Side effects

Question 1

Extrapyramidal symptoms (EPS)

Answer 1

ACUTE:
- Pseudoparkinsonism
- Dystonia
- Akathisia

CHRONIC
- Tardive dyskinesia

Question 2

EPS - most common with?

Answer 2

Group 3 phenothiazines
Butyrophenones
1st generation depot preparations

Question 3

EPS - Pseudoparkinsonism

Answer 3

Tremor or rigidity
More common in adults & elderly
Treatment = antimuscarinic e.g. procyclidine

Question 4

EPS - Dystonia + Dyskinesia

Answer 4

Abnormal face + body movements
More common in children & young adults.
Appears after a few doses
Treatment = antimuscarinic e.g. procyclidine

Question 5

EPS - Akathisia

Answer 5

Inner restlessness
Typically after large initial doses
Discontinue OR treat with alternative antipsychotic

Question 6

EPS - Tardive dyskinesia

Answer 6

Rhythmic, involuntary movements of tongue, face + jaw
Usually occurs with long-term therapy OR high doses
More common in elderly
May be irreversible
STOP at first sign - fine vermicular movements of tongue
Consider switch to atypical antipsychotic

Question 7

Hyperprolactinaemia

Answer 7

Typical + atypical
Dopamine inhibits prolactin release.
Antipsychotics block dopamine receptors - dopamine cant bind and inhibit prolactin secretion = hyperprolactinaemia.

Question 8

Hyperprolactinaemia - most common with?

Answer 8

Risperidone
Amisulpride
1st generation antipsychotics

Question 9

Hyperprolactinaemia - symptoms

Answer 9

Sexual dysfunction
Reduced bone mineral density
Menstrual disturbances
Breast symptoms (enlargement, pain, galactorrhoea)
Menstrual irregularities

Question 10

Hyperprolactinaemia - monitoring

Answer 10

Prolactin levels (advisable) at start, 6 months then yearly.
Endocrine function in children - weight, height, sexual maturation, menstrual function

Question 11

Aripiprazole

Answer 11

ONLY antipsychotic without hyperprolactinemia as a SE - it is a partial dopamine agonist

Question 12

Sexual dysfunction - common with?

Answer 12

Haloperidol
Risperidone

Question 13

Sexual dysfunction

Answer 13

MEN
Decreased libido
Disorders of arousal and erection/ejaculation

Question 14

Cardiovascular

Answer 14

QT-interval prolongation with doses exceeding recommended maximum.
Cases of sudden death
- Tachycardia
- Arrhythmias
- Hypotension
Annual CV risk assessment

Question 15

Cardiovascular - most risk?

Answer 15

Pimozide
Haloperidol
IV antipsychotic doses
Doses above maximum limit

Question 16

Hyperglycaemia, weight gain + diabetes

Answer 16

Clozapine, olanzapine, risperidone
Regular monitoring

Question 17

Hypotension + interference with
temperature regulation

Answer 17

Risk of falls
Hypo/hyperthermia in elderly
Postural hypotension + syncope = clozapine, chlorpromazine + quetiapine

Question 18

Metabolic side effects

Answer 18

Hyperglycaemia + sometimes diabetes
Weight gain
Lipid changes (dyslipidaemia)

Question 19

Hyperglycaemia + sometimes diabetes

Answer 19

CiROQ
Clozapine
Risperidone
Olanzapine
Quetiapine

Question 20

Weight gain

Answer 20

COW
Clozapine
Olanzapine

Question 21

Neuroleptic malignant syndrome

Answer 21

Fatal
Discontinue immediately
Treatment = bromocriptine or dantrolene (dopamine receptor agonists)
Lasts 5-7 days after stopping, longer with depot preparations

Question 22

Neuroleptic malignant syndrome - symptoms

Answer 22

Muscle rigidity
Fluctuating consciousness
Hyperthermia
Autonomic dysfunction with pallor
Tachycardia
Sweating
Urinary incontinence
Labile BP

Question 23

Other side effects

Answer 23

Antimuscarinic (dry mouth, constipation, urinary retention, blurred vision, angle-closure glaucoma)
Blood dyscrasias (FBC if unexplained infection or fever)
Photosensitivity (high doses)
Jaundice
Sedation (driving, alcohol increases effects)