Antipsychotic meds Flashcards
Typical (1st Generation)
Decrease dopamine
Works best on positive symptoms
EPS and Anti-HAM side effects
Atypical (2nd Generation)
Decrease dopamine AND increase serotonin
Works on positive and negative symptoms
Metabolic side effects
antipsych meds
Class warnings
Black box warning- higher mortality rate in geriatric pts with dementia-related psychosis
Adverse cerebrovascular events
Neuroleptic malignant syndrome
Tardive dyskinesia
Weight gain, hyperglycemia, new-onset or worsening diabetes, hyperlipidemias (especially for kids)
Antipsychotic Side Effects
Metabolic Dysfunction
Anti-HAM
Neuromalignant Syndrome
Extrapyramidal Syndrome
Dystonia
Akathisia
Parkinsonian Syndrome
Tardive Dyskinesia
1st Generation Antipsychotics- think EPS and ANTI-HAM side effects
2nd Generation Antipsychotics- think more metabolic side effects
Extrapyramidal Syndrome
Sx
Dystonia: repetitive movements sometimes painful
Akathisia:restlessness, agitation
Parkinsonian Syndrome
Tardive Dyskinesia
Metabolic Dysfunction
Weight gain
Hyperglycemia
hyperlipidemia
More common with second generation antipsychotics
Need to check labs every 6-12 months (Lipids, weight, BP, A1C)
Tx: treat dysfunction respectively or consider changing antipsychotics if severe
Anti-HAM
Antihistamine - weight gain and sedation
Antiadrenergic - orthostatic hypotension, cardiac abnormalities, sexual dysfunction
Antimuscarinic (anticholinergic effects) - (dry mouth, tachycardia, urinary retention, blurry vision, constipation, precipitation of narrow-angle glaucoma
Hyperprolactinemia - low libido, galactorrhea, gynecomastia, impotence, amenorrhea
Neuromalignant Syndrome (NMS)
and tx
Occurs in up to 3% of patients taking neuroleptics
Extreme rigidity, AMS, fever, unstable BP, myoglobinemia
Can be FATAL
Tx: STOP medication, dantrolene and bromocriptine, supportive care
Extrapyramidal Symptoms (EPS) - MC 1st Gen
Akathisia
inner restlessness, can’t sit still
Not anxiety
Tx: reduce dose or change meds
Propranolol
Clonazepam
Parkinsonian syndrome
tremor, mask-like facies, rigidity, shuffling gait, bradykinesia
Typically starts within 1 month of starting medication
Elderly more at risk
Tx: change or reduce drug
Levodopa and other antiparkinsonian drugs
https://www.youtube.com/watch?v=f6yxH2bgkSY
Dystonia
Acute!
Typically starts within days of initiating drug
involuntary contractions of major muscle groups
Commonly tongue, face, neck, back
Tx: anticholinergics (benztropine), antiparkinsonian drugs
Diagnostic and curative!
https://www.youtube.com/watch?v=y2D5HAWPVC4
Tardive Dyskinesia
Involuntary movements - facial grimacing, tongue protrusion, lateral jaw movements, lip smacking, choreiform movements of the limbs (rarely)
Months to years to develop
Can develop at any time while on medication, 5% increase risk each year on FGA
Can be permanent
Tx: STOP agent once early symptoms arise.
VMAT2 Inhibitors - valbenazine and deutrabenazine
https://www.tardiveimpact.com/what-is-td
Tardive Dyskinesia
Involuntary movements - facial grimacing, tongue protrusion, lateral jaw movements, lip smacking, choreiform movements of the limbs (rarely)
Months to years to develop
Can develop at any time while on medication, 5% increase risk each year on FGA
Can be permanent
Tx: STOP agent once early symptoms arise.
VMAT2 Inhibitors - valbenazine and deutrabenazine
https://www.tardiveimpact.com/what-is-td
EPS Sx
Dystonia
Acute!
Typically starts within days of initiating drug
involuntary contractions of major muscle groups
Commonly tongue, face, neck, back
Tx: anticholinergics (benztropine), antiparkinsonian drugs
Diagnostic and curative!
https://www.youtube.com/watch?v=y2D5HAWPVC4
EPS sx
Akathisia
inner restlessness, can’t sit still
Not anxiety
Tx: reduce dose or change meds
Propranolol
Clonazepam
EPS Sx
AIMS
Screening for TD
Provider rates patient
Score of 2 indicates presence of TD
Performed every 6 months
Chlorpromazine (Thorazine)
typical
First antipsychotic developed, not commonly used
Effective Dose: 60mg - 800mg
FDA indications- Psychosis, mania, nausea and vomiting, intractable hiccups
Off label- bipolar disorder, behavioral disturbances, impulse control
Route: PO or IM
Monitoring- ECG if cardiac disease
Cost- pretty expensive
Side Effects- sedation, orthostasis, tachycardia, drowsiness, dry mouth, constipation, blurred vision, prolactin elevation, skin pigmentation, ocular changes, jaundice, photosensitivity
Fluphenazine (Prolixin)
typical
Effective Dose: 3 - 45mg
FDA indications- psychosis, schizophrenia
Off label- dementia associated psychosis or agitation
Route- PO and IM
Cost- cheap
Side Effects- EPS, headache, drowsiness, dry mouth