Antipsychotic Medications sideffects Flashcards
Psychiatric Se
- Akathisia
- Akinesia
- Dysphoria
- Anticholinergic
NMS S/S
- Elevated temperature (up to 107F)
- Increased HR, RR and labile BP
- Diaphoresis
- Incontinence
Labs for Antipsychotic
Labs: leukocytosis, elevated CK, aminotransferase,
lactate dehydrogenase, myoglobinuria
All Cause Mortality Rate
Among Individuals with
Psychiatric Illness
Males 1.7 times higher than general pop
– Females 1.3 times higher than general pop
largest single cause in mortality
CV
Schizophrenics hi hg er rates of
arrhythmia, syncope and heart failure, diabetes and
stroke
risk factors for individuals with pyschiatric illness
– Medical comorbidities
– Treatment with antipsychotic medications
– Rapid tranquillization
PMH
CVD: MI, HF, myocarditis, low EF, prolonged QT
– Renal/liver impairment
– Alcohol/Drug use
– Medication history
family medical history
Arrhythmia
– Sudden death
Cardiovascular Effects of Antipsychotic
Drugs - common
– Orthostatic (postural) hypotension
– Syncope
Cardiovascular Effects of Antipsychotic
Drugs - Rare
Reduced heart rate variability
– Prolongation Prolongation of the QT/QTc intervals intervals
– Widened QRS complex
Cardiovascular Effects of Antipsychotic
Drugs - Very Rare
Ventricular tachycardia – Torsades de pointes – Myocarditis – Cardiomyopathy – Pericarditis – Cardiac arrest and sudden cardiac death
Sudden Death - Cause
unceratin
Suspected: – Fatal arrhythmias • prolonged QT • Torsade de Pointes • V‐Tachycardia • V‐fibrillation
Risk Factors for QT Prolongation and
Torsade de Pointes
• Demographics
Old age
• Female gender
Risk Factors for QT Prolongation and
Torsade de Pointes - Underlying conduction
Bradycardia – Congenital prolonged QT – Significant T wave abnormalities – Mutations of sodium channels – Electrolyte imbalances (especially hypokalemia and hypomagnesemia)
normal QTC
400 - 444
QTC of concern
beyond 500
Risk Factors for QT Prolongation and
Torsade de Pointes - CV disease
– LV hypertrophy, ischemia, low LV ejection fraction
Risk Factors for Sudden Death - • Healthy people
Repolarisation abnormalities (long QT syndromes)
• Ventricular pre‐excitation (Wolff–Parkinson– White
syndrome)
Risk Factors for Sudden Death - those with cardiac failure
Ischemic heart disease disease • Dilated cardiomyopathy • Left ventricular systolic dysfunction • Abnormal signal‐averaged ECG • Non‐sustained ventricular tachycardias on
Risk Factors for Sudden Death - Holter monitor recordigns
- Reduced heart rate variability
- T‐wave alternans
- B‐type natriuretic peptide
Psychotropic Drugs With Greater Risk
Arrhythmia and Sudden Death
• Higher risk
– thioridazine, clozapine, droperidol, pipamperone,
pimozide, sertindole and ziprasidone;
Psychotropic Drugs With Greater Risk
Arrhythmia and Sudden Death
– quetiapine, haloperidol, chlorpromazine and
olanzapine
Potassium*, sodium, calcium channels during
repolarization
– May induce
– May induce Torsade de Pointes and death in
apparent healthy individuals
Drug‐Drug Interaction: Drugs
Associated with Prolonged QT - first four
Antibiotics (macrolides, fluoroquinolones, clindamycin)
• Antiarrhythmics (calcium channel blockers, amiodarone,
bretyllium, others)
• Serotonin antagonists (cisapride)
• Antipsychotics
Drug‐Drug Interaction: Drugs
Associated with Prolonged QT - last four
Antidepressants (TCAs, fluoxetine, paroxetine,
venlafaxine)
• Antimalarials
• Antihistamines (astemizole, terfenadine)
• Antimigraine agents (triptans)
Monitoring
• Baseline and Serial
EKG
– Repeat when steady state reached
– Measure QTc (rate corrected QT interval)
– Know norms
– Cut Point: >500 ms or change >60ms from
baseline
Monitoring LAbs
– Liver, renal, electrolytes, CBC
antipsycothic Drugs that require reduced dosage: depends
on severity, check literature
- Mirtazapine Duloxetine
- Venlafaxine Tianeptine
- Citalopram Paroxetine
antipsychotic renal system
• 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
• Modifiable variables for antipsychotic‐induced
sudden death
established (or occult) cardiovascular disease.
– the cumulative cumulative dose of antipsychotic antipsychotic (including (including
Polypharmacy)
what do you need to pay attention to in primary care
– 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
