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2.1
Antipsychotic Agent
Agents Antipsychotic

Images

WIKIDATA, Public Domain
WIKIDATA, Public Domain
WIKIDATA, Public Domain
WIKIDATA, Public Domain
WIKIDATA, CC BY-SA 4.0

Presentation

Reasons of psychiatrists to switch to olanzapine were the expectation of better efficacy and tolerability of the present treatment and patient preferences to continue with the present medication. [ncbi.nlm.nih.gov]

This study will compare four atypical antipsychotic medications in terms of the risk of specific side effects each of them presents in middle-aged and elderly individuals. [clinicaltrials.gov]

The monohydroxylated metabolite M9 was solely present in urine samples of extensive CYP2D6 metabolizers, whereas M10, another metabolite monohydroxylated at the alicyclic ring system, was present in feces of poor metabolizers as well. [dmd.aspetjournals.org]

Entire Body System

  • Weight Gain

    CONCLUSION: The TaqI A polymorphism of DRD2 gene is therefore unlikely to play an important role in antipsychotic agent-induced weight gain, a side effect of antipsychotic treatment. [ncbi.nlm.nih.gov]

Gastrointestinal

  • Nausea

    […] and vomiting.DB00450DroperidolA butyrophenone derivative and dopamine antagonist used to prevent and treat postoperative nausea and vomiting.DB00477ChlorpromazineA phenothiazine antipsychotic used to treat nausea, vomiting, preoperative anxiety, schizophrenia [drugbank.ca]

    Both regimens are known for producing nausea and vomiting. [reuters.com]

    They can be beneficial in the control of nausea, in the treatment of intractable hiccups, in controlling the movement disorders associated with Huntington's chorea and Gilles de la Tourette's syndrome, and, in combination with other drugs, for the control [medical-dictionary.thefreedictionary.com]

    […] tranquilizer (trade name Loxitane) used to treat schizophrenia Moban, molindone antipsychotic drug (trade name Moban) used in the treatment of schizophrenia prochlorperazine antipsychotic and antiemetic drug used to treat schizophrenia and to combat nausea [vocabulary.com]

    Withdrawal of these agents can cause nausea, emesis, anorexia, diarrhea, rhinorrhea, diaphoresis, myalgia, paresthesia, anxiety, agitation, restlessness, and insomnia. [doi.org]

Cardiovascular

  • Orthostatic Hypotension

    Adverse effects include orthostatic hypotension, tachycardia, benign hyperthermia, hypertension, seizures, and sedation. Many of these effects are transient. [ncbi.nlm.nih.gov]

    Adverse effects Extrapyramidal effects (dystonia, akathisia, parkinsonism), tardive dyskinesia due to blocking of basal ganglia; sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation [medical-dictionary.thefreedictionary.com]

    […] prevent orthostatic hypotension The nurse has just given a client 5 mg of Haldol IM. The nurse tells him that he should lie down for at least 30 min. This will help...with the distribution of the drug or prevent orthostatic hypotension. [quizlet.com]

    hypotension); and family history (e.g., diabetes). [uspharmacist.com]

    Orthostatic hypotension—the medical name for the fuzzy feeling you get when standing up to quickly—is very common. Hepatic (Liver) Effects: These agents increase the serum concentration of alkaline aminotransferase. [goodtherapy.org]

Musculoskeletal

  • Motor Restlessness

    The patient factors include mild severity of akathisia, lack of apparent motor restlessness, no voluntary expression of inner restlessness, no clear communication of inner restlessness, restlessness in body parts other than the legs, atypical expressions [doi.org]

    Extrapyramidal effects: Dystonias (sustained contraction of muscles leading to twisting, distorted postures), Parkinson-like symptoms, akathisia (motor restlessness), and tardive dyskinesia (involuntary movements, usually of the tongue, lips, neck, trunk [brilliantnurse.com]

    Akathisia can be described as a subjective sense of unease and motor restlessness. It can be misinterpreted as increasing agitation or anxiety. [clinicaladvisor.com]

    Akathisia (motor restlessness) is particularly unpleasant and may lead to nonadherence; it can be treated with propranolol. [merckmanuals.com]

    The nurse may observe this as restlessness or an inability to be still. The patient’s motor restlessness is visable and is subjectively experienced as anxiety, or agitation. Akathesia may develop weeks or months after the onset of drug therapy. [nurseslearning.com]

Skin

  • Pruritus

    Many of these drugs may also be effective against nausea, emesis, and pruritus. Definition (NCI) Also known as neuroleptics, major tranquilizers, or antischizophrenics, natural or synthetic. [fpnotebook.com]

    […] motion sickness.DB00372ThiethylperazineFor the treatment or relief of nausea and vomiting.DB00680MoricizineAn antiarrhythmic used to treat arrhythmias.DB01246AlimemazineAn antihistamine agent used to prevent and relieve allergic conditions which cause pruritus [drugbank.ca]

    Many of these drugs may also be effective against nausea, emesis, and pruritus. [ncbi.nlm.nih.gov]

    • Prometathazine is not a good antipsychotic drug, but the agent is used in treating pruritus because of its antihistaminic properties. Mohsin Aziz 37 38. Mohsin Aziz 38 [slideshare.net]

    An important reason for this inequality may be that—notably mild—hypothermia tends to present with rather subtle and atypical symptoms, such as confusion, vertigo, nausea, hunger, chills, pruritus, and dyspnea ( 4 ) and may, therefore, easily go unnoticed [doi.org]

  • Decreased Sweating

    These include dry mouth, decreased sweating, constipation and dry eyes. Somnolence and low blood pressure are common. [encyclopedia.com]

  • Alopecia

    Patients presented with findings such as hirsutism, acne, alopecia, menstrual abnormalities, acne, acanthosis nigricans and central obesity. [healio.com]

Psychiatrical

  • Delusion

    These include hallucinations (sights, sounds, smells, tastes, or touches that a person believes to be real but are not real), delusions (false beliefs), and dementia (loss of the ability to think, remember, learn, make decisions, and solve problems). [cancer.gov]

    Antipsychotics are drugs that are used to treat symptoms of psychosis such as delusions (for example, hearing voices), hallucinations, paranoia, or confused thoughts. [drugs.com]

    Delusions and hallucinations are often modified and may be eliminated by such an agent, but once the drug is discontinued, the delusions and hallucinations often return within a short while. [medical-dictionary.thefreedictionary.com]

    Psychoses can affect cognitive processes such as judgment and frequently cause delusions and hallucinations. The most widely known psychosis is schizophrenia. [britannica.com]

    • CATATONIC : a person is withdrawn, mute, negative and often assumes very unusual postures ( motor symptoms). • RESIDUAL : a person is no longer delusion or hallucinating (psychotic), but has no motivation or interest in life. [slideshare.net]

Neurologic

  • Agitation

    […] rapidly-acting pharmacologic options for acute agitation are outlined in Table 1. [ncbi.nlm.nih.gov]

    Medications used to treat agitation include antipsychotics and benzodiazepines, usually administered intramuscularly when rapid action is desired. [doi.org]

  • Akathisia

    She was rated on Barnes Akathisia Rating Scale (BAS) and on global clinical assessment for akathisia, she was rated as four, indicative of marked akathisia. [ncbi.nlm.nih.gov]

    Abstract This article reviews what causes clinicians to overlook or underdiagnose akathisia. The causes are considered to be related to both the patient's symptoms and the clinician's attitude toward akathisia. [doi.org]

    Akathisia can be acute or chronic, occurring in a tardive form with symptoms that last >6 months. 1-3 Much isn’t known about drug-induced akathisia Our understanding of the pathophysiology of akathisia is incomplete. [mdedge.com]

  • Seizure

    […] medication inducing seizure activity. [ncbi.nlm.nih.gov]

    All antipsychotic medications decrease the seizure threshold to varying degrees. [epilepsy.com]

    All antipsychotics can lower the seizure threshold. Nonetheless, overall, seizures are relatively rare. [clinicaladvisor.com]

  • Dystonia

    There is currently no cure for dystonia, but there are several popular treatments depending on the type of dystonia and age of onset. [psychcentral.com]

    Adverse effects Extrapyramidal effects (dystonia, akathisia, parkinsonism), tardive dyskinesia due to blocking of basal ganglia; sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation [medical-dictionary.thefreedictionary.com]

    Laryngeal dystonia Lorazepam 4 mg IV over 10 minutes, then 1–2 mg IV slowly Intubation may be needed. [msdmanuals.com]

  • Stupor

    Individuals develop a severe rigidity with catatonia, autonomic instability, and stupor, which may persist for more than one week. [britannica.com]

    Muscle rigidity, akinesia, tremor Hyperthermia Autonomic instability (tachycardia, labile blood pressure, tachypnea, diaphoresis, dysrhythmias) Mental status change: confusion, delirium, reduced vigilance, stupor Diagnostics ↑↑ Creatine kinase Leukocytosis [amboss.com]

    Neuroleptic malignant syndrome: This potentially fatal reaction to antipsychotic drugs is characterized by muscle rigidity, fever, altered mental status and stupor, unstable blood pressure, and myoglobinemia. [brilliantnurse.com]

    Levels of consciousness may vary; however, stupor and even coma are not uncommon. [nurseslearning.com]

Workup

Anterior chamber cell Keratic Precipitates Flare Hypopyon Iris nodules Posterior synechiae Fibrin Pupillary miosis Band keratopathy Diagnostic procedures The basic workup for acute anterior uveitis includes an HLA-B27, syphilis testing, and testing for [eyewiki.aao.org]

Serum

  • Hyponatremia

    Clemastine Carbinoxamine Chronic constipationa Clomipramine Carboplatin SIADH or hyponatremia Clonazepam Clemastine (various) Chronic constipation Dabigatran Clozapine Chronic seizures or epilepsy Desiccated thyroid Cisplatin SIADH or hyponatremia Dexbrompheniramine [ncbi.nlm.nih.gov]

    […] tachypnea, diaphoresis, dysrhythmias) Mental status change: confusion, delirium, reduced vigilance, stupor Diagnostics ↑↑ Creatine kinase Leukocytosis ↑ Transaminases Metabolic acidosis Myoglobinuria Electrolyte abnormalities (hypocalcemia, hyperkalemia, hyponatremia [amboss.com]

    Greenblatt, Antidepressant-Associated Hyponatremia in the Elderly, Journal of Clinical Psychopharmacology, 36, 6, (545), (2016). [doi.org]

QT, RR, ST Intervals

  • Prolonged QT Interval

    Smaller increase in prolactin levels compared to typical antipsychotics Most common in risperidone, amisulpride, and paliperidone Prolonged QT interval Potassium channel-mediated effect Can lead to life-threatening arrhythmias (torsades de pointes and [amboss.com]

    QT interval Baseline electrocardiography if patient has history of heart disease, syncope, sudden death in a family member younger than 40 years, congenitally prolonged QT interval, or polypharmacy Table 4. [aafp.org]

    All patients who receive atypical antipsychotics need to understand their adverse effects, including weight gain, prolonged Qt interval, diabetes, sedation, and the risk of dyskinesias. [ncbi.nlm.nih.gov]

    Furthermore, a pharmacodynamic drug interaction may be the result of combining two or more drugs with established risk of prolongation of corrected QT interval (QTc), such as chlorpromazine and haloperidol [ 11, 13 ]. [omicsonline.org]

    Side-effects include a prolonged QT interval in the heart, which can be dangerous for patients with heart disease or those taking other drugs that prolong the QT interval. Amisulpride (Solian) - Selective dopamine antagonist. [marefa.org]

Treatment

Furthermore, increase in body weight is unlikely to be prediction of therapeutic response to antipsychotic treatment in schizophrenia. [ncbi.nlm.nih.gov]

Prognosis

[…] versatile mechanisms of tumoricidal actions and due to its highly traversing capability through the blood-brain barrier, pimozide highly deserves to be studied in animal models of drug resistant refractory cancers and glioblastoma, which have very poor prognosis [ncbi.nlm.nih.gov]

Uveitis is classified by anatomical location which correlates with etiology and affects treatment as well as prognosis (see Figure 1). [cancertherapyadvisor.com]

Prognosis In general, patients who arrive alive at health care facilities have a very good prognosis. Most deaths from these agents occur in the prehospital period. Thus, if an individual survives to hospital admission, the prognosis is quite good. [clinicaladvisor.com]

Prognosis Some forms of AAU have a tendency to recur. [eyewiki.aao.org]

Etiology

Abstract Schizophrenic illness is associated with high rates of osteoporosis, the etiology of which remains obscure, but which may be at least partly explained by the prolactin-raising properties of antipsychotic medication. [ncbi.nlm.nih.gov]

Uveitis is classified by anatomical location which correlates with etiology and affects treatment as well as prognosis (see Figure 1). [cancertherapyadvisor.com]

[…] symptoms (EPS) Definition: : a collection of movement disorders that are typically due to disruption of dopaminergic pathways in the basal ganglia, resulting in bradykinesia, rigidity, dystonia, athetosis, chorea, ballismus, akathisia, tics, and tremors Etiology [amboss.com]

Etiological differential Diagnosis 31 32. “ 32 Feature Granulomatous Uveitis Non-granulomatous Uveitis 1. Onset Insidious Acute 2. Pain Minimal Marked 3. Photophobia Slight Marked 4. Ciliary congestion minimal Marked 5. [slideshare.net]

Epidemiology

DESIGN: Retrospective, epidemiologic survey of spontaneously reported adverse events related to olanzapine therapy SETTING: Government-affiliated drug evaluation center. [ncbi.nlm.nih.gov]

Uçar HN, Eray S, Kocael Ö, Uçar L, Kaymak M, Lettieri E & Vural AP PDF INTERNET SEARCHES FOR “SUICIDE”, ITS ASSOCIATION WITH EPIDEMIOLOGICAL DATA AND INSIGHTS FOR PREVENTION PROGRAMS Waszak PM, Górski P, Springer J, Kasprzycka-Waszak W, Duzy M & Zagozdon [hdbp.org]

Pathophysiology

CI-686's unique preclinical profile suggests a mechanism of action other than dopamine antagonism which could have implications regarding current thinking on the pathophysiology of schizophrenia. [ncbi.nlm.nih.gov]

These efforts should be based on the pathophysiology of the diseases and the affected neurotransmitter systems. [doi.org]

These drugs have also proved to be of great value in studying the pathophysiology of schizophrenia and other psychoses. [accessmedicine.mhmedical.com]

Prevention

It is important to clarify whether olanzapine could have a role in long-term prevention of manic and depressive relapses. [ncbi.nlm.nih.gov]

There are no established drug treatments to prevent or counter these problems. [doi.org]

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