ADRs

Question 1

Antipscyhotics

D2 receptor block

Answer 1

Mesolimbic: drop in positive symptoms
Mesocortical: increase in negative symptoms
Nigrostriatal: increase in extrapyramidal side effects
Tuberoinfundibular: hyperprolactinemia
Hypothalamus: poikilothermia, weight gain
Chemoreceptor trigger zone: anti-emetic

Question 2

Antipsychotic
D2 receptor block
Extrapyramidal Side effects

Answer 2

seen with typical hi potency (eg haldoperodol)

• acute dystonia (onset 1-5 days), treat with anticholinergics
• akathisia (can’t sit still) (onset 6-60 days), treat by reducing does, changing drug, or anticholinergics
• Pseudoparkinsonism (onset 5-90 days), treat with anticholinergics
• tardive dyskinesia (onset 3-6 months) D2 recpetort SUPERsensitivity, no treatment, PREVENT

Question 3

Antipsychotic
5HT2A receptor block
ADRs

Answer 3

Agranulocytosis (with CLOZAPINE)
Weight gain (due to hypothalamic DA bloc)
Poikilothermia
Galactorrhea
Photosensitivity
Neuroleptic malignant syndrome
Lowered seizure threshold (1-4% with clozapine)

Question 4

SSRI side effects (ACUTE)

Answer 4

Insomnia, somnolence, diarrhea, nausea

often diminish over time

Question 5

SSRI side effects (DELAYED ONSET)

Answer 5

Sexual dysfxn (less with bupropion),
Weight gain (more: TCADS, paroxetine; less: fluoxetine, venlafaxine; least: bupropion)
Cognitive blunting
(most concerning to patients)

Question 6

SSRI side effect PRECAUTIONS

TCADs

Answer 6

Anticholinergic side effects
Arrhythmias
Orthostatic hypOthension

Question 7

SSRI side effect PRECAUTIONS

MAOIs

Answer 7

Orthostatic HypOtension

Question 8

SSRI side effect PRECAUTIONS

Venlaxine-Duloxetine

Answer 8

HypERtension

Question 9

SSRI side effect PRECAUTIONS

Withedrawal Syndrome

Answer 9

Pareoxetine, venlafaxine

LEAST with fluoxetine

Question 10

Antimanic

LITHIUM

Answer 10

(anti-TSH) hypothyroidism
(anti-ADH) polyuria-polydipsia
Fine tremor, GI uposet, muscle weakness

Question 11

a1 BDZs and “Z-Drugs”

Answer 11

Amnesia, Additive CNS depression

Question 12

a2-a5 BDZs

Answer 12

Motor incoordination, tolerance/dependence/addition, drop in REM

Question 13

BDZs

Answer 13

Daytime sedation
(esp. Flurazepam - long half life/hi dose)
Anterograde amnesia
(triazolam>temazepam)
Rebound insomnia
Psych & physiologic dependence (worse in hi dose, regular use)

Question 14

Carbamazepine

Answer 14

Diplopia-ataxia-sedation (dose related)
GI upset
RARE but SERIOUS: Aplastic anemia-agranulatosis
Hepatotoxicity
STRONG INDUCER OF CYP450

Question 15

Phenytoin

Answer 15

Nystagmus-diplopia-atazia-sedation (does related)
Rash (GINGIVAL hyperplasia)
Osteomalaica, peripheral neuropathry with LONG TERM use
STRONG INDUCER OF CYP450

Question 16

Levetiracetam

Answer 16

Somnolence, asthenia, dizziness
Low incidence of cognitive effects
No CYP450 metbalism, (minimal DDIs)

Question 17

Ethosuximide

Answer 17

few side effects
poss DDIs with CYP
Gastric distress (related to dose)
Others rare

Question 18

Valproate

Answer 18

few side effects
GI (dose related)
Weight gain
Black box warnings: hepatic failure, life threatening pancreatitis, teratogenic effects (neural tube defects)

Question 19

Phenobarbital

Answer 19

Irritability (overactivity in kids)
Mild ataxia, nystagmus, rash, osteomalacia
May interfere with learning (cognitive defects)