Side effects Flashcards
Extrapyramidal symptoms (EPS)
ACUTE:
- Pseudoparkinsonism
- Dystonia
- Akathisia
CHRONIC
- Tardive dyskinesia
EPS - most common with?
Group 3 phenothiazines
Butyrophenones
1st generation depot preparations
EPS - Pseudoparkinsonism
Tremor or rigidity
More common in adults & elderly
Treatment = antimuscarinic e.g. procyclidine
EPS - Dystonia + Dyskinesia
Abnormal face + body movements
More common in children & young adults.
Appears after a few doses
Treatment = antimuscarinic e.g. procyclidine
EPS - Akathisia
Inner restlessness
Typically after large initial doses
Discontinue OR treat with alternative antipsychotic
EPS - Tardive dyskinesia
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
Hyperprolactinaemia
Typical + atypical
Dopamine inhibits prolactin release.
Antipsychotics block dopamine receptors - dopamine cant bind and inhibit prolactin secretion = hyperprolactinaemia.
Hyperprolactinaemia - most common with?
Risperidone
Amisulpride
1st generation antipsychotics
Hyperprolactinaemia - symptoms
Sexual dysfunction
Reduced bone mineral density
Menstrual disturbances
Breast symptoms (enlargement, pain, galactorrhoea)
Menstrual irregularities
Hyperprolactinaemia - monitoring
Prolactin levels (advisable) at start, 6 months then yearly.
Endocrine function in children - weight, height, sexual maturation, menstrual function
Aripiprazole
ONLY antipsychotic without hyperprolactinemia as a SE - it is a partial dopamine agonist
Sexual dysfunction - common with?
Haloperidol
Risperidone
Sexual dysfunction
MEN
Decreased libido
Disorders of arousal and erection/ejaculation
Cardiovascular
QT-interval prolongation with doses exceeding recommended maximum.
Cases of sudden death
- Tachycardia
- Arrhythmias
- Hypotension
Annual CV risk assessment
Cardiovascular - most risk?
Pimozide
Haloperidol
IV antipsychotic doses
Doses above maximum limit
Hyperglycaemia, weight gain + diabetes
Clozapine, olanzapine, risperidone
Regular monitoring
Hypotension + interference with
temperature regulation
Risk of falls
Hypo/hyperthermia in elderly
Postural hypotension + syncope = clozapine, chlorpromazine + quetiapine
Metabolic side effects
Hyperglycaemia + sometimes diabetes
Weight gain
Lipid changes (dyslipidaemia)
Hyperglycaemia + sometimes diabetes
CiROQ
Clozapine
Risperidone
Olanzapine
Quetiapine
Weight gain
COW
Clozapine
Olanzapine
Neuroleptic malignant syndrome
Fatal
Discontinue immediately
Treatment = bromocriptine or dantrolene (dopamine receptor agonists)
Lasts 5-7 days after stopping, longer with depot preparations
Neuroleptic malignant syndrome - symptoms
Muscle rigidity
Fluctuating consciousness
Hyperthermia
Autonomic dysfunction with pallor
Tachycardia
Sweating
Urinary incontinence
Labile BP
Other side effects
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)
