Flashcards in Adverse Effects Deck (79):
Antidepressant with longest half life
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
Anticholinergic side effects
Dry mouth, constipation, urinary retention, narrow angle glaucoma
Which antidepressant has significant anticholinergic side effects and is contraindicated in close angled glaucoma?
Which mechanisms causes confusional state by antipsychotics?
Muscarinic receptor blockade
Irrespective of the prescribed drug, 74% discontinued treatment in 18 months. Olanzapine had lowest discontinuation rate (64%) but highest side effect burden
Medications used for clozapine induced hypersalivation
Pirenzepine (selective M1 & M4 antagonist), benzhexol (trihexphenidyl), hyoscine, amitriptyline, combination of benztropine and terazosin
Cholinergic side effects
GI side effects nausea, anorexia, muscle cramps, seizures
Which psychotropics can cause floppy baby syndrome?
Diuretic that can be used to control lithium induced polyuria without causing lithium toxicity
Amiloride (potassium diuretic)
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
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
Mechanisms in weight gain side effect
H1 antagonism, 5HT2C antagonism, hyperprolactinaemia, increased serum leptin as a result of secondary leptin desensitisation
Which drug is associated with nephrolithiasis?
Topiramate is a weak inhibitor of carbonic anhydrase and can promote the developmental of renal stones
Which drug is contraindicated for a patient receiving MAO inhibitor?
Meperidine is an opioid that can interact with MAO inhibitor resulting in serotonin syndrome
Which antidepressant is associated with dystonia and orofacial dyskinesia
Which antidepressant most commonly cause withdrawal syndrome
Which antidepressant cause hyponaetraemia
Fluvoxamine and fluoxetine
Which SSRI cause less sexual dysfunction
Which antidepressant cause hypoglycaemia
Treatment for akathisia
Propranolol, clonazepam, cyproheptadine, Trazodone, mianserin
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
Alpha 1 blocker, is observed to be effective in reducing excessive sweating caused by antidepressant treatment, especially venlafaxine and SSRIs
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
Dry mouth, constipation, urinary retention, blurred vision and glaucoma
Common and early side effect of lithium
Fine tremors, polyuria, polydypsia, nausea, bad metallic taste, transient raised leucocyte and platelet count
Tricyclics with lower risk of orthostatic hypotension but highest antihistaminergic effect
Important difference between NMS and serotonin syndrome
Hyperreflexia and myoclonus in serotonin syndrome
Side effect of mianserin
Sedation, postural hypotension, blood dyscrasias and agranulocytosis, bone marrow suppression
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
Hypertensive crisis during MAOI use can be managed by
Phentolamine or phenoxybenzamine
Tardive dystonia/tardive dyskinesia
Occurs after months to years of antipsychotic treatment
Alpha adrenergic blockade causes...
Postural hypotension, dizziness, tachycardia and arrthymias
-Potentiates the effects of warfarin, alcohol, hypnotics, anxiolytics and antipsychotics -Reduce the antihypertensive actionof clonidine and guanethidine TCA level is increased by cimetidine
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
Risk of ebstein’s anomaly in children of mothers taking lithium while pregnant
20 times (1 of 1000)
Priapism is a dreaded side effect associated with
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
Mechanism of weight gain side effect
Antagonism of histamine H1 and serotonin 5HT2C
Which class of antidepressant has highest weight gain effect?
Which tricyclics are most toxic?
Dosulepin and amitriptyline (seizures and cardiac arrhythmia
Which SSRi is unsafe for post MI patients?
Increased risk of GI bleeding in elderly
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.
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.
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.
Most common side effects of sodium valproate
Nausea, vomitting, dyspepsia and diarrhea are the most common adverse effects of valproate
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
Botulinum toxin may have a role in the treatment of
Side effects of rivastigmine
Rivastigmine have experienced nausea, vomiting, diarrhea, high blood pressure and hallucinations but constipation is very rare.
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.
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.
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.
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.
Commonest side effect of methylphenidate is
The most common side effects with methylphenidate are nervousness, agitation, anxiety, and insomnia.
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
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.
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.
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.
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
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
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.
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.
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.
Which of the following drugs is associated with nephrolithiasis?
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
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
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.
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.
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.
The tricyclic with highest antihistaminic activity is
Doxepine has a lower risk of orthostatic hypotension but has a higher antihistaminergic effect.
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.
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.
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.
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
Loss of accommodation, xerostomia
Visual Field Defects
Mood stabiliser vigabatrin