L5- Antipsychotics (drug AEs) Flashcards
(1) are the high potency antipsychotics, leading to a higher risk of developing (2)
1- fluphenazine, haloperidol
(1) are the low potency antipsychotics, and therefore have a low risk of developing (2); the lower risk of (2) is also partly due to the (3) activity of (1)
1- chlorpromazine, thioridazine
2- EPR
3- strong anticholinergic activity
atypical antipsychotics have a (higher/lower) risk of developing EPR as an AE in comparison to classical agents
lower
list the disorders included in EPR
- Parkinsonism
- Dystonia (sustained muscular contraction)
- Akathisia (pacing, tapping movements)
- Tardive dyskinesia
Parkinsonism:
- (1) definition
- (2) Tx
- (3) is an important contraindication
1- EPR disorder with combination Parkinson’s sxs: tremor, slow movement, impaired speech, muscle stiffness, ect
2- Antimuscarinic agent: bentropine, trihexyphenidyl, diphenhydramine, amantadine
3- Levodopa (used in PD)
Dystonia:
- (1) definition
- (2) Tx
1- EPR with sustained muscle contraction
2- benztropine, trihexyphenidyl, diphenhydramine
Akathisia:
- (1) definition
- (2) Tx
1- EPR with restlessness and inability to stay still
2:
- reduction in dosage or change in antipsychotic
- clonazepam (benzodiazepines), propanolol (β-blocker)
discuss the development of Tardive Dyskinesia with use of antipsychotics (including some Sxs)
- seen with long-term use
- potentially irreversible
- may be due to upregulation of DA receptors
-abnormal choreoathetoid movements: jerky movements of tongue, jaw, extremities
discuss the management of Tardive Dyskinesia
- discontinue antipsychotic OR reduce dose- Clozapine is usually recommended as the antipsychotic
- eliminate drugs with central anticholinergic activity
- **VMAT inhibitors: tetrabenzine, valbenazine
- benzodiazepine may help
list VMAT inhibitors and indicate relative half-life
- tetrabenzine- short half life, many doses required
- valbenazine- long half life, few doses
(1) is a rare and life-threatening neurological AE with use of antipsychotics and can be managed partly by (3).
1- Neuroleptic Malignant syndrome
2- dantrolene (works on SR in muscle to preven contraction) OR bromocriptine (5-HT agonist, α2 antagonist)
describe the signs and symptoms of Neuroleptic Malignant syndrome
- rigidity, tremor, hyperthermia
- altered mental status
- autonomic instability
- elevated WBC, elevated CK
- myoglobinemia, with potential nephrotoxicity
(1) is an additional neurological effect of antipsychotics usually with atypical antipsychotics or low potent antipsychotics due to (2) activity
1- sedation
2- central H1 receptor blockade
list the common autonomic effects of some antipsychotic agents
Antimuscarinic: may be beneficial in terms of preventing EPRs
Antiadrenergic, α1 receptor blockade –> orthostatic hypotension, impaired ejaculation
______ antipsychotic is avoided used because it can cause agranulocytosis
clozapine (affects 1-2% of patients)
-if used, monitor via CBC
