Side Effects

Question 0

Extrapyramidal Side Effects (EPS)

Answer 0

Parkinsonism: masklike face, cogwheel rigidity, pill-rolling tremor

Akathisia: restlessness and agitation

Dystonia: sustained contraction of muscles of neck, tongue, eyes, diaphragm

• occurs with high-potency traditional antipsychotics
• reversible
• occurs within DAYS of starting med
• can be LIFE THREATENING (ex. dystonia of diaphragm causing asphyxiation)
• DOC to treat EPS sxs is benzotropine

Question 1

Serotonin Syndrome

Answer 1

• confusion
• flushing
• diaphoresis
• tremor
• myoclonic jerks
• hyperthermia
• hypertonicity
• rhabdomyolysis
• renal failure
• death
• occurs when there is too much serotonin, classically when selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) are combined

Tx: stop drugs

Question 2

Hyperprolactinemia

Answer 2

• occurs with high-potency traditional antipsychotics and risperidone

Question 3

Tardive Dyskinesia

Answer 3

• choreoathetoid muscle movements, usually of the mouth and tongue
• occurs after YEARS of antipsychotic use (particularly high-potency typical antipsychotics)
• can be irreversible

Question 4

Neuroleptic Malignant Syndrome

Answer 4

• fever
• tachycardia
• hypertension
• tremor
• elevated creatine phosphokinase (CPK)
• “lead pipe” rigidity
• can be caused by ALL antipsychotics after short or long time (increased with high-potency traditional antipsychotics)
• a medical emergency with 20% mortality rate

Question 5

CYP450 Inducers

Answer 5

• smoking
• carbamazepine
• barbiturates
• St. John’s wort

= decreased drug levels

Question 6

CYP450 Inhibitors

Answer 6

• fluvoxamine
• fluoxetine
• paroxetine
• duloxetine
• sertraline
• valproic acid

= increased drug levels