Téma: Clinical pharmacology

Adverse effects of neuroleptics in higher

Štefan Krajčík, Peter Mikus

Common indications of antipsychotic drugs (neuroleptics) are Behavioural and Psychological Symptoms of Dementia (BPSD), occurring in 2/3 of patients with dementia and posing serious problems in 1/3 of demented people living at home. The prevalence of BPSD in care homes reaches up to 79 %, and 58 % of these residents have to take psychotropic drugs. There are 2 main categories of antipsychotic drugs: 1. Classical - having the biggest blocking effect on dopamine D2 receptors, 2. Atypical - blocking predominately serotonin and muscarinic receptors. The atypical antipsychotics do not harm cognitive functions and have less prevalence of Parkinsonism, tardive dyskinaesias and malignant neuroleptic syndrome. Antipsychotics almost double the risk of sudden cardiac death. The other adverse cardiovascular effects include a higher incidence of stroke, deep vein thrombosis. Antipsychotics impair glucose metabolism. The risk of cardiovascular and metaboli adverse effects is slightly higher in atypical antipsychotics. Both categories of antipsychotic drugs increase the risk of hip fractures due to impaired gait, sedation, confusion and orthostatic hypotension. Antipsychotic drugs increase pneumonia incidence by 60 %. This risk is the highest at the beginning of treatment. The result of fore-mentioned adverse effects is an increased total mortality rate. 17.9 % of the patients treated by classical and 14.6 % of those treated by atypical neuroleptics die in the first 180 days of treatment.

Ročník 2011  Témy časopisu Internal medicine 1 / 2011

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