Major Adverse Drug Reactions (Psych)
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What demographic is at an increased risk of developing dystonia?
What is dystonia? When does it develop?
- Muscle spasms (esp head and neck)
- Within days of starting drug
Tx of dystonia?
- w/o laryngospasm: IM benztropine or diphenhydramine
- w/ larynospasm: IV atnicholinergics
What is akathisia?
- Most common SE of antipsychotics
- SUBJECTIVE sensation of inner restlessness
Tx of akathisia?
- Reduce offending medication
- Beta-blocker (Propranolol)
- Benzos (Lorazepam)
What is EPS? When does it develop?
- Neuroleptic-induced parkinsonism (rigidity (lead pipe or cogwheel), akinesia)
- Within first few weeks to tx
Tx for EPS?
- Reduce dosage of antipsychotic
- Add anticholinergic
What is NMS?
- Occurs in response to drugs that block dopamine
- FALTER --Fever, Autonomic instability, Leukocytosis, Tremor, Elevated CPK, Rigidity
Tx of NMS?
- d/c antipsychotic
- dantrolene (muscle relaxant)
- bromocriptine (dopamine agnoist)
What is tardive dyskinesia?
- Develops with long-term use of neuroleptics
- Constant, involuntary stereotype movements (usually head and neck)
Tx of tardive dyskinesia?
- Changing anti-psychotics
- Lowering dosage
- Switching to clozapine
What is the difference between tardive dyskinesia and dystonia?
- TD: long-term use of neuroleptics
- Dystonia: acute use of neuroleptics
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
Tx of serotonin syndrome?
What combination of drugs can produce serotonin syndrome?
MAOIs with meperidine or dextromethorphan
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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