Extrapyramidal side effects Flashcards

(42 cards)

1
Q

Prevalence of dystonia with typical antipsychotics

A

10%

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2
Q

Risk factors for developing dystonia on antipsychotics

A

Young males
Neuroleptic naive
High potency drugs e.g. haloperidol

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3
Q

Prevalence of pseudo-parkinsonism with typical antipsychotics

A

20%

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4
Q

Risk factors for developing pseudo-parkinsonism on antipsychotics

A

Elderly females

Pre-existing neurological damage e.g. stroke

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5
Q

Prevalence of akathisia with typical antipsychotics

A

25%

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6
Q

Prevalence of tardive dyskinesia with typical antipsychotics

A

5% per year of antipsychotic exposure

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7
Q

Risk factors for developing tardive dyskinesia with antipsychotic treatment

A

Elderly females
Affective illnesses
Those who have had EPSEs earlier on in treatment
Intellectual disability and brain damage

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8
Q

Time taken for dystonia to develop after starting antipsychotics

A

Minutes to hours

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9
Q

Time taken for pseudo-parkinsonism to develop after starting antipsychotics

A

Days to weeks - can also start days to weeks after an antipsychotic is increased

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10
Q

Time taken for akathisia to develop after starting antipsychotics

A

Hours to weeks

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11
Q

Time taken for tardive dyskinesia to develop after starting antipsychotics

A

Months to years - higher risk the longer the antipsychotics have been given for

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12
Q

Extrapyramidal side effect involving prolonged and unintentional muscular contractions

A

Dystonia

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13
Q

Extrapyramidal side effect involving tremor, rigidity, and bradykinesia

A

Pseudo-parkinsonism

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14
Q

Extrapyramidal side effect involving a subjective feeling of restlessness

A

Akathisia

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15
Q

Extrapyramidal side effect involving involuntary repetitive movements, often of the face, tongue, and lips

A

Tardive dyskinesia

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16
Q

Extrapyramidal side effect most resistant to treatment

A

Akathisia

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17
Q

Antipsychotic which carries the highest risk of extrapyramidal side effects

18
Q

Antipsychotic which carries the lowest risk of extrapyramidal side effects

19
Q

Treatments for dystonia

A

Anticholinergic drugs
Switch to alternative antipsychotic
Botulinum toxin

20
Q

Treatments for pseudo-parkinsonism

A

Reduce dose
Switch to alternative antipsychotic
Anticholinergic drugs

21
Q

Treatments for akathisia

A
Reduce dose
Switch to alternative antipsychotic
Propanolol
Mirtazapine
Anticholinergic drugs
Cyproheptadine
Benzodiazepines
Clonidine
22
Q

Treatments for tardive dyskinesia

A
Reduce dose
Switch to alternative antipsychotic
Stop any anticholinergic medications already prescribed
Tetrabenazine
Ginkgo biloba
23
Q

Anticholinergics used for extrapyramidal side effects

A

Procyclidine
Trihexyphenidyl
Orphenadrine
Benztropine

24
Q

Antihistamine used for extrapyramidal side effects due to its anticholinergic properties

A

Diphenhydramine

25
Most serious extrapyramidal side effect
Laryngeal dystonia
26
Type of dystonia where there are muscle spasms resulting in a twisted posture of the neck
Torticollis
27
Type of dystonia where the jaw muscles are contracted
Trismus
28
Type of dystonia where there is an arched posturing of the head, trunk, and extremities
Opisthotonus
29
Type of dystonia where there is difficulty breathing
Laryngeal dystonia
30
Type of dystonia where there is involuntary contraction of one or more of the extraocular muscles leading to a fixed gaze +/- diplopia
Oculogyric crisis
31
Extrapyramidal side effect which may be a feature of schizophrenia rather than just a treatment side effect
Tardive dyskinesia
32
Benzodiazepines recommended for treating akathisia
Diazepam | Clonazepam
33
Factors that increase symptoms of tardive dyskinesia
Emotional arousal | Distraction
34
Factors that decrease symptoms of tardive dyskinesia
Relaxation | Using the muscles for voluntary tasks
35
Effect of sleep on symptoms of tardive dyskinesia
Symptoms disappear
36
Only licensed treatment for tardive dyskinesia in the UK
Tetrabenazine
37
Percentage of cases of tardive dyskinesia which are reversible on reducing or stopping the antipsychotic
50-55%
38
Dystonia occurring after months to years of antipsychotic treatment
Tardive dystonia
39
Treatment options for tardive dystonia
Botulinum toxin ECT Deep brain stimulation
40
Risk factors for developing akathisia
``` Older women Iron deficiency Negative symptoms Affective features Cognitive impairment ```
41
Vitamin used as an add on treatment for tardive dyskinesia
Pyridoxine (vitamin B6)
42
Most well established risk factor for developing tardive dyskinesia
Older age