Side Effects And Safety Mneumonics

Question 2

What does the SHIVERS mnemonic stand for in serotonin syndrome?

Answer 2

• S: Shivering
• H: Hyperreflexia
• I: Increased temperature
• V: Vital sign instability
• E: Encephalopathy (confusion)
• R: Restlessness
• S: Sweating

Question 3

What causes serotonin syndrome?

Answer 3

Excess serotonin from combining serotonergic meds (e.g., SSRIs + MAOIs, SNRIs, TCAs, triptans, etc.)

Question 4

What is the treatment for serotonin syndrome?

Answer 4

Discontinue offending agents, supportive care, possibly cyproheptadine

Question 5

What does the FINISH mnemonic stand for in SSRI/SNRI discontinuation syndrome?

Answer 5

• F: Flu-like symptoms
• I: Insomnia
• N: Nausea
• I: Imbalance (dizziness, ataxia)
• S: Sensory disturbances (brain zaps)
• H: Hyperarousal (anxiety, agitation)

Question 6

Which SSRIs/SNRIs are most associated with discontinuation syndrome?

Answer 6

Paroxetine, fluvoxamine, venlafaxine (short half-lives)

Question 7

What causes neuroleptic malignant syndrome (NMS)?

Answer 7

Dopamine blockade from antipsychotics

Question 8

What are hallmark signs of NMS?

Answer 8

Lead-pipe rigidity, hyperthermia, confusion, elevated CK, autonomic instability

Question 9

What is the treatment for NMS?

Answer 9

Discontinue antipsychotic, supportive care, bromocriptine or dantrolene

Question 10

How do you differentiate NMS from serotonin syndrome?

Answer 10

NMS = rigid muscles + slow reflexes
Serotonin syndrome = clonus + hyperreflexia

Question 11

What are the 4 major types of EPS?

Answer 11

1. Acute dystonia (spasms)
2. Akathisia (restlessness)
3. Parkinsonism (bradykinesia, tremor)
4. Tardive dyskinesia (late, involuntary movements)

Question 12

What causes EPS?

Answer 12

Dopamine D2 blockade in the nigrostriatal pathway

Question 13

How is acute dystonia treated?

Answer 13

IM or IV benztropine or diphenhydramine

Question 14

What is the treatment for akathisia?

Answer 14

Propranolol or benzodiazepines

Question 15

What medication is used to treat tardive dyskinesia?

Answer 15

Valbenazine (Ingrezza) or deutetrabenazine (Austedo)

Question 16

What’s the BBW for all antidepressants in youth?

Answer 16

Increased risk of suicidal thoughts and behaviors

Question 17

What’s the BBW for clozapine?

Answer 17

Agranulocytosis, seizures, myocarditis

Question 18

What’s the BBW for lamotrigine?

Answer 18

Stevens-Johnson syndrome (esp. if titrated too fast)

Question 19

What does the mnemonic LITH stand for in lithium toxicity?

Answer 19

• L: Leukocytosis
• I: Insipidus (diabetes insipidus)
• T: Tremor
• H: Hypothyroidism