AEs Of APS/Mood stabilizers

Question 1

First Generation Antipsychotics

Answer 1

EPS
QTc prolongation
Increased prolactin
Dermatologic
Photosensitivity
Blueish skin
Orthostatic hypotension
Altered thermoregulation

Question 2

BBW for all antipsychotics

Answer 2

Dementia-related psychosis (especially elderly)

Question 3

Drug for Alzheimer’s-related agitation

Answer 3

Brexpiprazole (Rexulti)

Question 4

Which SGA are used to augment MDD?

Answer 4

Aripiprazole
Brexpiprazole
Olanzapine
Quetiapine

Question 5

Aripiprazole

Answer 5

Insomnia
Akathisia
Restlessness
Impulsivity

Question 6

Asenapine

Answer 6

QTc prolongation
Skin reactions w patch (avoid heat)
CI - severe hepatic disease
(Less metabolic AEs, less anticholinergic, less sedating)

don’t eat/drink right after

Question 7

Brexpiprazole

Answer 7

Akathisia
Impulsivity
(Fewer metabolic AEs)

Question 8

Cariprazine

Answer 8

AEs occur late with accumulation
Akathisia

Question 9

Clozapine

Answer 9

QTc prolongation
Bradycardia
Myocarditis
Seizure risk
Constipation/GI impaction
Hypersalivation
Hepatotoxicity
Fever
Anticholinergic
BBW: blood dyscrasias

Question 10

Iloperidone

Answer 10

Or tho static hypotension
Priapism
QTc warning
Avoid in hepatic impairment

Question 11

Lurasidone

Answer 11

Neurological ADRs in dementia pts
Sedation

Question 12

Olanzapine

Answer 12

High metabolic risk
Post-injection delirium/sedation (LAI)
DRESS
QTc risk
Anticholinergic

Question 13

Lybalvi

Answer 13

Increased risk of death w/ concomitant opioid use

Question 14

Paliperidone

Answer 14

QTc risk
GI obstruction
Priapism
Thrombocytopenia
Increased prolactin

Question 15

Quetiapine

Answer 15

High metabolic risk
Increased sedation
Cataracts
Hypothyroidism
QTc risk
Anticholinergic
(Misuse reported)

Question 16

Risperidone

Answer 16

Increased prolactin
Increased EPS risk
Priapism
Thrombocytopenia

Question 17

Ziprasidone

Answer 17

DRESS
SJS/TENS
- rash/urticaria
QTc Risk
Priapism
Take with food = better absorption

Question 18

Drug for Aggression in Schizophrenia and BP

Answer 18

SL dexemetomidine

Question 19

Lithium

Answer 19

Unmasks Brugada syndrome
Renal and CVD risk
Polydipsia/polyuria
AKI/SKD
Tremor/weakness (take Li level)
Monitor thyroid and renal function

Question 20

What can increase lithium levels?

Answer 20

NSAIDs
ACEi
ARBS
Thiazide diuretics
Smoking or caffeine cessation

Question 21

Valproate

Answer 21

Thrombocytopenia
Weight gain
Increased ammonia
Alopecia
BBW: pancreatitis, hepatotoxicity, urea disorders, teratogenicity

GI, tremor, sedation
Very GI irritating

Question 22

Carbamazepine

Answer 22

Neutropenia
Bone marrow suppression
Agranulocytosis
ASIAN = HLA-B1502 holders, high risk of SJS/TENS
Hyponatreamia

Question 23

MAOIs

Answer 23

Wait 4-5 t1/2s (~2 weeks for SSRIs)
Avoid tyramine foods to prevent hypertensive crisis

Question 24

SSRIs

Answer 24

Insomnia
Sexual dysfunction
Serotonin Syndrome
QTc prolonging
Increased bleed risk with NSAIDs and anti platelets/DOACs
Avoid in hepatic impairment

Question 25

Who should avoid paroxetine?

Answer 25

Old and pregnant

Question 26

SNRIs

Answer 26

Abnormal bleed risk
Increased energy compared to SSRIs

Question 27

TCAS

Answer 27

Anticholinergic
CVD (heart block, ventricular tachycardia)
Do not abruptly stop!

Question 28

Spravato (Esketamine)

Answer 28

CI in vascular disease hx, cerebral hemorrhage
Impaired ability to drive
Only thru REMS

Question 29

Brexanolone

Answer 29

BBW: Hypoxia & excessive sedation
Avoid in active pregnancy, postpartum only

Question 30

What are the augmentation agents for MDD?

Answer 30

Lithium
SGAs
(Maybe buspirone, not preferred)

Question 31

NMS is caused by ___________, while serotonin syndrome is caused by _________

Answer 31

NMS = dopamine antagonists
SS = serotonin agonists