movement , more common in children and young adults. Appears after a few doses

Question 6

What is Akathisia ?

Answer 6

inner restlessness, usually after large initial doses

Question 7

Explain tardive dyskinesia ?

Answer 7

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

Question 8

what is the first sign of tardive dyskinesia ?

Answer 8

fine vermicular movements of tongue

Question 9

With which antipsychotics hyperprolactinaemia is more likely to occur ?

Answer 9

rispderidone, amisulrpide and first generation

Question 10

What are the symptoms of hyperprolactinaemia and monitoring requirements ?

Answer 10

1. Breast symptoms: enlargement, pain, galactorrhea
2. Reduced bone mineral density
3. menstrual irregularities
4. 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

Question 11

There is only one antipsychotic that doesn’t cause hyperporlactinaemia, because it is a partial dopamine agonist ?

Answer 11

Aripiprazole

Question 12

What are the metabolic side effects that most likely occur with second generation antipsychotics ?

Answer 12

• hyperglycaemia and sometimes diabetes: most likely with clozapine, risperidone, olanzapine, quetiapine
• weight gain: commonly with olanzapine and clozapine
• lipid changes: dyslipidaemia

Question 13

Which antipsychotics are most likely to cause sexual dysfunction ?

Answer 13

haloperidol and risperidone

Question 14

Antipsychotic drugs are associated with what type of cardiovascular side effects ?

Answer 14

tachycardia, arrythmias, hypotension , QT interval prolongation

Question 15

Which antipsychotics have the most risk of causing QT prolongation ?

Answer 15

pimozide, haloperidol. And IV antipsychotics also doses above maximum limit.
aripirprazole has negligible effect on QT interval

Question 16

Of what side effects particularly elderly patients are at risk when given antipsychotic ?

Answer 16

hypotension and interference with temperature regulation thus elderly are particularly at risk of falls, hypothermia and hyperthermia ( dose related s/e)

Question 17

Should elderly with mild to moderate symptoms of schizophrenia should be given antipsychotic , yes or no and why ?

Answer 17

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

Question 18

Which antipsychotics can cause postural hypotension ?

Answer 18

clozapine, chlorpromazine, lurasidone, quetiapine

Question 19

What are the symptoms of NMS?

Answer 19

muscle rigidity
fluctuating consciousness
hyperthermia and autonomic dysfunction with pallor, tachycardia, sweating, urinary incontinence, labile BP

Question 20

Which dopamine receptor agonists have been used to reverse NMS?

Answer 20

bromocriptine and dantrolene

Question 21

How long NMS syndrome last after stopping antipsychotics ?

Answer 21

lasts 5-7 days, but longer with depot preparations

Question 22

What are other important side effects of antipsychotics ?

Answer 22

antimuscarinic side effects, blood dyscrasias, photosensitivity ( high doses ), jaundice ( including cholestatic ), sedation

Question 23

Which antipsychotic can cause contact sensitisation and thus direct contact should be avoided ?

Answer 23

chlorpromazine

Question 24

Pimozide has a high risk of which cardiac side effect?

Answer 24

Prolongs QT interval, cases of sudden death

Question 25

Which drugs shouldn’t be give with pimozide due to risk of QT prolongation ?

Answer 25

TCAs, antipsychotics, antiarrhytmics

and those that cause hypokalaemia

Question 26

Phenothiazine antipsychotics can cause what side effects?

Answer 26

hepatoxicity
Acute dystonic reactions: facial and skeletal muscle spasms and oculogyric crises.
At risk are especially girls, young women and children under < 10 kg