Certain Side Effects

Question 1

What two drug classes have “HAM” side effects?

Answer 1

TCAs

Low potency typical antipsychotics (chlorpromazine and thioridazine)

Question 2

What are HAM side effects?

Answer 2

H- antihistamine (sedating, weight gain)
A- antiadrenergic (hypotension)
M- antiMuscarinic (dry mouth, urinary retention, blurry vision, constiapation)

Question 3

What are 9 symptoms of serotonin syndrome?

Answer 3

1. Confusion
2. Flushing
3. Diaphoresis
4. tremor
5. Myoclonic jerks
6. hyperthermia
7. hypertonicicty
8. rhabdo
9. renal failure

Question 4

What combination of drugs classically causes serotonin syndrome?

Answer 4

MAOI + SSRI (wait two weeks before switching form one to the other)

also mixing ergot drugs: ondansetron, meperidine, metoclopromide, tramadol, fentanyl

Question 5

Treatment for serotonin syndrome

Answer 5

1. Stop offending drugs
2. My need cyproheptadine (serotonin antagonist)
3. Control all other symptoms , including cooling bath etc as needed

Question 6

What are the three main EPS types?

Answer 6

1. Parkinsonism- mask like face, cogwheel rigidity, pill-rolling tremor
2. akathisia - restlessness and agitation (ants in the pants)
3. Dystonia - sustained contractions of the neck, tongue, eyes, diaphragm

Question 7

What time line do EPS usually occur on?

Answer 7

Within days to months of starting the offending drug

Question 8

What drugs are usually implicated in EPS?

Answer 8

High potency antipsychotics (haloperidol, fluphenazine, palperidol, pimozide)

• in general high potency have increased incidence of EPS, low potency have high incidence of anticholinergic and “HAM” side effects.

Question 9

How do you treat EPS?

Answer 9

Either diphenhydramine or benzotropine

Question 10

What two drug classes/ drug are notorious for causing hyperprolactinemia?

Answer 10

1. high potency typical antipsychotics (haloperidol, palperidol, fluphenazine, trifluoperazine)
2. Risperidone

Question 11

What is tardive dyskinesia?

Answer 11

Choreoatheoid movements of the mouth and tongue (grimacing, tongue protrusion)

Question 12

What is the time line for development of tardive dyskinesia? What main drugs cause?

Answer 12

Usually after years of taking high potency typicals (haloperidol, palperidone, fluphenazine, trifluoperazine)

Question 13

What are 8 symptoms of neuroleptic malignant syndrome? (mnemonic)

Answer 13

1. Fever
2. Autonomic instability ( tachycardia, labile hypertension)
3. Leukocytosis
4. Tremor
5. Elevated CPK
6. Rigidity (“lead pipe” rigidity)
7. Excessive sweating
   8 Delirium

FALTERED

Question 14

What is treatment for NMS?

Answer 14

1. STOP offending drug

2. Dantroline or bromocriptine

Question 15

What drugs cause NMS?

Answer 15

ANY antipsychotic and can occur at any point while on medication

Question 16

What are 4 CYP inducers

Answer 16

1. Smoking
2. Carbamazepine
3. Barbituates
4. St. John’s Wort

Question 17

What are 5 CYP inhibitors?

Answer 17

1. Fluvoxamine
2. Fluoxetine
3. Paroxetine
4. Duloxetine
5. Sertraline