Side effects of antipsychotics and anti depressants drugs

Question 1

Second generation antipsychotics are used as 1st line therapy because of

Answer 1

lower risk of extrapyramidal side effects compared to first generation medication.

Question 2

common side effects of second generation antipsychotics

Answer 2

weight gain, dyslipidemia, hyperglycemia (including new onset diabetes) highest risk drugs: clozapine and olanzapine

Question 3

how to monitor patients who are on second generation anti psychotics with regards to side effects

Answer 3

baseline and regular follow up with BMI fasting glucose and lipid panels blood pressure waist circumference no need to check TSH or LFTs. those with DM2 and those who gain >5% of initial weight should be monitored closely.

Question 4

2nd generation antipsychotics with less risk for metabolic side effects are:

Answer 4

aripiprazole and ziprasidone

Question 5

which 2nd generation antipsychotic drug can cause agranulocytosis and how is this monitored?

Answer 5

clozapine, NOT olanzapine. Monitored with weekly CBC in 1st 6 months of treatment due to increased risk for agranulocytosis.

Question 6

how to treat drug induced parkinsonism (DIP)

Answer 6

Treatment is with stopping offending agent or switch to antipsychotic with low potential for causing extrapyramidal effects quetiapine or clozapine

Question 7

drug induced Parkinsonism is caused by

Answer 7

dopamine D2 receptor antagonists are most common offending agents (typical antipsychotics - haloperidol) and atypical antipsychotics (respiridone) and antiemetics. See Parkinsonism with bradykinesia rigidity and tremor.

Question 8

abnormal involuntary movements from prolonged use of antipsychotic meds or metoclopramide see orofacial dyskinesia (tongue protrusion, lip smacking, and grimacing)

Answer 8

this is tardive dyskinesia

Question 9

limb dyskinesia (dystonic postures, foot tapping, chorea) trunk dyskinesia (rocking, thrusting, shoulder shrugging)

Answer 9

other presentation of tardive dyskinesia

Question 10

management of tardive dyskinesia

Answer 10

discontinue causative agent if feasible switch to second generation antipsychotic (quetiapine, clozapine) if continued antipsychotic is needed treat with valbenazine and deutetrabenazine

Question 11

risk factors for tardive dyskinesia

Answer 11

female >12 weeks duration of the tx older age DM2 hx

Question 12

frequent fidgeting, pacing, rocking while standing, crossing and uncrossing legs while sitting and inner sense of restlessness and inability to sit still

Answer 12

akathisia

Question 13

what is the problem about akathisia

Answer 13

distressing for pts and makes them uncomfortable also recognized as anxiety and agitation and mistaken for psychotic decompensation. increasing the medication can worsen the akasthsia

Question 14

acute dystonic reaction is

Answer 14

sudden onset of distressing involuntary contraction of neck, mouth, tongue and eye muscles occurs within the 1st few days of antipsychotic exposure treat with anticholinergic medication (benztropine or diphenhydramine)

Question 15

important side effects of antipsychotic medications are

Answer 15