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Drug Side Effects Flashcards

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1
Q

Least EPS of all the typicals

A

Thioridazine (Mellaril)

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2
Q

Significant QT prolongation

A

Thioridazine (Mellaril)

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3
Q

Side effect of high dose (>800 mg/day) of thioridazine

A

Retinitis pigmentosa = progressive degeneration of rod photoreceptors => loss of peripheral vision (tunnel vision)

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4
Q

Which antipsychotic can cause loss of peripheral vision?

A

Retinitis pigmentosa at high doses (>800 mg/day) of Thioridazine

Thioridazine = Mellaril = low potency typical antipsychotic

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5
Q

Distinguish the side effect profiles of high vs. low dose typical antipsychotics

A

Both doses have the same efficacy, potency differs by side effect profiles

  • High potency agents: cause worse EPS
  • Low potency agents: cause more anticholinergic, antihistaminergic, and antiadrenergic side effects
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6
Q

3 features of EPS

A

Extrapyramidal symptoms

  • akathisia
  • dystonic rxns
  • Parkinsonism
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7
Q

What is akathisia?

A

Internal restlessness and anxiety

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8
Q

How to treat akathisia?

A

Anticholinergics, beta-blockers, or benzos

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9
Q

What are dystonic rxns?

A

Painful muscle spasms usually of the extremities, neck, ocular muscle

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10
Q

How to treat dystonic rxns

A

PO or IM anticholinergics

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11
Q

Describe Parkinsonian symptoms (feature of EPS)

A

Tremor, bradykinesia, masked faces, shuffling gait, cogwheel rigidity

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12
Q

How to treat Parkinsonian symptoms (side effect of EPS)

A

Anticholinergics, dopaminergic agents (Amantidine), or beta-blockers

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13
Q

List adverse events of typical antipsychotics

A
  • EPS
  • hyperprolactinemia
  • sedation
  • weight gain
  • anticholinergic effects
  • orthostatic hypotension
  • decreased seizures threshold (more in low potency agents)
  • sexual dysfxn
  • dermatologic effects
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14
Q

What does hyperprolactinemia cause in

(a) Males
(b) Females

A

Hyperprolactinemia

(a) Males: gynecomastia and impotence
(b) F: Amenorrhea

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15
Q

Dermatologic effects of antipsychotics

A

Dermatitis and photosensitivity

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16
Q

2 serious adverse events of typical antipsychotics

A
  • Tardive dyskinesia

- Neuroleptic malignant syndrome

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17
Q

Features of tardive dyskinesia

A

Involuntary choreoathetoid mov’ts of face, neck, trunk, and extremities

  • often permanent and can be grossly debilitating
  • involuntary repetitive body mov’t
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18
Q

Possible mechanism of tardive dyskineasia

A

Effect of long term typical antipsychotics due to D2 blockade in the nigrostriatal tract

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19
Q

Features of NMS

A

NMS = Neuroleptic malignant syndrome

  • life-threatening condition of hyperpyrexia, autonomic instability, muscle rigidity, and delirium (cognitive impairment)
  • can occur w/ all antipsychotics, uncommon but random occurrence
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20
Q

How to treat NMS

A

Removing offending agent (discontinue the antipsychotic) + supportive care

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21
Q

Describe the anticholinergic side effects

A

Dry mouth, constipation, blurry vision, urinary retention, confusion, ECG changes

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22
Q

Contrast the SEs of typical vs. atypical antipsychotics

A

Typicals: higher EPS
-TD, NMS

Atypicals: higher rates of metabolic problems- hyperglycemia, DM2, hyperlipidemias

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23
Q

Which two atypical antipsychotics carry the greatest risk of metabolic syndrome?

A

Olanzapine (Zyprexa) and cloazpine (Clozaril)

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24
Q

Which atypical antipsychotic has the most serious possible adverse effect?

A

Clozapine (Clozaril)

-agranulocytosis => frequent WBC monitoring required

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25
Common side effects of atypical antipsychotics
- weight gain (most substantial on clozapine and olanzapine)/metabolic problems - sedation - orthostatic hypotension - anticholinergic effects
26
Which atypical antipsychotic poses a risk of EPS?
Risperidone at high doses (above 6 mg/day) can cause EPS
27
Why was a metabolite of risperidone developed?
Paliperidone (Invega) = metabolite of risperidone w/ potentially less EPS than risperidone
28
Why do pts get ECG upon admission to psych ward?
Antipsychotics can cause QT interval prolongation, get ECG baseline - don't start antipsychotic if QT interval at baseline > 500 ms - get repeat EKG to see if QT interval has prolonged
29
Main drug classes w/ anticholinergic effects
- Typical and atypical antipsychotics | - TCAs
30
Main adverse effects of TCAs
- anticholinergic effects - sedation - weight gain - orthostatic hypotension - sexual dysfxn - mania in bipolar pts - rare, seizures Two serious adverse effects: cardiotoxicity and neurotoxicity
31
Serious adverse effects of TCAs
Cardiotoxicity: TCAs slow cardiac conduction => EKG changes, arrhythmias, AV block Neurotoxicty: tremor and ataxia -in OD => agitation, delirium, coma, and death
32
Adverse effects of MAOIs
- orthostatic hypotension: can be pretty severe, may require support stockings - weight gain - sexual dysfunction - insomnia - myoclonus (muscle pains, paresthesias) - mania
33
Foods to be avoided in pts taking MAOIs
Food including tyramine: aged cheese, fava beans, liver
34
Why are pts on MAOIs kept on a low-tyramine diet?
Tyramine is broken down in the GI tract by MAO-A. In pts on MAOIs tyramine gets into the bloodstream undigested and acts as a false transmitter in adrenergic pathways => sudden, catastrophic rise in BP
35
Describe the side effects of SSRIs by receptor (a) 5HT3 (b) 5HT2C (c) 5HT2A
Side effects due to overstimulation of 5HT receptors widely distributed throughout the body (a) 5HT3: GI system. Overstimulation => diarrhea, N/V (b) 5HT2C: CNS. Overstimulation => anxiety and mental agitation (c) 5HT2A: CNS, spinal cord. Overstimulation => anxiety, mental agitation. Akathisia (motor restlessness), insomnia, myoclonus, sexual dysfxn
36
General side effects of SSRIs
- weight gain - mania - serotonin discontinuation syndrome => don't abruptly stop, make sure to taper down
37
Why are SSRIs tapered down to stop treatment?
Avoid serotonin discontinuation syndrome = headache, dizziness, irritability, fatigue (same thing w/ SNRIs)
38
What is required for a pt previously on an MAOI to start an SSRI?
MAOI washout of 2 weeks prior to initiation of SSRI tx -avoid serotonin syndrome
39
Describe the features of serotonin syndrome
Hyperthermia, myoclonus, autonomic instability, rigidity, coma, death
40
Possible cause of serotonin syndrome
Co-administration of SSRI and MAOI
41
Which two psychiatric meds have a distinct discontinuation syndrome?
SSRIs and SNRIs
42
Side effects of SNRIs
GI: dio, N/V Neuro: tremor, agitation, akathisia, myoclonus Autonomic: tachycardiac, HTN Psych: agitation, anxiety, insomnia, mania Other: sexual dysfunction, seizures (rare)
43
Which antidepressants can also be used for sedation (to induce sleep)?
Mirtazapine (NaSSA) and trazodone (SARI) | -so sedating that sometimes used as sleep aid
44
Side effects of mirtazapine
Mirtazapine (Remeron) = NaSSA Side effects - sedation - increased appetite/weight gain Serious AEs: -Agranulocytosis and other blood abnormalities
45
Which psychiatric medications have an association w/ agranulocytosis
(1) Clozapine = atypical antipsychotic (2) Mirtazapine = NaSSA antidepressant (3) Carbamazepine = mood stabilizer/anticonvulsant
46
Side effects of SARIs
SARIs = Trazodone and nefazodone Side effects: - sedation - nausea - dizziness - mania
47
Which antidepressant could be used to avoid sexual dysfunction
SARIs (trazodone and nefazodone) b/c due to 5HT2A blockade sexual dysfunction is avoided
48
Which antidepressant can cause priapism
Priapism (prolonged erection) is a rare, serious, AE of trazodone (SARI)
49
Which antidepressant has a black box warning for liver toxicity?
Nefazodone (SARI)
50
Which psychiatric meds can cause liver toxicity?
- Nefazodone: SARI antidepressant - Carbamazepine: mood stabilizer/anticonvulsant - Valproic acid: mood stabilizer/anticonvulsant - Atomoxetine: novel CNS stimulant
51
Side effects of bupropion
- activation - insomnia - nausea - tremor Serious AE: seizures at higher doses (hence why contraindicated in seizure d/o)
52
Side effect profile of Vilazodone
Vilazodone = selective serotonin reuptake inhibition and serotonin partial agonist -side effects similar to SSRIs, but theoretically lower risk of sexual dysfunction and weight gain
53
Benefit of buspirone over alprazolam
Buspirone (5HT1A agonist nonbenzo anxiolytic) vs. alprazolam (benzo, Xanax) Buspirone- doesn't have sedation or addictive potential of benzos
54
Are benzos lethal in OD?
Such a high therapeutic index that generally not lethal in OD, but can be if - preexisting cardiopulmonary compromise - mixed w/ other sedatives or EtOH
55
Side effects of propranolol
Proproanolol (beta blocker) side effects: - dizziness - fatigue - bradycardia and hypertension
56
Side effects of hydroxyzine
Hydroxyzine (nonbenzo anxiolytic for situation anxiety) side effects: - sedation - weight gain - anticholinergic side effects
57
Side effects of buspirone
- dizziness - headache - fatigue - GI distress *doe NOT have the sedative or addictive potential of benzos
58
Side effects of benzos
- drowsiness - dizziness and ataxia - cognitive impairment/amnesia - tolerance - dependence - withdrawal
59
Describe the withdrawal syndrome of benzodiazepines
Anxiety, insomnia, restlessness, agitation, irritability, muscle tenison
60
Which two drugs can be lethal in withdrawal?
EtOH and Benzodiazepine withdrawal can be life-threatening
61
Side effects of zolpidem
Zolpidem (Ambien, GABAergic for insomnia) - dizziness - N/V, GI distress
62
Side effects of zaleplon
Zaleplon (Sonata, GABAergic for insomnia) - dizziness - dyspepsia
63
Side effects of eszopiclone
Eszopiclone (Lunesta) -headache
64
Side effects of diphenhydramine
Diphenhydramine (Benadryl) - sedation - weight gain - anticholinergic side effects
65
Side effects of Ramelteon
Ramelteon = melatonin receptor agonist to normalize circadian rhythm - dizziness - fatigue
66
Main side effects of lithium
- GI irritation - polyuria, polydipsia, nephrogenic diabetes insipidus - tremor** - benign leukocytosis - weight gain - subtle incoordination, cognitive blunting
67
Signs of lithium toxicity
Nausea, diarrhea, vomiting - oligouria - ataxia, coarse tremors, increased DTRS - obtundation (altered level of consciousness) - seizure and death
68
Serious adverse effects of lithium
- lithium toxicity - thyrotoxicity - long term nephrotoxicity - cardiac arrhtyhmias and T-wave flattening
69
Adverse effects of carbamazepine
- N/V/D - sedation, light headedness, tremor - cognitive blunting - electrolyte abnormalities (hyponatremia) - anticholinergic side effects - rash (may progress to Stevens-Johnson syndrome) - weight gain
70
Signs of carbamazepine overdose
Carbamazepine overdose => coarse tremor, coma, death
71
What lab results are monitored on carbamazepine
- Blood count (for blood dyscrasias) - liver fxn - metabolic fxn
72
Serious adverse effects of carbamazepine
- Blood dyscrasias: aplastic anemia, agranulocytosis, thrombocytopenia - hepatotoxicity
73
What lab results are monitored on valproic acid?
- serum level - blood count - liver and pancreatic fxn
74
Serious adverse effects of valproic acid
- thrombocytopenia (low platelet count) - hemorrhagic pancreatitis - hepatotoxicity - polycystic ovaries
75
Signs of valproic acid overdose
Coarse tremor, coma, death
76
General side effects of anticonvulsants
- N,V,D - sedation, light headedness, tremor - cognitive blunting - weight gain
77
What drug can commonly cause Stevens-Johnson syndrome?
Lamotrigine = anticonvulsant used as mood stabilizer
78
Describe Steven Johnson syndrome
Type of toxic epidermal necrolysis in which cell death causes the epidermis to separate from the dermis - mortality rate of about 5% - can start w/ fever, sores, and fatigue => often misdiagnosed as infection
79
Side effects of CNS stimulants
- anxiety - insomnia - anorexia - tachycardia
80
Serious AEs of CNS stimulants
- drug dependence - hypertension - cardiac arrhythmias - cardiovascular collapse (rare)
81
Serious AEs of atomoxetine
black box warning for severe liver injury
82
AEs of atomoxetine
- dyspepsia, N,V - anorexia - dizziness - insomnia - sexual dysfxn

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