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anti-psychotics (general info (Side effects of typicals (Extrapyramidal…

- - - - Acute dystonia (4 hours) "muscle"
      - Akathisia (4 days) "rustle'
      - Akinesia (parkinsonism) (breat with benzos) (4 weeks) "hustle"
      - treat: by reducing dose, then IM benztropene or PO
- - - - Acute dystonia sudden involuntary muscle spasm Affects face, neck and trunk, especially after IMI administration of AP
        Could be within hours to 1-3 days after they leave ED, especially young males.
        Laryngospasm potentially fatal
        Occulogyric crisis (involuntary contractions of the eye resulting in conjugate gase, usually upwards. And opisthotonus (tetanic spasm of mm of back)
        Use the AIMS abnormal involuntary movements scale to test for the movement disorder,
        Use benztropine (anti-cholinergic) 1-2 mg every 10-15 min of necessary
      - Akinesia (parkinsonsim) Bradykinesia, resting tremor high frequency pill rolling
        Muscular rigidity, cogwheel, leadpipe.
        Use the AIMS abnormal involuntary movements scale to test for the movement disorder
        Use benztropine (anti-cholinergic) .5 mg
      - akathesia Severe sense of agitation and restlessness of the limbs may present as a feeling of inner restlessness. Develops within hours to days, may be so severe that it leads to suicide. Common with aripiprazole.
        Use the Barnes akathisia rating scale. dysphoria: restlessness inside and uneasiness.
        Rx: propanolol, diazepam or mirtazapine
    - - hyperprolactinaemia Inhibition of DA at the tuberoinfundibular pathway by a neuroleptic leads to increased prolactin. Weight gain, prolactin increase and galactorrhea, gynecomastia, sexual dysfunction, amenorrhea/ menstrual irregularity infertility.
        Typicals which cause this include: amisulpride, risperidone (olanzapine is modest and transient)
        Measure prolactin, consider DDx and get MRI of pituitary
      - QTc interval prolongation: Prolongued due to the effect on K channels which delay depolarisation.
        Risk of sudden death by torsades de points VF.
        HIGH RISK: thioridazine, properidol, pimozide, ziprasidone
        POTENTIAL: zuclopenthixol
        LOW: atypicals
        Assess for dizziness, syncope, presyncope, palpitations
        HIGH RISK: long QT interval, IHD, CCF, LVF, family history of arrhythmias, (perform baseline ecg and avoid high risk meds)
      - other side effects
        1.anticholinergic: strong anticholinergic activity correlates with EPSE Muscarinic blockade: dry mouth, dry eyes, git, urinary, sexual, confusion.
        
        Anti-alpha-adrenergic= postural hypotension, hypothermia, impotence / failure to ejaculate, = risperidone.
        
        Anti-histaminergic causes drowsiness= quetiapine.
      - metabolic syndrome for some people the risks of metabolic syndrome outweigh the risks of untreated psychosis. Weight gain and obesity, impaired glucose tolerance, hyperlipidaemia, hypertension
      - Neuroleptic malignant syndrome
        
        cause Systemic dopamine blockade/ sensitivity
        
        complications Metabolic acidosis, myoglobulinaemia, renal failure, PE, chronic cerebellar syndrome, DIC and death.
        
        Management cease AP, resuscitate, cooling, BP, hydration, fluids, benzodiazepine, medical review and transfer to ICU.
        
        presentation Over days to weeks, after starting and antipsychotic medication. Altered mental state: confusion, sgitation, delerium, coma. Muscle hyperactivity: restlessness, incordination, rigidity, febrile. other autonominc dysregulatory patterns.
        
        Investigations Observations, vitals, check med chart for Aps, iv access and measure CK! UEC, coags, lithium level, other drug levels, urinary drug screen, transaminases. raised WCC.
  - - - fatal side effects: AGRANULOCYTOSIS, hyperglycaemia and ketoacidosis, seizures, constipation causing ischaemic bowel, cardiac, cardiomyopathy, myocarditis.