Antipsychotic Medications sideffects

Question 1

Psychiatric Se

Answer 1

• Akathisia
• Akinesia
• Dysphoria
• Anticholinergic

Question 2

NMS S/S

Answer 2

• Elevated temperature (up to 107F)
• Increased HR, RR and labile BP
• Diaphoresis
• Incontinence

Question 3

Labs for Antipsychotic

Answer 3

Labs: leukocytosis, elevated CK, aminotransferase,

lactate dehydrogenase, myoglobinuria

Question 4

All Cause Mortality Rate
Among Individuals with
Psychiatric Illness

Answer 4

Males 1.7 times higher than general pop

– Females 1.3 times higher than general pop

Question 5

largest single cause in mortality

Answer 5

CV

Question 6

Schizophrenics hi hg er rates of

Answer 6

arrhythmia, syncope and heart failure, diabetes and

stroke

Question 7

risk factors for individuals with pyschiatric illness

Answer 7

– Medical comorbidities
– Treatment with antipsychotic medications
– Rapid tranquillization

Question 8

PMH

Answer 8

CVD: MI, HF, myocarditis, low EF, prolonged QT
– Renal/liver impairment
– Alcohol/Drug use
– Medication history

Question 9

family medical history

Answer 9

Arrhythmia

– Sudden death

Question 10

Cardiovascular Effects of Antipsychotic

Drugs - common

Answer 10

– Orthostatic (postural) hypotension

– Syncope

Question 11

Cardiovascular Effects of Antipsychotic

Drugs - Rare

Answer 11

Reduced heart rate variability
– Prolongation Prolongation of the QT/QTc intervals intervals
– Widened QRS complex

Question 12

Cardiovascular Effects of Antipsychotic

Drugs - Very Rare

Answer 12

Ventricular tachycardia
– Torsades de pointes
– Myocarditis
– Cardiomyopathy
– Pericarditis
– Cardiac arrest and sudden cardiac death

Question 13

Sudden Death - Cause

Answer 13

unceratin

Suspected:
– Fatal arrhythmias
• prolonged QT
• Torsade de Pointes
• V‐Tachycardia
• V‐fibrillation

Question 14

Risk Factors for QT Prolongation and
Torsade de Pointes
• Demographics

Answer 14

Old age

• Female gender

Question 15

Risk Factors for QT Prolongation and

Torsade de Pointes - Underlying conduction

Answer 15

Bradycardia
– Congenital prolonged QT
– Significant T wave abnormalities
– Mutations of sodium channels
– Electrolyte imbalances (especially hypokalemia and
hypomagnesemia)

Question 16

normal QTC

Answer 16

400 - 444

Question 17

QTC of concern

Answer 17

beyond 500

Question 18

Risk Factors for QT Prolongation and

Torsade de Pointes - CV disease

Answer 18

– LV hypertrophy, ischemia, low LV ejection fraction

Question 19

Risk Factors for Sudden Death - • Healthy people

Answer 19

Repolarisation abnormalities (long QT syndromes)
• Ventricular pre‐excitation (Wolff–Parkinson– White
syndrome)

Question 20

Risk Factors for Sudden Death - those with cardiac failure

Answer 20

Ischemic heart disease disease
• Dilated cardiomyopathy
• Left ventricular systolic dysfunction
• Abnormal signal‐averaged ECG
• Non‐sustained ventricular tachycardias on

Question 21

Risk Factors for Sudden Death - Holter monitor recordigns

Answer 21

• Reduced heart rate variability
• T‐wave alternans
• B‐type natriuretic peptide

Question 22

Psychotropic Drugs With Greater Risk
Arrhythmia and Sudden Death
• Higher risk

Answer 22

– thioridazine, clozapine, droperidol, pipamperone,

pimozide, sertindole and ziprasidone;

Question 23

Psychotropic Drugs With Greater Risk

Arrhythmia and Sudden Death

Answer 23

– quetiapine, haloperidol, chlorpromazine and

olanzapine

Question 24

Potassium*, sodium, calcium channels during
repolarization
– May induce

Answer 24

– May induce Torsade de Pointes and death in

apparent healthy individuals

Question 25

Drug‐Drug Interaction: Drugs

Associated with Prolonged QT - first four

Answer 25

Antibiotics (macrolides, fluoroquinolones, clindamycin)
• Antiarrhythmics (calcium channel blockers, amiodarone,
bretyllium, others)
• Serotonin antagonists (cisapride)
• Antipsychotics

Question 26

Drug‐Drug Interaction: Drugs

Associated with Prolonged QT - last four

Answer 26

Antidepressants (TCAs, fluoxetine, paroxetine,
venlafaxine)
• Antimalarials
• Antihistamines (astemizole, terfenadine)
• Antimigraine agents (triptans)

Question 27

Monitoring

• Baseline and Serial

Answer 27

EKG
– Repeat when steady state reached
– Measure QTc (rate corrected QT interval)
– Know norms
– Cut Point: >500 ms or change >60ms from
baseline

Question 28

Monitoring LAbs

Answer 28

– Liver, renal, electrolytes, CBC

Question 29

antipsycothic Drugs that require reduced dosage: depends

on severity, check literature

Answer 29

• Mirtazapine Duloxetine
• Venlafaxine Tianeptine
• Citalopram Paroxetine

Question 30

antipsychotic renal system

Answer 30

• Higher risk for Acute Kidney injury when
prescribed antipyschotic, especially elderly
• Use caution in patients with hypotension or
evidence of kidney injury in the past

Question 31

• Modifiable variables for antipsychotic‐induced

sudden death

Answer 31

established (or occult) cardiovascular disease.
– the cumulative cumulative dose of antipsychotic antipsychotic (including (including
Polypharmacy)

Question 32

what do you need to pay attention to in primary care

Answer 32

– Pay attention to BP, weight, blood sugar, lipids,
renal and liver function, EKG. In some cases, will
need to monitor CBC (Clozapine)
• If weight gain, may lead to drug change, addition of
other drug
– Watch for DM, Prolonged QT, hyperlipidemia