Management of antipsychotic overdose
-
Upload
sunil-kumar-daha -
Category
Health & Medicine
-
view
162 -
download
1
Transcript of Management of antipsychotic overdose
MANAGEMENT OF
ANTIPSYCHOTIC
OVERDOSE
Presented by:
Sunil Kumar Daha
ANTIPSYCHOTIC DRUGS
Inhibition of α-adrenergic receptors
Inhibition of dopaminergic receptors
Inhibition of histaminergic receptors
Inhibition of muscarinic receptors
Inhibition of serotonergic receptors
Inhibition sodium, potassium, and
calcium channels
COMMON USES
Antipsychotic
Control nausea and vomiting
Gastro esophageal disorders
SYMPTOMS
Anti-cholinergic features (tachycardia,
hypertention, confusion, hallucination,
sedation, myoclonus, fever, diplopia,
mydriasis, lleus, palpable bladder,
flushing, dry mouth
Serotogenic features (tachycardia, <-
>BP, confusion, hallucination, sedation,
coma, shivering, myoclonus, fever,
diarrhea, comitting, flushing)
Prolonged QT interval, torsades de
pointes
HYPERKINETIC MOVEMENT
DISORDER
Acute
Sub acute
Chronic
ACUTE SYMPTOMS
minutes of exposure
dystonia
generalized in children and focal in
adults (blepharospasm, torticollis,
oromandibular dystonia)
IV benzodiazpine (diazepam 10-20
mg, lorazepam 2-4 mg)
Dopamine agonist
SUBACUTE SYMPTOMS
Akathisia
motor restlessness with a need to
move that is alleviated by movement
removing the offending agent
benzodiazepine, anticholinergics,beta blockers or dopamine agonists.
CHRONIC SYMPTOMS
Tardive dyskinesia
Tardative dystonia: axial muscles, trunk,
pelvis
Tardive akathisia
Tardive Tourette's
Tardive tremor syndrome
Neuroepileptic Malignant Syndrome
(NMS)
TARDATIVE SYNDROMES
Tardive dyskinesia (TD)
choreiform movements in mouth, lips, tongue, trunk, limbs, respiratory muscles may also be affected
remits within 3 months of stopping the drug, and most patients gradually improve over the course of several years
abnormal movements may also develop or worsen after stopping the offending agent.
Atypical antipsychotics: lower risk of TD
TARDATIVE SYNDROMES…
Younger patients have a lower risk
Elderly, females, previous organic cerebral dysfunction at greater risk
Chronic use with increased risk (metoclopramide for more than 12 weeks)
Can be permanent and resistant to treatment
atypical neuroleptics should be the preferred
Treatment: Stop offending agent
Patient with traditional antipsychotic replace with an atypical antipsychotic (avoid acute
Neuroepileptic Malignant
Syndrome (NMS)
Acute or subacute onset of:o muscle rigidityo elevated temperatureo altered mental statuso tachycardiao labile blood pressureo renal failureo elevated creatine kinase levels• Evolve within days or weeks after strating
drug• Abrupt withdrawal of dopaminergic
medications in PD
NMS…
Stop offending antipsychotic drug
Introduction of a dopaminergic agent
(dopamine agonist or levodopa),
dantrolene, benzodiazepine.
Antipyretics, cooling blankets, hydration,
electrolyte replacement, control of renal
function and blood pressure.
MANAGEMENT
Management of ABC
Activated charcoal if within 1 hr of
ingestion
Cardiac monitoring for 6 hrs
CVS: MgSO4, 2g IV over 1-2 min
Avoid class IA, IC antiarrhythmics
NaHCO3
REFERENCES
Harrison’s Principles of Internal
Medicine, 19th edition
Davidson’s Principles and practise of
Medicine, 22nd edition
https://www.ncbi.nlm.nih.gov/pubmed/
22668123