Antipsychotic Medications: Side Effects
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Questions and Answers

What is the black box warning associated with anti-psychotic medications in elderly patients?

  • Increased mortality in elderly patients with dementia-related psychosis (correct)
  • Increased risk of akathisia
  • Increased risk of tardive dyskinesia
  • Increased risk of extrapyramidal syndrome

    • What is the result of blocking D2 centers in the mesolimbic dopamine system?

  • Increased motivation and interest
  • Improved cognitive function
  • Increased risk of extrapyramidal syndrome
  • Apathy, anhedonia, poor motivation/interest, and lack of joy from social interactions (correct)

    • What is the umbrella term for symptoms caused by chronic blocking of D2 receptors in the nigrostriatal pathway?

  • Tardive dyskinesia
  • Parkinsonian syndrome
  • Dystonia
  • Extrapyramidal syndrome (correct)

    • Which of the following is a risk factor for acute dystonia?

    <p>Young age</p> Signup and view all the answers

    What is the most common form of extrapyramidal syndrome?

    <p>Akathisia</p> Signup and view all the answers

    What is the characteristic of Parkinsonian syndrome?

    <p>Mask-like face, resting tremor, cogwheel rigidity, shuffling gait, and bradykinesia</p> Signup and view all the answers

    What is the percentage of patients who develop tardive dyskinesia over a 5-year period?

    <p>25%</p> Signup and view all the answers

    What is the result of chronically blocking D2 receptors in the nigrostriatal pathway?

    <p>Tardive dyskinesia</p> Signup and view all the answers

    What is a potential consequence of prolonged hyperprolactinemia in men?

    <p>All of the above</p> Signup and view all the answers

    Which of the following antipsychotics is least likely to increase prolactin levels?

    <p>Aripiprazole</p> Signup and view all the answers

    What is a common side effect of blocking Histamine H1 receptors?

    <p>Weight gain and sedation</p> Signup and view all the answers

    What is a differential diagnosis of Neuroleptic Malignant Syndrome?

    <p>All of the above</p> Signup and view all the answers

    What is a treatment for Neuroleptic Malignant Syndrome?

    <p>All of the above</p> Signup and view all the answers

    What is a characteristic of Muscarinic Cholinergic side effects?

    <p>All of the above</p> Signup and view all the answers

    What is a metabolic side effect of antipsychotics?

    <p>All of the above</p> Signup and view all the answers

    What is the dosing schedule for Invega Sustenna?

    <p>4 weeks</p> Signup and view all the answers

    Study Notes

    Anti-Psychotic Medications

    Black Box Warning

    • Increased mortality in elderly patients with dementia-related psychosis

    Side Effects of Anti-Psychotic Medications

    Blocking of D2 Receptors

    • Apathy, anhedonia, poor motivation/interest, lack of joy from social interactions
    • Apathy, lack of initiative, anhedonia, indifference, blunted affect, and reduced insight into disease

    Extrapyramidal Syndrome (EPS)

    • Umbrella term for symptoms caused by chronic blocking of D2 receptors in the nigrostriatal pathway
    • Symptoms include:
      • Dystonia
      • Akathisia
      • Parkinsonian Syndrome
      • Tardive Dyskinesia

    Dystonia

    • Acute dystonia: involuntary contractions of major muscle groups
    • Risk factors: young age, male, use of cocaine, and history of dystonia
    • Not dose-related

    Akathisia

    • Most common form of EPS, dose-related
    • Risk factors: older age, female, negative symptoms
    • Presents as motor restlessness, urge to move, and inability to sit still

    Parkinsonian Syndrome

    • Symptoms include:
      • Mask-like face
      • Resting tremor
      • Cogwheel rigidity
      • Shuffling gait
      • Pill rolling
      • Bradykinesia

    Tardive Dyskinesia (TD)

    • Results from chronic blocking of D2 receptors in the nigrostriatal pathway
    • Hyperkinetic movement disorder that may cause tongue and facial movements
    • 25% develop TD over a 5-year period
    • May be reversed if D2 blockade is removed early enough, but irreversible in some patients

    Neuroleptic Malignant Syndrome (NMS)

    • Life-threatening emergency
    • Can occur at any time in treatment
    • Symptoms include:
      • Mental status change
      • Muscular rigidity
      • Hyperthermia (usually high fever)
      • Autonomic instability
    • Treatment:
      • Discontinuation of antipsychotic
      • Treatment of hyperthermia
      • IV hydration
      • IV dantrolene
      • IV benzodiazepines

    Hyperprolactinemia

    • Blocking of D2 receptors in the tuberoinfundibular pathway
    • May cause:
      • Galactorrhea
      • Gynecomastia
      • Amenorrhea in women
      • Sexual dysfunction
    • Prolonged hyperprolactinemia may lead to osteoporosis, infertility, and hypogonadism in men
    • Treatment: changing to a prolactin-sparing medication such as Aripiprazole, Caripiprazine, or Quetiapine

    Muscarinic Cholinergic Side Effects

    • Degrees of muscarinic cholinergic blockade differ by antipsychotic
    • Typical agents often cause more EPS and have weak anticholinergic properties
    • Atypical agents often cause fewer EPS and have stronger anticholinergic properties

    Other Side Effects

    • Blockade of Histamine H1 receptors: weight gain and sedation
    • Blockade of α1-adrenergic receptors: orthostatic hypotension and drowsiness
    • Metabolic side effects: weight gain, dyslipidemia, diabetes/insulin resistance, and hypertension

    Long-Acting Injectables (LAI)

    • Dosing schedules:
      • Invega Sustenna: 4 weeks
      • Invega Trinza: ...

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    Description

    Learn about the potential side effects of antipsychotic medications, including black box warnings, effects on dopamine systems, and extrapyramidal syndrome (EPS).

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