Medication Side Effects

Question 1

What are side effects of lithium?

Answer 1

• acne
• follicular and maculopapular eruptions
• cause and exacerbate psoriasis
• alopecia has been reported
• major side effects: gastrointestinal complaints, tremor, diabetes insipidus, hypothyroidism, weight gain, cardiac arrhythmia, and edema

Question 2

How does lithium affect ADH?

Answer 2

Lithium decreases the kidney’s ability to respond to ADH, resulting in decreased fluid resorption from the distal tubules and increased urine output

Question 3

What are side effects of Lamictal?

Answer 3

Anemia, SJS, thrombocytopenia, liver failure, and pancreatitis

Question 4

What are side effects of oxcarbazepine?

Answer 4

• leukopenia
• thrombocytopenia
• SJS

Question 5

How does risperidone increase the volume of pituitary adenomas?

Answer 5

blocking dopamine and increasing serum prolactin levels
- when an adenoma grows beyond 1.5cm it can encroach on the medial portion of both optic nerves outside of the sella turcica causing bitemporal hemianopsia
- treatment: stop drug and consider administration of bromocriptine

Question 6

What are the most sedating TCAs

Answer 6

Amitriptyline, trimipramine and doxepin

Question 7

What are the least sedating TCAs?

Answer 7

• desipramine
• protriptyline

Question 8

What medications are not contraindicated with MAOIs?

Answer 8

lithium and phentolamine

Question 9

Which can cause hypertensive crisis buproprion or venla?

Answer 9

venla

Question 10

SSRI induced SIADH

Answer 10

• most common in elderly
• irritability, personality changes, decreased appetite, nausea, vomiting, weakness, confusion, hallucinations, severe: seizure, stupor, coma
• as ADH rises the body holds onto water-sodium levels drop

Question 11

Side effects of phenytoin?

Answer 11

Notorious for causing hirsutism in women, facial dysmorphism, and gingival hypertrophy
- can also cause cerebellar atrophy when taken over a long period of time (ataxic gait, dysmetria of extremities)

Question 12

What are the side effects of carbamazepine?

Answer 12

Induces own metabolism
SJS
Hyponatremia by an antidiuretic hormone-like effect
Leukopenia
Toxic hepatitis

Question 13

Side effects of valproate?

Answer 13

• Leukopenia
• Liver failure
• Weight gain
• Hair loss
• Fetal neural tube defects such as spina bifida
• PCOS

Question 14

Side effects of levetiracetam

Answer 14

Infrequent agitation and hyperactivity

Question 15

What are symptoms of lithium toxicity?

Answer 15

ataxia, tremor, N/V, nephrotoxicity, muscle weakness, convulsions, coma, lethargy, confusion, hyperreflexia, nystagmus, nonspecific twave changes

Question 16

TCAs act as what type of antiarrhythmics?

Answer 16

1A
so they can terminate ventricular fibrillation and increase collateral blood supply to ischemic heart tissue

Question 17

Nortriptyline has a unique therapeutic window between 50 and 150. waht happens over 150

Answer 17

reduced efficacy

Question 18

valproic acid levels as high as 125

Answer 18

thromocytopenia may occur
- get liver tests at start of treatment and every 6-12 months and valproic acid levels periodically

Question 19

blockade of muscarinic cholinergic receptors

Answer 19

blurred vision, dry mouth, and difficulty urinating, confusion and delirium

Question 20

retrograde ejaculation is seen with

Answer 20

thioridazine (very sedating, orthostatic hypotension, anticholinergic side effects, low rates of extrapyramidal symptoms)

Question 21

desvenlafaxine

Answer 21

• orthostasis
• hyponatremia (especially in elderly)
• hypertension
• black box warning suicidality especially in teens (as with all ssri and snri)

Question 22

mild to moderate lithium toxicity

Answer 22

• 1.5-2
• vomiting, abdominal pain, ataxia, dizziness, slurred speech, dry mouth, nystagmus

Question 23

moderate to severe lithium toxicity

Answer 23

2-2.5
- anorexia, muscle fasiculations, clonic limb movements, hpyeractive deep tendon reflexes, choreoathetoid movements, convulsions, delirium, stupor, coma, circulatory failure(low bp, arrhythmia)

Question 24

severe lithium toxicity

Answer 24

greater than 2.5
generalized convulsions, oliguria, renal failure, death

Question 25

Does duloxetine have discontinuation withdrawal symptoms

Answer 25

yes and so does paroxetine

Question 26

do doses of 600mg/ day of clozapine increase chance of seizures compared to lower doses

Answer 26

yes - also adding lithium to clozapine increases risk of NMS

Question 27

is clozapine agranulocytosis dose related

Answer 27

no

Question 28

can smoking decrease clozapine levels

Answer 28

yes

Question 29

dose dependent side effects for valproic acid

Answer 29

blurred vision, vertigo, GI distrubances, and task performance impairment

Question 30

dose independent valproic acid side effects

Answer 30

agranulocytosis, SJS, aplastic anemia, hepatic failure, rash, pancreatitis

Question 31

major side effect of carbamazapine especially in elderly

Answer 31

hyponatremia - acts like a vasopressin agonist and has antidiuretic actions

Question 32

eosinophilic collitis is associated with what med

Answer 32

clozapine

Question 33

pancreatitis is associated with what med

Answer 33

valproic acid

Question 34

interferon side effects

Answer 34

depression, si, insomnia, and cognitive insufficiency, fatigue

Question 35

carbamazapine in preg

Answer 35

developmental delay, minor craniofacial abnormalities, spina bifida

Question 36

babies being breast fed while on fluoxetine

Answer 36

- irritability, vomiting, diarrhea

Question 37

valproic acid in pregnancy

Answer 37

- neural tube defects, limb and cardiac defects late in pregnancy can cause clotting abnormalities

Question 38

lithium in pregnancy

Answer 38

- ebsteins malformation-right ventricular hypoplasia, tricuspid insufficiency - diureses in childburth can cause toxic lithium levels