I have said that the chemical structure of a drug determines its efficacy, then the side effects, too, are determined by the chemical structure of the drug.
A rule: drugs with good efficacy, including antipsychotic drugs and antidepressants, drugs with good efficacy, often have more side effects, too, why? Because the reason for good efficacy is that the drug acts on a wide range of neurotransmitters and has a wide range of pharmacological effects, but also brings more side effects, this law does not apply to the drugs used, individual drugs will also be effective side effects are also small.
The following is a description of common side effects.
I. Extrapyramidal side effects.
The reason for this side effect is that antipsychotic drugs block the DA (dopamine) receptors in the nigrostriatal neural pathway of the brain, antipsychotic drugs block the limbic DA neural pathway of the midbrain to treat hallucinatory delusions, and block the DA neural pathway of the midbrain cortex to treat negative symptoms. Antipsychotic drugs are often not selective for blocking the brain’s DA neural pathway, so they can both treat the disease and produce drug side effects.
1. Pharmacogenic Parkinson’s syndrome
Patients who take or intramuscularly inject antipsychotic drugs develop symptoms similar to those manifested in Parkinson’s disease, or pharmacogenic Parkinson’s disease. The main manifestations are.
(1) Difficulty in movement: After taking antipsychotic drugs, patients experience “wanting to move but not being able to move”, feeling tight and having difficulty moving around, often sitting on the sidelines and not doing anything.
(2) Increased muscle tone: When examining a patient’s joint movement, the examiner often feels resistance, which can be called increased muscle tone.
(3) Resting tremor, etc. Here, a slight explanation of tremor: tremor, in general, can be divided into three categories.
a. Postural tremor A small, rapid tremor that occurs when the limb is allowed to maintain a certain posture. The tremor is usually magnified when the examiner extends the arm forward and lays a piece of paper flat on the fingers. It is commonly seen in hyperthyroidism.
b. Intentional tremor A small tremor, often 8-12 times per second, occurs when the hand or fingers are used for purposeful movements. It is common in the elderly and becomes ‘shivering’.
c. Resting tremor A slow, large-amplitude tremor occurs in the limbs or other parts of the body when no movement is made and no attention is paid to it. Once attention is paid, the tremor is reduced or disappears. It also disappears during sleep. This is the case for tremor in Parkinson’s-like disease caused by antipsychotics.
There is also a forward-like minuet gait, difficulty swallowing, etc.
Older antipsychotics, drugs with pharmacological effects mainly on the DA system, and antipsychotic injections are more prone to this side effect. The side effects are related to the dose of some drugs: high doses are prone to occur, and some drugs are related to individual differences in patients: side effects can vary greatly from patient to patient at the same dose. Treatment: oral benzhexol, isoproterenol is sufficient. It is generally considered that no medication is needed if there are no extrapyramidal side effects. Preventive medication is not recommended.
2. Acute dystonia
Shortly after taking antipsychotic drugs, the patient develops dystonia in the muscles of the whole body, manifested as torsional spasm (the whole body twists to one side), coracoacusis (the whole body tilts backward), motility crisis (both eyes roll upward), and slanting neck. It is common after the injection of antipsychotic drugs such as haloperidol, the patient is very painful, the family is very nervous; as long as the injection of scopolamine 0, 3mg, it can immediately improve.
3. Inability to sit still
After taking antipsychotic drugs, patients appear distracted, distracted, fidgeting, sometimes feel as if there are ‘ants’ in the body ‘crawling’ as uncomfortable, oral propranolol (Take-Away) or atenolol, benzhexol have a good effect If the anxiety is more serious, oral Lola can be.
4, delayed movement disorder.
Most commonly seen in patients on long-term medication, the main clinical feature is involuntary, rhythmic repetitive stereotyped movements. The earliest manifestation is tongue tremor or drooling, characterized by mouth movements in the elderly, and limb involvement is common in younger patients. The most common case is the mouth-tongue-cheek triad. Treatment is more difficult that, the focus is on early detection and early treatment as well as prevention, commonly used drugs are: promethazine, vitamin E, Valium, etc..
Second, obesity.
Obesity caused by taking antipsychotic drugs is very common, and is generally considered to be related to a variety of factors, such as.
1, the sedative effect of the drug so that patients have less activity, sleep more, naturally fat.
2, drugs stimulate the eating center, increasing appetite.
3, drugs affect lipid metabolism
4, affect endocrine. From all antipsychotic drugs seem to have this effect, only the degree of severity.
Treatment; encourage the patient to be more active, control the diet, medications are appropriately adjusted, and if the fat is rapid, it is recommended to adjust the treatment plan.
Obesity, hyperlipidemia, hypertension, and hyperglycemia are called metabolic syndrome. The drug most likely to cause metabolic syndrome is: clozapine. This side effect of olanzapine is also present. The side effect of increasing body weight is less common with haloperidol, ziprasidone, and pentafluridol. Taking metformin for diabetes, which has a weight loss effect, is beneficial in reducing this side effect.
Third, endocrine effects.
It mainly causes an increase in central prolactin in patients, which results in non-menstruation and menstrual disorders in women. Male sexual function decreases, obesity, etc. There is no good way to adjust the treatment plan. How do you know when your prolactin is high? Just check a central prolactin.
The most likely drugs to cause high prolactin: sulpiride, risperidone.
IV. Drowsiness.
Generally the heaviest with clozapine, followed by chlorpromazine, olanzapine, quetiapine, risperidone, ziprasidone. And aripiprazole, endorphin, haloperidol is lighter. Pentoxifylline, is slowly absorbed after administration, so drowsiness is not apparent and is generally almost absent. The side effect of drowsiness is usually gradually adapted after a few days of continuous administration. Drowsiness side effects often vary from person to person.
V. Cardiovascular side effects.
Second-generation antipsychotics, led by clozapine, often affect heart function and even lead to sudden death. Studies have found that it is related to the drug causing prolongation of the QT interval. excessive QT prolongation can lead to serious heart rhythm disorders and even sudden death. From the current data, it appears that this adverse effect is most severe with methiodiazide, ziprasidone, and clozapine. Clozapine tends to cause abnormal ECG T waves suggesting an effect on myocardial blood supply.
Treatment: Regularly review the ECG and take Chinese medicine to improve the blood supply to the heart muscle.
Upright hypotension: When you first start taking antipsychotics, the blood vessels in the legs relax. At this time, if you suddenly stand up, the blood vessels will not be able to contract in time to supply blood to the brain, and you may experience dizziness or even fainting. So at the beginning of the medication should pay attention to the possibility of upright hypotension; after taking the medication for a long time, you will adapt.
VI. Abnormal liver function.
Antipsychotics may occasionally cause pharmacogenic liver function changes, the total number is not large, but should be taken seriously; therefore, it is necessary to check regularly. Thorazine is the most frequent, followed by clozapine and olanzapine. Regular monitoring is needed.
Treatment: Generally speaking, taking a little liver-protective drugs, enzyme-lowering drugs is also possible, pharmacogenic liver function abnormalities, often liver function values are not large.
VII. Pharmacogenic forcing.
The problem of compulsion induced by second-generation antipsychotics, led by clozapine, is more serious. Haloperidol, sulpiride, pentoxifylline, this problem was not seen
Treatment: visit the doctor, clarify the nature of the compulsion, adjust the medication if necessary, and add anti-compulsive drugs.
VIII. Suppression of mental activity
The effect that all antipsychotics have, so that it appears ‘no spirit, lazy, do not want to do anything’; this is a normal reaction, not an abnormality.
Treatment; dynamic observation.
IX. Hematologic effects.
Mainly antipsychotic drugs reduce white blood cells, mainly seen in clozapine. This may occur in about one in a thousand cases, often within half to one year, so it is important to check on a regular basis when first applied. If it has been applied for more than a year, it is generally said that there is no problem.
Treatment: Periodic recheck of white blood cells, oral white-raising drugs if necessary: lisinopril good, lisinopril, etc.
X. Pharmacogenic depression.
Some drugs can cause depressive states, the need to closely observe changes in the condition, the addition of antidepressants.
Eleven, constipation
Drugs can lead to slow intestinal peristalsis, resulting in constipation, commonly used laxative methods are: oral laxative capsules, laxative capsules, clearing tablets, Ma Ren Zi Spleen Pill and other drugs, you can also temporarily use Chinese medicine rhubarb, senna leaves to drink water, pay attention to a small amount, so as not to diarrhea, you can also temporarily use the open plug, glycerin enema solution to the anus to laxative.