Major Adverse Drug Reactions (Psych)

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Author:
sini
ID:
230021
Filename:
Major Adverse Drug Reactions (Psych)
Updated:
2013-08-14 18:12:02
Tags:
Major Adverse Drug Reactions Psych
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Description:
Dystonia/Akathisia/EPS/NMS/TD/5HT syndrome
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  1. What demographic is at an increased risk of developing dystonia?
    Young men
  2. What is dystonia? When does it develop?
    • Muscle spasms (esp head and neck)
    • Within days of starting drug
  3. Tx of dystonia?
    • w/o laryngospasm: IM benztropine or diphenhydramine
    • w/ larynospasm: IV atnicholinergics
  4. What is akathisia?
    • Most common SE of antipsychotics
    • SUBJECTIVE sensation of inner restlessness
  5. Tx of akathisia?
    • Reduce offending medication
    • Beta-blocker (Propranolol)
    • Benzos (Lorazepam)
  6. What is EPS? When does it develop?
    • Neuroleptic-induced parkinsonism (rigidity (lead pipe or cogwheel), akinesia)
    • Within first few weeks to tx
  7. Tx for EPS?
    • Reduce dosage of antipsychotic
    • Add anticholinergic
  8. What is NMS?
    • Occurs in response to drugs that block dopamine
    • FALTER --Fever, Autonomic instability, Leukocytosis, Tremor, Elevated CPK, Rigidity
  9. Tx of NMS?
    • Supportive:
    • d/c antipsychotic
    • dantrolene (muscle relaxant)
    • bromocriptine (dopamine agnoist)
  10. What is tardive dyskinesia?
    • Develops with long-term use of neuroleptics
    • Constant, involuntary stereotype movements (usually head and neck)
  11. Tx of tardive dyskinesia?
    • Changing anti-psychotics
    • Lowering dosage
    • Switching to clozapine
  12. What is the difference between tardive dyskinesia and dystonia?
    • TD: long-term use of neuroleptics
    • Dystonia: acute use of neuroleptics
  13. What is serotonin syndrome?
    • Usually occurs with multiple medications that affect 5HT metabolism
    • Associated with MAOIs or 5HT agents
    • Shivering, hyperrelexia, and clonus, GI S/S
  14. Tx of serotonin syndrome?
    • Supportive
    • Cyproheptadine
  15. What combination of drugs can produce serotonin syndrome?
    MAOIs with meperidine or dextromethorphan
  16. What features distinguish NMS from serotonin syndrome? (3)
    • NMS has gradual onset/ 5HT is abrupt
    • 5HT S/S: shivering hyperreflexia, clonus, GI S/S
    • NMS occurs with use of antipsychotics/5HT with use of MAOIs or 5HT agents

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