Major Psychiatric Drug Reactions (Blueprints)

Front 1

Dystonia, what is it?

Back 1

Movement disorder characterized by muscle spasms, commonly involving head/neck but can involve trunk/limbs

Front 2

Symptoms of dystonia?

Back 2

Ranges from mild subjective sensation of increased muscle tension to a life-threatening syndrome of severe muscle tetany and laryngeal dystonia (laryngospasm)

Front 3

What are specific forms of dystonia?

Back 3

Head and Neck Dystonia - Abnormal posturing

Tongue Dystonia - Dysarthria

Pharyngeal Dystonia - Drooling

Ocular Dystonia - Oculogyric crisis

Front 4

Risk factors for dystonia?

Back 4

1) High potency typicals antipsychs
2) Young men

Front 5

When does dystonia occur?

Back 5

Early in drug therapy, within days

Front 6

Treatment of dystonia?

Back 6

Anticholinergics (Benztropine, Benadryl)

Most cases oral is fine, but if there is swallowing problems then IM

Rarely is intubation needed

Front 7

Akathisia, what can cause it?

Back 7

1) Typical antipsychs
2) SSRI

Front 8

Akathisia, what is it?

Back 8

Subjective sensation of inner restlessness or strong desire to move one's body

Front 9

Akathisia, when is it seen?

Back 9

Shortly after initiation of an antipsychotic

Front 10

Akathisia, risks?

Back 10

1) High potency typicals
2) Young men

Front 11

Akathisia, severe problems?

Back 11

Severe dysphoria and anxiety
Can drive pts to try suicide

Front 12

Need to have high suspicion of akathisia because?

Back 12

If mistaken for agitation or worsening psychosis, may increase antipsychotic dose with resultant worsening of akathisia

Front 13

Time frame for akathisia?

Back 13

Within first month of drug initiation, but can occur anytime during treatment

Front 14

Treatment for akathisia?

Back 14

First Line - Propranolol

Second Line - Benzos such as Lorazepam

Third Line - Anticholinergics

Front 15

Signs of Parkinsonism?

Back 15

1) Lead pipe rigidity
2) Cogwheel rigidity
3) Pill rolling tremor
4) Bradykinesia
5) Akinesia

Front 16

What is lead pipe rigidity?

Back 16

Rigidity present continuously throughout passive movement of an extremity

Front 17

What is cogwheel rigidity?

Back 17

Rigidity with a catch-and-release character

Front 18

Risk factors for Parkinsonism

Back 18

1) Increasing age
2) Female gender
3) High potency typicals
4) Previous incidence

Front 19

Time frame for Parkinsonism

Back 19

First few weeks of therapy

Front 20

Treatment of Parkinsonism

Back 20

1) Reduce dosage
2) Anticholinergics
3) Levodopa / Amantadine

Front 21

NMS, what is it and what is it not?

Back 21

Life threatening complication of antipsychotic drug use

It is NOT an allergic reaction

Front 22

Symptoms of NMS?

Back 22

FALTER

Fever
ANS instability (tachy, hyper/hypo)
Leukocytosis
Tremors
Elevated CPK / LFTs
Rigidity (lead pipe)

Front 23

Risk factors for NMS development?

Back 23

1) High dose antipsychotics
2) Rapid dose escalation
3) IM Injections of antipsychotics
4) Dehydration
5) Agitation
6) Prior NMS

Front 24

Treatment of NMS

Back 24

1) D/C the antipsychotic
2) Supportive interventions
3) Dantrolene (muscle relaxant) to reduce rigidity and myonecrosis
4) Bromocriptine (to restore some dopamine)

Front 25

NMS vs. Serotonin Syndrome

Back 25

Many symptoms are similar... But...

In NMS, muscular rigidity with myonecrosis is a predominant feature absent in SS

NMS is from antidopamine drugs
SS is from drugs that increase serotonin

Front 26

Serotonin Syndrome, what is it caused by mechanistically?

Back 26

High synaptic levels of serotonin

Front 27

What is a classic cause of SS?

Back 27

Serotonin altering medication + MAOI

Front 28

What is a less obvious cause of SS?

Back 28

MAOI + Meperidine or Dextromethorphan or other Opiates

Front 29

Symptoms of SS?

Back 29

Tachycardia, HTN, hyperthermia, shivering, clonus, hyperreflexia, restless, agitation, delirium, prominent GI symptoms

Front 30

Mnemonic for SS?

Back 30

Hyperthemia
Hypertension
Hyperreflexia
Hypermovement (shiver/clonus)
Hyper (agitated/restless)

Front 31

TX for SS?

Back 31

1) D/C meds
2) Supportive care
3) Cyproheptadine

Front 32

What is mechanism of Cyproheptadine?

Back 32

5HT-2A receptor antagonist

Front 33

What is Cyproheptadine used for?

Back 33

Treatment of serotonin syndrome

Front 34

What is Tardive Dyskinesia?

Back 34

Movement disorder s/p long term neuroleptic use

(rarely occurs spontaneously in elders without prior medication use)

Front 35

What are the symptoms of TD?

Back 35

Choreoathetoid, constant, involuntary movements of head/neck, especially mouth and tongue

Front 36

Risk factors for TD?

Back 36

1) Long term treatment with typicals
2) Female gender
3) Presence of a mood disorder

Front 37

TD course?

Back 37

It is reversible, but often will stay permanent

Front 38

Treatment for TD?

Back 38

1) Reduce dose
2) Change meds
3) Try Clozapine instead

Front 39

Why choose Clozapine when TD is in the picture?

Back 39

It seems to work by a different mechanism from the other antipsychotics

Front 40

What is metabolic syndrome?

Back 40

Obesity
Insulin Resistance
Hyperlipidemia

Front 41

What is the side effect all atypicals can cause?

Back 41

Metabolic disorder

Front 42

Which atypicals have highest incidence of causing metabolic problems?

Back 42

Olanzapine
Clozapine

Front 43

What should be recorded prior to initiation of atypicals? (3)

Back 43

BMI
Fasting glucose
Lipid Panel

Front 44

Time course for...

Dystonia
Akathisia
Parkinsonism (EPS)
TD
NMS

Back 44

Dystonia (first few days)
Akathisia (first few weeks)
EPS (first few weeks)
NMS (first few weeks)
TD (after years)