A 43 year old male patient presenting with hallucinations and delusions was prescribed chlorpromazine, a phenothiazine derivative for reduction of the positive symptoms of schizophrenia.
Identify one of the extrapyramidal side effects caused by this medication that involves torticollis and retrocollis:
Correct Answer A:
Answer: A - Acute dystonias is marked by sudden muscle spasms in the form of torticollis and retrocollis and trismus. These symptoms would be very distressing to the patient. This is most common in the young patients and especially in men receiving high doses of chlorpromazine. The best medication for the control of acute dystonias is anti-cholinergic drugs, which reduce the symptoms for large extent if given through IV route. Acute dystonias can also be controlled by switching the medication to atypical medication.
B. Akathesia is marked by restlessness, agitation and inner tension.
C. Pseudoparkinsonism is the side effect of the antipsychotic drugs, like phenothiazine derivatives.
D. Tardive dyskinesia is marked by abnormal movements of the body, which can occur in any part of the body.
E. Neuroleptic malignant syndrome is characterized by hyperthermia, altered consciousness and autonomic changes.
A 24-year-old female had been healthy with no significant medical illnesses until about 3 months ago, when she was diagnosed with schizophrenia and treatment was initiated. She is now concerned because she has gained 4.5kg (10 lb) since beginning treatment. A comprehensive metabolic panel is normal, with the exception of a fasting blood glucose level of 8.7 mmol/L.
Which one of the following medications would be most likely to cause these findings?
Correct Answer E:
Second-generation, or “atypical,” antipsychotics are associated with weight gain, elevated triglycerides, and type 2 diabetes mellitus. Olanzapine and clozapine are associated with the highest risk. Clonazepam, a benzodiazepine, does not share these risks. Thioridazine and chlorpromazine are first-generation antipsychotics, and carry less risk of these side effects. Aripiprazole, although it is a second-generation antipsychotic, has been found to cause weight gain and metabolic changes similar to those seen with placebo.
A 26-year-old female presents with symptoms of anhedonia and anxiousness. Your evaluation leads to a diagnosis of major depressive disorder. The patient consents to medical treatment and counseling, but she is engaged to be married in 2 months and is concerned that antidepressants may lower her libido even further.
Which one of the following would be best for reducing the likelihood of sexual dysfunction?
Paroxetine has been found to cause higher rates of sexual dysfunction than bupropion, fluoxetine, and sertraline. Bupropion has been found to have significantly lower rates of adverse effects on sexual function than fluoxetine or sertraline.
A 70-year-old female becomes psychotic and risperidone (Risperdal) is prescribed.
Which one of the following should be used to monitor the patient for adverse cardiac effects of this drug?
Both typical and atypical antipsychotics can cause prolongation of the QTc interval, resulting in torsades de pointes, ventricular tachycardia, and sudden death. The best way of monitoring the QTc interval is electrocardiography.
A patient on clozapine has to be concerned with which of the following side effects?
Correct Answer C:
Clozapine is used in the management of psychotic disorders including schizophrenia. Because of concern for the side effect of agranulocytosis, clozapine should be reserved for patients who have failed to respond to other standard medications or who are at risk for recurring suicidal behavior.
Clozapine may cause a severe reduction in white blood cell count, a condition known as agranulocytosis, in approximately 1 in 100 patients who take it for at least one year. White blood cells fight infections, and a severe reduction in white blood cells can result in severe infections. If not caught early, agranulocytosis can be fatal. Therefore, the white blood cell count should be measured (with a blood test) prior to starting treatment and regularly (weekly) while patients receive this medication, and for 4 weeks after it is stopped.
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