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MRCPsych > Adverse effects > Flashcards

Adverse effects Flashcards

1
Q

What % of tardive dyskinesia cases are reversible?

A

Around 50%

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2
Q

Most common side effect of Valproate

A

Diarrhoea

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3
Q

Which TCA has the highest antihistaminergic activity?

A

Doxepin

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4
Q

Side effects of AChE inhibitors

A

GI - nausea, vomiting, diarrhoea, anorexia
Muscle cramps
Urinary incontinence
Donepezil associated with bradycardia

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5
Q

Which SSRI has the greatest risk of causing delayed ejculation and impotence?

A

Paroxetine

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6
Q

What is the commonest side effect of methylphenidate?

A

Insomnia

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7
Q

What % of patients develop tardive dyskinesia?

A

5%

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8
Q

Blockade of which receptors leads to postural hypotension

A

Alpha-1

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9
Q

When treating serotonin syndrome, antagonism of which receptor is useful for controlling neurological signs?

A

5-HT2A

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10
Q

What is the CATIE study?

A

Clinical Antipsychtoic Trials of Intervention Effectiveness

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11
Q

What were some of the outcomes from CATIE?

A

Irrespective of prescribed drug, 74% discontinued treatment in 18 months
Olanzapine had the lowest discontinuation rate - 64% but highest side effect burden
First generation drugs do as well as second
Haloperidol was not included in the trial
Quetiapine group had less EPSEs

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12
Q

When is the maximum risk of Ebstein anomaly when taking lithium seen?

A

Maximum risk 2-6 weeks after conception

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13
Q

The toxic confusional state caused by antipsychotics is mainly due to which receptor?

A

Muscarinic receptor blockade

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14
Q

Which benzo is most toxic?

A

Alprazolam

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15
Q

Incidence of NMS

A

0.07-0.2%

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16
Q

What are some possible treatment options for Clozapine induced hypersalivation?

A 
Anticholinergics - amitriptyline
Benzatropine
Trihexyphenidyl
Hyoscine
Pirenzepine
Clonidine has also been used
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17
Q

Medications to treat akathisia

A 
Propranolol 
Clonazepam
Mirtazapine
Anticholinergics
Low evidence for clonidine
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18
Q

Which class of antidepressant should be avoided in people who do not want to gain weight?

A

Tricyclics

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19
Q

Which drug can cause nephrolithiasis?

A

Topiramate

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20
Q

Risk factors for tardive dyskinesia

A
  • Chronic use of antipsychotics
  • Cessation of chronic treatment
  • Concomitant anticholinergic treatment
  • Elderly
  • Female
  • Organic disorder
  • Previous head injury
  • Alcoholism
  • Comorbid mood disorder
  • Negative symptoms of schizophrenia
  • DM
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21
Q

What is the risk of developing fatal agranulocytosis with clozapine?

A

1 in 4250 but less than 1 in 8000 with standard monitoring

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22
Q

Which drug is licensed for treatment of tardive dyskinesia in the UK?

A

Tetrabenazine

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23
Q

Sexual side effects of SSRIs are due to the stimulation of which receptors?

A

5HT2

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24
Q

Lithium induced hypothyroidism is more common in which group?

A

Young females

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25
Q

Which diuretic can be used to treat lithium induced poyuria without causing lithium toxicity?

A

Amiloride

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26
Q

Reflexes in NMS vs serotonin syndrome

A

NMS - bradyreflexia

Serotonin syndrome - hyperreflexia/clonus

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27
Q

Lab findings in NMS vs serotonin syndrome

A

NMS - high WCC, high CK

Serotonin syndrome - no leucocytosis, CK normal

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28
Q

In overdose, how do TCAs cause death?

A

Myocardial sodium channel blockade leading to intraventricular conduction delays, ventricular dysrhythmias, decreased CO and hypotension

29
Q

How should you treat a MAO induced hypertensive crisis?

A

Alpha-adrenergic antagonists - phentolamine or chlorpromazine

30
Q

Moclobemide MOA

A

Reversible MAO inhibitor

31
Q

Which SSRI has the highest level in breast milk?

A

Fluoxetine

32
Q

Upper limit of QTc for men

A

440

33
Q

Which other antiepileptic can cause steven-johnsons?

A

Carbamazepine

34
Q

MOA Ramelteon

A

MT1/MT2 receptor agonist

35
Q

MOA atomoxetine

A

Selective noradrenaline reuptake inhibitor

36
Q

How long does it generally take for tardive dyskinesia to appear?

A

Usually after 1-2 years of treatment

37
Q

What is tardive dyskinesia?

A

Abnormal, involuntary movements of muscles of head, limbs and trunk
Perioral movements are most common

38
Q

When is TD absent?

A

When sleeping

39
Q

Do patients have insight about TD?

A

No

40
Q

How can you manage tardive dyskinesia?

A

Most cases remit spontaneously
Clozapine can reduce risk and also treat TD
Adding clonazepam can be considered

41
Q

Why do you get priapsm?

A

Alpha-1 blockade and anticholinergic activity

42
Q

What can be used to treat sexual dysfunction in men that is associated with hyperprolactinaemia?

A

Bromocriptine

43
Q

What effect can long term chlorpromazine have on skin?

A

Blue-gray discolouration in skin exposed to sunlight

44
Q

What eye problems are associated with high doses of thioridazine?

A

Irreversible retinal pigmentation

45
Q

What eye problems are associated with high doses of chlorpromazine?

A

Pigmentation of anterior lens and posterior cornea - benign and not vision impairing

46
Q

What is chlorpromazine associated with in first month of treatment?

A

Cholestatic jaundice with rash and eosionophilia - recommended to stop and avoid in future

47
Q

Which TCA is most selective of serotonergic reuptake?

A

Clomipramine

48
Q

Which TCS is most selective for noradrenaline reuptake?

A

Desipramine

49
Q

Which TCA has the most antihistaminic activity?

A

Doxepin

50
Q

Management of serotonin syndrome

A

Withdraw offending agent
Supportive care
Benzo
5HT2A antagonists - cyproheptadine, atypical antipsychotics, chlorpromazine

51
Q

Gynae effect of fluoxetine

A

Can change duration of menstrual cycle

52
Q

Haematological effect of SSRIs

A

Can cause functional impairment of platelet aggregation but not a reduction in platelet numbers

53
Q

Effect of buspirone on haloperidol concentrations

A

Increases haloperidol levels

54
Q

Cardiac effects of lithium

A

ECG with therapeutic lithium doses similar to hypokalaemia - flat/inverted T waves

55
Q

Effect of lithium on sinus node

A

Can depress sinus node so contraindicated in sick sinus syndrome

56
Q

Which group of patients are at higher risk of lithium?

A

Pre-existing antithyroid antibodies
Young women
Rapid cycling patients

57
Q

Which gynae problem can valproate cause?

A

Polycystic ovaries

58
Q

Which blood finding can valproate cause?

A

5 to 40% of people experience a persistent elevation in liver transaminases up to 3x the upper limit of normal - resolves after discontinuing drug

59
Q

Most common teratogenic effects of valproate

A

Ebstein’s anomaly - 20x risk of general pop

LD and low IQ in children

60
Q

Why is tacrine not used in uk anymore?

A

Fatal hepatotoxicity

61
Q

Which receptor does zopiclone act on?

A

Alpha-1 subunit on omega-1 receptor

62
Q

Best antipsychotic if patient has hyponatraemia

A

Clozapine

63
Q

Which antidepressant is less likely to cause a switch to mania?

A

Buproprion

64
Q

Which scan can show loss of dopaminergic neurons?

A

DAT scan

65
Q

Serious Side effects of cholinesterase inhibitors

A
  • Increase GI bleeding risk
  • Bradycardia
  • COPD exacerbation
  • Urinary retention
  • Increased seizure risk
66
Q

How is memantine metabolised?

A

Excreted unchanged in urine

67
Q

Does Rivastigmine’s metabolism rely on liver enzymes?

A

No

68
Q

Unique side effect of eszopiclone

A

unpleasant taste

69
Q

What does the black triangle symbol?

A

Drug is newly licensed and requires additional monitoring

MRCPsych (19 decks)

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