Drug-Induced Neurologic Conditions Overview

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Questions and Answers

High doses and concomitant use of certain drugs can be risk factors for cerebrovascular disorders.

True (A)

Cognitive impairment and delirium can only occur in elderly patients.

False (B)

Neuroleptic Malignant Syndrome typically develops within a few hours after the onset of symptoms.

False (B)

The majority of drug-induced seizures present as Generalised Tonic Clonic (GTC) seizures.

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Dopamine blockade is a mechanism that can contribute to movement disorders.

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CNS stimulants are responsible for inducing insomnia.

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Estrogen and progestin therapy can increase the risk of stroke by raising cholesterol and platelet aggregation.

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Benzodiazepines do not have anticholinergic side effects.

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Cerebrovascular disorders can lead to ataxia and nystagmus.

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Delirium is characterized by impairment in cognitive function without any disturbance in consciousness.

<p>False (B)</p> Signup and view all the answers

Serotonin syndrome is associated with cognitive behavior changes and autonomic instability.

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Peripheral neuropathy can result in muscular weakness and loss of coordination.

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Optic neuritis can lead to colour blindness and loss of visual acuity.

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Headaches can occur due to intracranial hypertension.

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Excessive daytime sleepiness is a side effect of insomnia.

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Withdrawal seizure can occur as a side effect of severely reducing seizure thresholds.

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Muscular rigidity is a common symptom of neuroleptic malignant syndrome.

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Parkinsonism is not associated with movement disorders.

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Flashcards

Neurological Drug Side Effects

Neurological complications of prescribed drugs are often associated with various drug side effects and adverse events.

Cerebrovascular Disorders

Cerebrovascular disorders such as stroke and cerebellar syndrome can manifest as symptoms like ataxia (lack of coordination) and nystagmus (involuntary eye movements).

Cognitive Impairment

Cognitive impairment, often associated with dementia, can lead to confusion, memory loss, and reduced ability to focus, think, and reason.

Delirium

Delirium is a state characterized by a disturbance in consciousness, impaired cognition, and fluctuating levels of alertness. It can be caused by numerous factors, including drug side effects.

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Headache

Headaches, including cluster headaches, migraines, and generalized headaches, can be a side effect of certain medications.

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Nerve and Muscle Disorders

Peripheral neuropathy, neuromuscular blockade, myopathy, and demyelination are nerve and muscle disorders that can result from drug exposure.

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Neuroleptic Malignant Syndrome

Neuroleptic malignant syndrome is a serious medical condition characterized by fluctuating heart rate, muscle rigidity, respiratory problems, high fever, and altered consciousness.

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Movement Disorders

Movement disorders, including akathisia, dystonia, tardive dyskinesia, and parkinsonism, can manifest as tremors, spasms, facial grimacing, and tongue protrusion.

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Optic Neuritis and Visual Disturbances

Optic neuritis and visual disturbances can lead to loss of visual acuity, color blindness, and other vision problems.

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Seizure Disorders

Seizure disorders, including withdrawal seizures and iatrogenic seizures, can be triggered by certain medications, leading to possible loss of consciousness.

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Drug-induced Parkinsonism

Drug-induced movement disorders can mimic Parkinson's disease and affect up to 50% of patients.

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Neuroleptic Malignant Syndrome (NMS)

A serious adverse drug reaction characterized by muscle rigidity, fever, and altered mental status. It is often triggered by antipsychotic medications, such as haloperidol, and can be fatal.

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Drug-Induced Seizures

This condition happens when a drug interferes with the brain's ability to regulate nerve activity, causing seizures. It can occur with a wide range of medications, even those not primarily intended to affect the nervous system.

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Drug-Induced Loss of Coordination

This effect happens when certain medications interfere with the brain's ability to maintain balance and coordination. It can lead to dizziness, unsteady gait, and falls.

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Drug-Induced Insomnia

This can be caused by medications that block certain receptors in the brain or by altering neurotransmitter levels, leading to difficulty falling asleep, staying asleep, or waking up too early.

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Drug-Induced Seizures

A brain disorder marked by sudden, uncontrolled electrical activity in the brain, resulting in changes in behavior, sensation, or consciousness. Drug-induced seizures can be triggered by a wide range of medications.

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Study Notes

Drug-Induced Neurologic Conditions (DINCS)

  • DINCS are neurological conditions caused by drugs.
  • Pathologic factors, medical illnesses, drug side effects, and psychological factors contribute to clinical conditions.
  • Illnesses/Clinical Conditions can lead to DINCS.
  • Psychological disorders/Pseudo-disease factors contribute to DINCS.

Neurological Complications of Prescribed Drugs

  • Cerebrovascular disorders:

    • Risk factors include high-dose and concomitant drug use.
    • Mechanism involves ion channel blockade, electrolyte imbalance, and vestibular toxicity.
    • Example drugs causing these disorders are lithium, carbamazepine, phenytoin, aminoglycosides.
    • Stroke mechanism involves increased cholesterol and platelet aggregation, exemplified by estrogen/progestin therapy.

  • Cognitive impairment and Delirium:

    • Risk factors are high doses and concomitant illnesses, especially in elderly patients.
    • Mechanism is related to CNS penetration blocking cholinergic receptors and anticholinergic side effects (sedation).
    • Examples of drugs that cause these disorders include 1st-generation antihistamines, antiparkinsonian agents, skeletal muscle relaxants, tertiary TCAs, and first and second-generation antipsychotics and benzodiazepines.

  • Neuroleptic Malignant Syndrome (NMS):

    • NMS onset ranges from hours (with serotonin syndrome) to days.
    • NMS may be fatal.
    • Mechanism involves dopamine blockade in the corpus striatum, spinal cord, and hypothalamus.
    • Example drugs include first-generation antipsychotics like chlorpromazine, haloperidol; Dâ‚‚-antagonists like metoclopramide; dopamine agonists (levodopa).
    • This can also be developed after abrupt discontinuation of dopamine agonist use.

  • Movement Disorders:

    • Prevalence: up to 50% of Parkinsonism may be drug-induced.
    • Mechanism is dopamine blockade or serotonin receptor agonist/antagonists.
    • Example drugs include 1st-generation antipsychotics (chlorpromazine, haloperidol), Dâ‚‚ antagonists (metoclopramide), and abrupt discontinuation of dopamine agonists (levodopa).

  • Seizure Disorders:

    • Drug-induced seizures are commonly generalised tonic-clonic seizures.
    • Mechanism is related to lowering the seizure threshold and excitating excitatory neurotransmitters.
    • Example drugs include antiarrhythmics (lidocaine, verapamil, diltiazem), antibiotics (cephalosporins, carbapenems), antidepressants (TCAs), antineoplastics (chlorambucil, methotrexate), antipsychotics, mood stabilisers (lithium), analgesics (fentanyl, pethidine, tramadol), and benzodiazepine withdrawal

  • Sleeping Disorders (Insomnia):

    • Prevalence: 40% drug-induced, common among women and elderly.
    • Mechanism involves CNS stimulants.
    • Example drugs include antiasthma agents (theophylline, beta agonists).

Managing DINCS

  • Identify the causal drug.
  • Remove the offending drug.
  • Manage DINCS with appropriate symptom management.
  • Closely monitor the patient's condition.

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Drug-Induced Neurological Conditions (DINCS) PDF

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