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Flashcards in Adverse Effects Deck (79):
1

Antidepressant with longest half life

Fluoxetine

2

Side effect of reboxetine and how can you ameliorate the side effect

Urinary hesitancy can be treated by a1A-adrenoceptor antagonist such as doxazosin or tamsulosin

3

Anticholinergic side effects

Dry mouth, constipation, urinary retention, narrow angle glaucoma

4

Which antidepressant has significant anticholinergic side effects and is contraindicated in close angled glaucoma?

Paroxetine

5

Which mechanisms causes confusional state by antipsychotics?

Muscarinic receptor blockade

6

Catie trial

Irrespective of the prescribed drug, 74% discontinued treatment in 18 months. Olanzapine had lowest discontinuation rate (64%) but highest side effect burden

7

Medications used for clozapine induced hypersalivation

Pirenzepine (selective M1 & M4 antagonist), benzhexol (trihexphenidyl), hyoscine, amitriptyline, combination of benztropine and terazosin

8

Cholinergic side effects

GI side effects nausea, anorexia, muscle cramps, seizures

9

Which psychotropics can cause floppy baby syndrome?

Benzodiazepines

10

Diuretic that can be used to control lithium induced polyuria without causing lithium toxicity

Amiloride (potassium diuretic)

11

Side effects of MAOIs

Common- insomnia, postural hypotension, peripheral oedema, restlessness, nausea dizziness, sexual difficulties, sweating and tremor. Rare- hepatocellular jaindice, peripheral neuropathy, bone marrow suppression and cardiac arrthymias

12

Neuroleptic malignant syndrome

-Risk in pts treated with conventional antipsychotics less than 0.5-1% -evolves rapidly over 24-72 hrs -lasts for 10-14 days of left untreated -is also seen very rarely with other drugs such as antipsychotics and lithium - s&s fluctuating bp, tachycardia, fever, confusion, diaphoresis, rigidity, raised ck, leukocytosis, altered lft

13

Mechanisms in weight gain side effect

H1 antagonism, 5HT2C antagonism, hyperprolactinaemia, increased serum leptin as a result of secondary leptin desensitisation

14

Which drug is associated with nephrolithiasis?

Topiramate is a weak inhibitor of carbonic anhydrase and can promote the developmental of renal stones

15

Which drug is contraindicated for a patient receiving MAO inhibitor?

Meperidine is an opioid that can interact with MAO inhibitor resulting in serotonin syndrome

16

Which antidepressant is associated with dystonia and orofacial dyskinesia

Paroxetine

17

Which antidepressant most commonly cause withdrawal syndrome

Paroxetine

18

Which antidepressant cause hyponaetraemia

Fluvoxamine and fluoxetine

19

Which SSRI cause less sexual dysfunction

Fluvoxamine

20

Which antidepressant cause hypoglycaemia

Fluoxetine

21

Treatment for akathisia

Propranolol, clonazepam, cyproheptadine, Trazodone, mianserin

22

CNS side effects like anxiety and agitation I. The initial few weeks of treatment with SSRIs are proposed to be due to

Overstimulation of 5HT2 receptors in the Limbic system

23

Terazosin

Alpha 1 blocker, is observed to be effective in reducing excessive sweating caused by antidepressant treatment, especially venlafaxine and SSRIs

24

Which SSRI is associated with erectile dysfunction more often than others

Sexual dysfunction due to activation of post synaptic 5HT 2 receptors is more prominent with paroxetine than with other SSRIs

25

Anticholinergic effect

Dry mouth, constipation, urinary retention, blurred vision and glaucoma

26

Common and early side effect of lithium

Fine tremors, polyuria, polydypsia, nausea, bad metallic taste, transient raised leucocyte and platelet count

27

Doxepine

Tricyclics with lower risk of orthostatic hypotension but highest antihistaminergic effect

28

Important difference between NMS and serotonin syndrome

Hyperreflexia and myoclonus in serotonin syndrome

29

Side effect of mianserin

Sedation, postural hypotension, blood dyscrasias and agranulocytosis, bone marrow suppression

30

Risk factors of tardive dyskinesia

Older age, female, pts with organic brain damage and affective disorders, those who have had acute EPSEs early on treatment

31

Hypertensive crisis during MAOI use can be managed by

Phentolamine or phenoxybenzamine

32

Tardive dystonia/tardive dyskinesia

Occurs after months to years of antipsychotic treatment

33

Alpha adrenergic blockade causes...

Postural hypotension, dizziness, tachycardia and arrthymias

34

TCAs

-Potentiates the effects of warfarin, alcohol, hypnotics, anxiolytics and antipsychotics -Reduce the antihypertensive actionof clonidine and guanethidine TCA level is increased by cimetidine

35

Moclobemide

MAOI-reversible

36

Antibiotic that can cause serotonin syndrome if combined with MAOIs

Linezolid, an antibiotic of the oxazolidone family, is a reversible, non selective MAOI used in the treatment of methicillin resistant staph aureus

37

Risk of ebstein’s anomaly in children of mothers taking lithium while pregnant

20 times (1 of 1000)

38

Priapism is a dreaded side effect associated with

Trazodone, risperidone

39

Risk factors of NMS

Psychomotor agitation, mental retardation, psychosis, organic brain disease, Parkinson’s disease, hyperthyroidism, alcoholism, abrupt withdrawal of anticholinergics, recent or rapid dose increase of antipsychotics, high potency typical drugs, rapid dose reduction of antipsychotics

40

Mechanism of weight gain side effect

Antagonism of histamine H1 and serotonin 5HT2C

41

Which class of antidepressant has highest weight gain effect?

Tricyclics

42

Which tricyclics are most toxic?

Dosulepin and amitriptyline (seizures and cardiac arrhythmia

43

Which SSRi is unsafe for post MI patients?

Citalopram

44

Increased risk of GI bleeding in elderly

SSRIs

45

Symptoms of anticholinergic delirium

Symptoms of anticholinergic delirium include hot, dry skin; dry mucous membranes; dilated pupils; absent bowel sounds; and tachycardia. Physicians must first determine and remove the offending agent because patients are at a high risk for a cholinergic crisis. Atropine can be used to treat anticholinergic delirium symptoms once the agent has been removed.

46

Features of hyperprolactinaemia

galactorrhoea, amenorrhoea, hypogonadism, Gynaecomastia, sexual dysfunction and an increased risk of osteoporosis. Risperidone, Amisulpride and Zotepine have potent prolactin-elevating effects, similar to conventional drugs.

47

Side effect of bupropion

Bupropion is an antidepressant that induces weight loss and even seems to be effective in obesity when combined with calorie-restricted diets. It is contraindicated in anorexia and other eating disorders.

48

Most common side effects of sodium valproate

Nausea, vomitting, dyspepsia and diarrhea are the most common adverse effects of valproate

49

Citalopram vs escitalopramw

Citalopram is a racemate consisting of a 1:1 mixture of the R(-)- and S(+)-enantiomers. Non-clinical studies show that the serotonin reuptake inhibitory activity of citalopram is attributable to the S-enantiomer, escitalopram. Escitalopram is the active S- isomer of the antidepressant citalopram. It is claimed that escitalopram has more efficacy and a faster onset of effect than citalopram. The side effect profile of escitalopram is similar to that of other SSRIs

50

Botulinum toxin may have a role in the treatment of

Tardive dystonia

51

Side effects of rivastigmine

Rivastigmine have experienced nausea, vomiting, diarrhea, high blood pressure and hallucinations but constipation is very rare.

52

high-risk factor for developing drug-induced hyponatraemia

extreme old age, female sex, warm weather, low body weight, reduced renal function, co-therapy with diuretics, NSAIDs, carbamazepine, cancer chemotherapy, medical co-morbidity such as diabetes, hypertension, COPD, hypothyroidism, head injury, CVA.

53

The sexual side effects caused by SSRI antidepressants are related to the consequence of stimulating which of the following receptors

5HT2 receptors Clinically significant consequences of stimulating 5HT1-a receptors leads to antidepressant actions, anti obsessive-compulsive disorder properties, anti-panic and anti-phobic properties and anti-bulimic properties. Clinically significant consequences of stimulating 5HT2 receptors includes agitation, akathisia, anxiety, panic attacks, insomnia and sexual dysfunction.

54

The upper limit of safe QTc interval for men is

The safe QTc interval for men is 440 msec and for women is 470 msec. If QTc is greater than 440 ms (men) or 470 ms (women) when taking antipsychotics, consider a switch to drug of lower effect; reperform ECG and consider referral to cardiologist. If the Qtc is greater than 500ms in both genders, immediately stop the suspected causative drugs and refer to a cardiologist.

55

In treating serotonin syndrome which of the following receptor antagonism is useful for controlling neurological signs?

Any agent that increases serotonergic function can put patients at risk of a central serotonergic syndrome. This syndrome most commonly affects patients on multiple serotonergic drugs and involves multiple systems. The CNS effects are thought to be related to 5HT-2A stimulation.

56

Commonest side effect of methylphenidate is

The most common side effects with methylphenidate are nervousness, agitation, anxiety, and insomnia.

57

Which one of the following drugs has a pronounced effect on QTc Prolongation?

Drugs with a high effect on QTc include sertindole, thioridazine, pimozide and droperidol. There have been reports of sudden death with Pimozide due to drug-induced QT prolongation

58

Which one among the following SSRIs is present in high concentrations in breast milk?

Antidepressants are excreted in varying degrees in breast milk, so breastfeeding in antidepressant- treated women should be done with caution. Fluoxetine's long half-life and potential for accumulation in breast milk have prompted some recommendations to avoid its use in women who are breast-feeding young infants.

59

Side effects of reboxetine

Urinary hesitancy can be an uncomfortable side effect during treatment with antidepressants such as the selective noradrenaline reuptake inhibitor reboxetine. The use of selective a1A-adrenoceptor antagonists such as doxazosin or tamsulosin can treat the urinary hesitancy - especially in the elderly with associated prostate enlargement.

60

side effect of acetylcholinesterase inhibitors

The most common cholinergic side effects of AChEIs involve the gastrointestinal tract. These side effects are usually mild and have been reported to occur in approximately 20% of patients taking these medications. Among the side effects reported in the package inserts of currently available AChEIs are nausea (11%-47%), vomiting (10%-31%), diarrhea (5%-19%), and anorexia (4%-17%). These can be minimized with the use of longer titration periods and the administration of these medications with food.

61

Floppy baby syndrome is a recognised complication associated with the use of which of the following psychotropic drugs in pregnancy

Floppy baby syndrome is a recognised complication associated with the use of which of the following psychotropic drugs in pregnancy

62

Which of the following diuretics can be used to control lithium-induced polyuria without causing lithium toxicity?

One of the major side effects of lithium is nephrogenic diabetes insipidus. The established treatment for the disorder is thiazide diuretics, but these are associated with hypokalemia and reduced lithium excretion, predisposing the patient to lithium toxicity. Amiloride is a potassium-sparing diuretic that reduces lithium-induced polyuria without affecting lithium or potassium levels. ( Treatment of severe lithium-induced polyuria with amiloride. Retrieved from

63

Which one of the following is a common side effect of MAOIs

Common side effects of MAOIs would include insomnia, postural hypotension, peripheral oedema, restlessness, nausea, dizziness, sexual difficulties, sweating and tremor. Rare side effects would include hepatocellular jaundice, Peripheral neuropathy, bone marrow suppression, and cardiac arrhythmias.

64

NMS

The risk is estimated to be less than 0.5-1%. It evolves rapidly over 24-72 hours and lasts for 10-14 days if left untreated. NMS is also seen very rarely with other drugs such as antipsychotics and lithium. The important clinical features of NMS would include Fluctuating consciousness, Fluctuating blood pressure, tachycardia, fever, confusion, diaphoresis, rigidity. Signs of NMS would include elevated creatinine kinase, leucocytosis, and altered liver function tests.

65

Weight gain as a side effect of antipsychotics is caused due to all of the following mechanisms

The suggested mechanisms for weight gain as a side effect of antipsychotics include 5HT2-c antagonism, H-1 antagonism, hyperprolactinaemia and increased serum leptin as a result of secondary leptin desensitisation.

66

Which of the following drugs is associated with nephrolithiasis?

Topiramate

67

Which of the following drugs is contraindicated for a patient receiving a monoamine oxidase (MAO) inhibitor?

Meperidine is an opioid that can interact with monoamine oxidase inhibitors resulting in serotonin syndrome

68

The CNS side effects like anxiety and agitation in the initial few weeks of treatment with SSRIs are proposed to be due to

Over stimulation of 5HT2 receptors in the limbic system

69

Which of the following is a prominent side effect of venlafaxine controlled by terazosin, alpha-adrenergic blocker?

Terazosin, a blocker of alpha-1 receptors, is observed to be effective in reducing excessive sweating caused by antidepressant treatment, especially venlafaxine and SSRIs.

70

Which one among the following is associated with erectile dysfunction more often than the other SSRIs?

Sexual dysfunction due to activation of post synaptic 5-HT 2 receptors is more prominent with paroxetine than with the other SSRIs.

71

Which one of the following is a common and early side effect of lithium?

Lithium has been shown to be effective in the treatment of bipolar affective disorder where it reduces both the number and severity of relapses. The mechanism of action of lithium remains unclear but appears to reduce the neurotransmitter-induced activation of second messenger systems. The effect may be via G-proteins and can affect adenylate cyclase and phosphatidylinositol cycle. Early and common side effects include fine tremors, polyuria, polydipsia, nausea, and bad metallic taste and transient raised leucocyte and platelet count. Propranolol can be useful in the treatment of lithium-induced tremors.

72

The tricyclic with highest antihistaminic activity is

Doxepine has a lower risk of orthostatic hypotension but has a higher antihistaminergic effect.

73

Differences between NMS and serotonin syndrome

Symptoms such as hyperreflexia and myoclonus are attributed to the enhanced release of serotonin in serotonin syndrome and are not seen in NMS.

74

A specific side effect of mianserin that requires regular monitoring is

Bone marrow suppression Mianserin was the first of the second-generation antidepressants to be developed. It lacked the amine reuptake inhibitory and MAOI actions of the first-generation drugs and also lacked the cardiotoxicity and anticholinergic activity of the TCAs. However, it was sedative (antihistaminic), caused postural hypotension (alpha-1 blockade) and also caused blood dyscrasias and agranulocytosis in a small number of patients. This has limited the use of mianserin in recent years.

75

Risk factors for tardive dyskinesia

Risk factors for TD-Older patients, females, patients with organic brain damage and patients with affective disorders, and those who have had acute EPSEs (Extra pyramidal side effects) early on treatment.

76

In managing the hypertensive crisis associated with monoamine oxidase (MAO) inhibitors and the ingestion of food with tyramine, the agent of choice is:

Hypertensive crisis during MAOI use can be managed using phentolamine or phenoxybenzamine

77

Clozapine therapy

Loss of accommodation, xerostomia

78

Visual Field Defects

Mood stabiliser vigabatrin

79

Which of the following SSRIs is most likely to cause significant weight gain?

Paroxetine