Types and mechanisms of adverse effects

Question 1

Side effects caused by histamine H1 blockade

Answer 1

Weight gain

Sedation

Question 2

Side effects caused by alpha 1 blockade

Answer 2

Orthostatic hypotension
Sedation
Sexual dysfunction including anorgasmia
Priapism

Question 3

Side effects caused by muscarinic central M1 blockade

Answer 3

Agitation, delirium
Memory impairment
Seizures

Question 4

Side effects caused by muscarinic peripheral M1 blockade

Answer 4

Dry mouth
Ataxia
Blurred vision from mydriasis
Narrow angle glaucoma
Constipation
Urinary retention
Tachycardia

Question 5

Antipsychotic side effects which are due to their antidopaminergic effects

Answer 5

Galactorrhoea
Gynaecomastia
Menstrual disturbance
Reduced libido
Lowered sperm count
Parkinsonism
Dystonia
Akathisia
Tardive dyskinesia

Question 6

Antipsychotic side effects which are due to their anticholinergic (antimuscarinic) effects

Answer 6

Dry mouth
Blurred vision
Urinary retention
Constipation

Question 7

Antipsychotic side effects which are due to their antiadrenergic side effects

Answer 7

Postural hypotension

Ejaculatory failure

Question 8

Antipsychotic side effects which are due to their histaminergic effects

Answer 8

Drowsiness

Question 9

Tricyclic antidepressant side effects which are due to their antimuscarinic effects

Answer 9

Dry mouth

Urinary retention

Question 10

Tricyclic antidepressant side effects which are due to their antihistaminergic efffects

Answer 10

Sedation

Weight gain

Question 11

Tricyclic antidepressant side effects which are due to their antiadrenergic effects

Answer 11

Postural hypotension
Sexual dysfunction
Cognitive impairment

Question 12

Tricyclic antidepressant side effects which are due to their membrane stabilisation effects

Answer 12

Cardiotoxicity

Reduced seizure threshold

Question 13

Type of adverse drug reaction which are dose dependent and can be predicted from the pharmacology of the medication

Answer 13

Type A

Question 14

Type of adverse drug reaction which is idiosyncratic and cannot be predicted from the pharmacology of the medication - includes allergic reactions

Answer 14

Type B

Question 15

Percentage of adverse drug reactions which type A accounts for

Answer 15

80%

Question 16

Type I allergic reactions

Answer 16

IgE mediated

Question 17

Type II allergic reactions

Answer 17

Cytotoxic

Question 18

Type III allergic reactions

Answer 18

Immune complex

Question 19

Type IV allergic reactions

Answer 19

Cell mediated

Question 20

Timing of type I allergic reactions

Answer 20

Minutes to hours after exposure

Question 21

Timing of type II allergic reactions

Answer 21

Variable

Question 22

Timing of type III allergic reactions

Answer 22

1-3 weeks after exposure

Question 23

Timing of type IV allergic reactions

Answer 23

2-7 days after exposure

Question 24

Type of exposure causing type IV allergic reactions

Answer 24

Cutaneous

Question 25

Quickest type of allergic reaction

Answer 25

Type I

Question 26

Clinical features of a type I allergic reaction

Answer 26

Anaphylaxis Urticaria Bronchospasm

Question 27

Clinical features of a type II allergic reaction

Answer 27

Blood abnormalities - neutropaenia, thrombocytopaenia

Question 28

Clinical features of a type III allergic reaction

Answer 28

Rash Fever Urticaria Vasulitis

Question 29

Clinical features of a type IV allergic reaction

Answer 29

Allergic contact dermatitis | Rash

Question 30

Proposed mechanisms of antipsychotic related weight gain

Answer 30

5HT2C antagonism H1 antagonism D2 antagonism Increased serum leptin leading to leptin desensitisation

Question 31

Mechanism of sexual side effects of SSRIs

Answer 31

5HT2A stimulation

Question 32

Proposed mechanism for anxiety and agitation sometimes seen on commencing SSRIs

Answer 32

Over stimulation of 5HT2 receptors in the limbic system

Question 33

Type A adverse effects

Answer 33

Augmented reactions - an exaggeration of a drug's normal pharmacological action when given at a therapeutic dose. Normally dose dependent

Question 34

Type B adverse effects

Answer 34

Bizarre reactions - novel responses which are not expected from the known mechanism of action of the drug

Question 35

Type C adverse effects

Answer 35

Continuing reactions - persist for a long time

Question 36

Type D adverse effects

Answer 36

Delayed reactions - become apparent after some time of use

Question 37

Type E adverse effects

Answer 37

End of use reactions - associated with withdrawal of a medication

Question 38

Mechanism of hypotensive side effects of antipsychotics

Answer 38

Alpha 1 receptor antagonism

Question 39

Mechanism of SSRI induced nausea and diarrhoea

Answer 39

5HT3 receptor activation

Question 40

Mechanism of antipsychotic induced tardive dyskinesia

Answer 40

Dopamine receptor super sensitivity

Question 41

Mechanism of antipsychotic induced akathisia and extra-pyramidal side effects in general

Answer 41

Striatum D2 blockade

Question 42

Receptor involved in serotonin syndrome

Answer 42

5HT2A