Drug-Induced Neurological Conditions (DINCS) PDF

Mohd b. Makmor Bakry, R.Ph., Ph.D. Professor of Pharmaceutical Care Faculty of Pharmacy Universiti Kebangsaan Malaysia  Drug side/adverse effects DINC Pathologic factors...

Mohd b. Makmor Bakry, R.Ph., Ph.D. Professor of Pharmaceutical Care Faculty of Pharmacy Universiti Kebangsaan Malaysia  Drug side/adverse effects DINC Pathologic factors Psychological factors Illnesses/ Psychological Medical illness Clinical disorders/Pseudo-disease Conditions Causes of Clinical Conditions  Neurological Complications of Prescribed Drugs (1/2) Related DINC Drug Side/Adverse effects syndromes/disorders Cerebrovascular disorders Stroke, cerebellar syndrome Ataxia; nystagmus Cognitive impairment Dementia Confusion; memory loss; decrease ability to concentrate, think & reason Delirium NA Disturbance in consciousness; impaired cognitive Headache Headache, intracranial Cluster, migraine, generalized hypertension Nerve & muscle disorders Peripheral neuropathy, Muscular weakness, loss of coordination, neuromuscular blockade, possible paralysis myopathy, demyelination Neuroleptic malignant syndrome NA Fluctuating heart rate, muscular rigidity, respiration levels, fever and level of consciousness  Neurological Complications of Prescribed Drugs (2/2) DINC Related syndromes/disorders Drug Side/Adverse effects Movement disorders Akathisia, dystonia, tardive Tremor; muscular spasm; facial dyskinesia, parkinsonism grimacing; tongue protrusion Optic neuritis, visual disturbance NA Loss of visual acuity; colour blindness Seizure disorders Withdrawal seizure, iatrogenic Possible loss of consciousness seizure threshold reduction Serotonin syndrome NA Cognitive behaviour changes; autonomic instability; neuromuscular excitability Sleep disorders Insomnia Excessive daytime sleepiness; decrease ability to concentrate, think & reason.  Cerebrovascular Disorders  Risk factors:  High dose & concomitant use Loss of coordination/balance  Mechanism  Ion channel blockade, electrolytes imbalance, vestibular toxicity  Example of drugs  Lithium, carbamazepine, phenytoin, aminoglycosides Stroke  Mechanism  Increase cholesterol and platelet aggregation  Example of drugs  Estrogen &/ progestin therapy  Cognitive impairment & Delirium  Risk factors:  High dose, concomitant illnesses, elderly  Mechanism  CNS penetration, binds (block) to cholinergic receptors, anticholinergic side effects, sedation  Example of drugs  1st generation antihistamines (diphenhydramine, hydroxyzine)  Antiparkinsonian agents (benztropine, trihexyphenidyl)  Skeletal muscle relaxants  Tertiary Tricyclic Antidepressant (TCAs)  Antipsychotics (1st & 2nd generations)  Benzodiazepines  Neuroleptic Malignant Syndrome  Onset and Severity  Start with serotonin syndrome within a few hours, NMS developed after several days, maybe fatal  Mechanism  Dopamine receptor D2 blockade (corpus striatum, spinal cord, hypothalamus)  Example of drugs  1st generation antipsychotic agents (chlorpromazine, haloperidol)  D-antagonist (metoclopramide)  Abrupt discontinuation of dopamine agonist (levodopa)  Movement Disorders  Prevalence  Drug-induced movement disorders up to 50% of ‘parkinsonism’  Mechanism  Dopamine blockade  Serotonin receptor agonist/antagonist  Example of drugs  1st generation antipsychotic agents (chlorpromazine, haloperidol)  D-antagonist (metoclopramide)  Abrupt discontinuation of dopamine agonist (levodopa)  Seizure Disorders  Natural history  Drug-induced seizure, majority presented as Generalised Tonic Clonic (GTC)  Mechanism  Lowering seizure threshold  Excitation of excitatory neurotransmitters  Example of drugs  Antiarrrhythmics (Lidocaine, verapamil, diltiazem)  Antibiotics (Cephalosporins, carbapenems)  Antidepressants (TCAs)  Antineoplastics (chlorambucil, methotrexate)  Antipsychotics (Chlorpromazine, clozapine)  Mood stabiliser (Lithium)  Analgesics (Fentanyl, pethidine, tramadol)  Withdrawal of drugs (benzodiazepines, fentanyl, pethidine)  Sleeping Disorders (Insomnia)  Prevalence  40% drug-induced, women and elderly  Trouble to fall asleep, to stay asleep, or wake up to early  Mechanism  CNS stimulants  Example of drugs  Antiasthma agents (Theophylline, beta agonists)  Managing DINC  Identify the causal drug  Removal of the offending agents.  Manage DINC with appropriate signs and symptoms management.  Closed monitoring of the patient’s conditions. Thank you