[PCOL-FIN-01-PT5] ANTIPSYCHOTICS

THIS FLASHCARDS IS ABOUT [PCOL] EXTRAPYRAMIDAL SYMPTOMS

Acute dystonia

Adverse Effects: Extrapyramidal Syndrome (EPS)

Spasm of muscles of tongue, face, neck, back; may mimic seizure; not hysteria.

Seizures

Acute dystonia may mimic ____, not hysteria.

Torticollis/Retrocollis

What is the medical term for spasm of the tongue, face, neck, and back muscles?

Acute dystonia

This EPS is the easiest to treat among all EPS; but it could be fatal compared to other EPS.

1-5 days

In acute dystonia, what is the time of maximal risk?

Unknown

In acute dystonia, what is the proposed mechanism?

• Diphenhydramine via IV

• Promethazine (anticholinergic)

What are the (2) Drugs used as a treatment for Acute dystonia?

Hint: Di-Pro

Akathisia

Adverse Effects: Extrapyramidal Syndrome (EPS)

Motor restlessness; not anxiety or “agitation”

Akathisia

This is the most difficult to treat and the only EPS that is not treated with anticholinergic.

Anxiety or agitation

Akathisia is about motor restlessness and not?

(This symptom is usually seen if taking antipsychotics from days to months)

5-60 days

In akathisia, what is the time of maximal risk?

Unknown

In akathisia, what is the proposed mechanism?

• Antiparkinson agents

• Benzodiazepines

• Propranolol (beta blocker)

What are the (3) Drugs used for the treatment of Akathisia? (Reduce dose or change drug)

Hint: An-BP

Pseudoparkinsonism

Adverse Effects: Extrapyramidal Syndrome (EPS)

Due to the decrease of dopamine in the nigrostriatal system, features like tremors, rigidity, akinesia, postural, instability, shuffling gait are present.

5-30 days

In pseudoparkinsonism, what is the time of maximal risk?

Antagonism of dopamine

In pseudoparkinsonism, what is the proposed mechanism?

• Trihexyphenidyl

• Procyclidine

• Benztropines

What are the (3) Drugs used to treat pseudoparkinsonism? (Antiparkinson agents are helpful)

Hint: Tri-PB (anticholinergics/skeletal relaxants)

Neuroleptic malignant syndrome

Adverse Effects: Extrapyramidal Syndrome (EPS)

It manifests fever, unstable blood pressure; increase muscle contraction; can be fatal.

Weeks; can persist for days after stopping neuroleptics

In neuroleptic malignant syndrome, what is the time of maximal risk?

Antagonism of dopamine may contribute

In neuroleptic malignant syndrome, what is the proposed mechanism?

• Dantrolene (muscle relaxant)

• Bromocriptine

What are the (2) Drugs used for treatment of Neuroleptic Malignant Syndrome? (Stop neuroleptic immediately)

Hint: Dan-Bro

Tardive dyskinesia

Adverse Effects: Extrapyramidal Syndrome (EPS)

Oral-facial dyskinesia; widespread choreoathetosis or dystonia.

After months or years of treatment (worse on withdrawal)

In tardive dyskinesia, what is the time of maximal risk?

Widespread choreoathetosis or dystonia

This is due to the hypersensitivity of dopamine receptor.

Neuroleptics

Tardive dyskinesia happens during the abrupt withdrawal of?

Excess function of dopamine hypothesized

In tardive dyskinesia, what is the proposed mechanism?

Stop neuroleptics, then Diazepam, change to clozapine/olanzapine

What is the treatment for tardive dyskinesia?

Clozapine

This is the only antipsychotic drug that doesn’t have EPS but it has significant side effects.