DPT 6 Exam 1 Study Guide - Focus on Antipsychotics and Related Treatments (Drayton pt.2)

what are the four types of extrapyramidal side effects (EPS)?

akasthisia

tardive dyskinesia

dystonia

parkinsonism

dystonia

idiosyncratic, unpredictable

involuntary muscle contraction

face, neck, trunch, pelvis extremities

painful

life threatening

50% occur within 48 hours

90% occur within 5 days

young males are at higher risk

why are young African American males at higheset risk for dystonia?

due to the fact that they receive higher doses of first-generation antipsychtoics than other patients

types of dystonic reactions

oculogyric crisis, eye balls

blepharospasm, eye lids

torticollis, neck

opisthotonis, entire body

how are dystonic reactions treated?

IM benztropine 2mg

IM diphenhydramine 50mg

D/C offending agent

akathisia

inner restlessness

deadly consequences

patients have a hard time describing how they feel

uncomfortable for patients, but not painful

incidence is 20-40% for high potency first generation antipsychotics

when does akathisia typically occur?

early in treatment and will go away when medication is stopped or the dose is reduced

it will begin in some patients as early as the first or second dose

higher doses and FGAs are more likely to cause akathisia

treatment for akathisia

decrease dose of antipsychotic

switch agents

propranolol 10mg orally twice daily, titrate as needed

Parkinsonism

side effect of antipsychotic

symptoms look like someone has Parkinson's disease, but they don't

incidence is around 15-35% for the first generation antipsychotics

presentation of Parkinsonism

masked facial expression

shuffling gait

stooped posture

arms not swinging by side

describe the onset of Parkinsonism

insidious in onset, so often patients don't recognize or have the perception that the medication caused this

who is at a higher risk of Parkinsonism?

the elderly as opposed to younger patients becuase they already have more dopamine dysregulation occuring.

will go away when antipsychotic is stopped or dose is decreased

treatment for Parkinsonism

reduce dose of antipsychotic

change agents

last option: initiate benztropine 1mg, titrate to 30mg twice daily as needed in addition to their current antipsychotic

tardive dyskinesia (TD)

abnormal involuntary muscle movements

disfiguring

once it starts, may be permanent

some treatments may help

counseling on TD very important

incidence is around 5% per year on medications

overall prevalence is around 20% with long term treatment

true or false: tardive dyskinesia is a long term adverse effect of antipsychotic use. it would not happen with just a few doses.

true

true or false: the higher the dose and the longer a patient is taking an antipyschotic, the higher the risk of TD

true

true or false: first generation APs have a higher risk of TD than second generaion APs

true

treatment for TD

change medication (SGA preferred)

clozaril or seroquel

treatment for moderate to severe TD

*VMAT2 inhibitors*

valbenazine (Ingrezza)

deutetrabenzaine (Austedo)

tetrabenazine (Xenazine)

valenbenazine (Ingrezza)

3A4 and 2D6 substrate

drowsiness, fatigue, sedation, somnolence >10% of patients

QT prolongation

deutetrabenzaine (Austedo)

2D6 substrate

QT prolongation

drowsiness

tetrabenazine (Xenazine)

not approved for TD, only Hunington's disease

general priniciples for TD

antipsychotics only if clear indication

lowest effective dose

educate patients on APs > 6 months

document education provided to patients