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Psychopharm > Drug Side Effects > Flashcards

Drug Side Effects Flashcards

1
Q

Least EPS of all the typicals

A

Thioridazine (Mellaril)

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2
Q

Significant QT prolongation

A

Thioridazine (Mellaril)

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3
Q

Side effect of high dose (>800 mg/day) of thioridazine

A

Retinitis pigmentosa = progressive degeneration of rod photoreceptors => loss of peripheral vision (tunnel vision)

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4
Q

Which antipsychotic can cause loss of peripheral vision?

A

Retinitis pigmentosa at high doses (>800 mg/day) of Thioridazine

Thioridazine = Mellaril = low potency typical antipsychotic

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5
Q

Distinguish the side effect profiles of high vs. low dose typical antipsychotics

A

Both doses have the same efficacy, potency differs by side effect profiles

  • High potency agents: cause worse EPS
  • Low potency agents: cause more anticholinergic, antihistaminergic, and antiadrenergic side effects
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6
Q

3 features of EPS

A

Extrapyramidal symptoms

  • akathisia
  • dystonic rxns
  • Parkinsonism
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7
Q

What is akathisia?

A

Internal restlessness and anxiety

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8
Q

How to treat akathisia?

A

Anticholinergics, beta-blockers, or benzos

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9
Q

What are dystonic rxns?

A

Painful muscle spasms usually of the extremities, neck, ocular muscle

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10
Q

How to treat dystonic rxns

A

PO or IM anticholinergics

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11
Q

Describe Parkinsonian symptoms (feature of EPS)

A

Tremor, bradykinesia, masked faces, shuffling gait, cogwheel rigidity

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12
Q

How to treat Parkinsonian symptoms (side effect of EPS)

A

Anticholinergics, dopaminergic agents (Amantidine), or beta-blockers

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13
Q

List adverse events of typical antipsychotics

A
  • EPS
  • hyperprolactinemia
  • sedation
  • weight gain
  • anticholinergic effects
  • orthostatic hypotension
  • decreased seizures threshold (more in low potency agents)
  • sexual dysfxn
  • dermatologic effects
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14
Q

What does hyperprolactinemia cause in

(a) Males
(b) Females

A

Hyperprolactinemia

(a) Males: gynecomastia and impotence
(b) F: Amenorrhea

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15
Q

Dermatologic effects of antipsychotics

A

Dermatitis and photosensitivity

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16
Q

2 serious adverse events of typical antipsychotics

A
  • Tardive dyskinesia

- Neuroleptic malignant syndrome

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17
Q

Features of tardive dyskinesia

A

Involuntary choreoathetoid mov’ts of face, neck, trunk, and extremities

  • often permanent and can be grossly debilitating
  • involuntary repetitive body mov’t
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18
Q

Possible mechanism of tardive dyskineasia

A

Effect of long term typical antipsychotics due to D2 blockade in the nigrostriatal tract

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19
Q

Features of NMS

A

NMS = Neuroleptic malignant syndrome

  • life-threatening condition of hyperpyrexia, autonomic instability, muscle rigidity, and delirium (cognitive impairment)
  • can occur w/ all antipsychotics, uncommon but random occurrence
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20
Q

How to treat NMS

A

Removing offending agent (discontinue the antipsychotic) + supportive care

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21
Q

Describe the anticholinergic side effects

A

Dry mouth, constipation, blurry vision, urinary retention, confusion, ECG changes

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22
Q

Contrast the SEs of typical vs. atypical antipsychotics

A

Typicals: higher EPS
-TD, NMS

Atypicals: higher rates of metabolic problems- hyperglycemia, DM2, hyperlipidemias

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23
Q

Which two atypical antipsychotics carry the greatest risk of metabolic syndrome?

A

Olanzapine (Zyprexa) and cloazpine (Clozaril)

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24
Q

Which atypical antipsychotic has the most serious possible adverse effect?

A

Clozapine (Clozaril)

-agranulocytosis => frequent WBC monitoring required

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25
Q

Common side effects of atypical antipsychotics

A
  • weight gain (most substantial on clozapine and olanzapine)/metabolic problems
  • sedation
  • orthostatic hypotension
  • anticholinergic effects
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26
Q

Which atypical antipsychotic poses a risk of EPS?

A

Risperidone at high doses (above 6 mg/day) can cause EPS

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27
Q

Why was a metabolite of risperidone developed?

A

Paliperidone (Invega) = metabolite of risperidone w/ potentially less EPS than risperidone

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28
Q

Why do pts get ECG upon admission to psych ward?

A

Antipsychotics can cause QT interval prolongation, get ECG baseline

  • don’t start antipsychotic if QT interval at baseline > 500 ms
  • get repeat EKG to see if QT interval has prolonged
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29
Q

Main drug classes w/ anticholinergic effects

A
  • Typical and atypical antipsychotics

- TCAs

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30
Q

Main adverse effects of TCAs

A
  • anticholinergic effects
  • sedation
  • weight gain
  • orthostatic hypotension
  • sexual dysfxn
  • mania in bipolar pts
  • rare, seizures

Two serious adverse effects: cardiotoxicity and neurotoxicity

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31
Q

Serious adverse effects of TCAs

A

Cardiotoxicity: TCAs slow cardiac conduction => EKG changes, arrhythmias, AV block

Neurotoxicty: tremor and ataxia
-in OD => agitation, delirium, coma, and death

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32
Q

Adverse effects of MAOIs

A
  • orthostatic hypotension: can be pretty severe, may require support stockings
  • weight gain
  • sexual dysfunction
  • insomnia
  • myoclonus (muscle pains, paresthesias)
  • mania
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33
Q

Foods to be avoided in pts taking MAOIs

A

Food including tyramine: aged cheese, fava beans, liver

34
Q

Why are pts on MAOIs kept on a low-tyramine diet?

A

Tyramine is broken down in the GI tract by MAO-A. In pts on MAOIs tyramine gets into the bloodstream undigested and acts as a false transmitter in adrenergic pathways => sudden, catastrophic rise in BP

35
Q

Describe the side effects of SSRIs by receptor

(a) 5HT3
(b) 5HT2C
(c) 5HT2A

A

Side effects due to overstimulation of 5HT receptors widely distributed throughout the body

(a) 5HT3: GI system. Overstimulation => diarrhea, N/V
(b) 5HT2C: CNS. Overstimulation => anxiety and mental agitation
(c) 5HT2A: CNS, spinal cord. Overstimulation => anxiety, mental agitation. Akathisia (motor restlessness), insomnia, myoclonus, sexual dysfxn

36
Q

General side effects of SSRIs

A
  • weight gain
  • mania
  • serotonin discontinuation syndrome => don’t abruptly stop, make sure to taper down
37
Q

Why are SSRIs tapered down to stop treatment?

A

Avoid serotonin discontinuation syndrome = headache, dizziness, irritability, fatigue

(same thing w/ SNRIs)

38
Q

What is required for a pt previously on an MAOI to start an SSRI?

A

MAOI washout of 2 weeks prior to initiation of SSRI tx

-avoid serotonin syndrome

39
Q

Describe the features of serotonin syndrome

A

Hyperthermia, myoclonus, autonomic instability, rigidity, coma, death

40
Q

Possible cause of serotonin syndrome

A

Co-administration of SSRI and MAOI

41
Q

Which two psychiatric meds have a distinct discontinuation syndrome?

A

SSRIs and SNRIs

42
Q

Side effects of SNRIs

A

GI: dio, N/V

Neuro: tremor, agitation, akathisia, myoclonus

Autonomic: tachycardiac, HTN

Psych: agitation, anxiety, insomnia, mania

Other: sexual dysfunction, seizures (rare)

43
Q

Which antidepressants can also be used for sedation (to induce sleep)?

A

Mirtazapine (NaSSA) and trazodone (SARI)

-so sedating that sometimes used as sleep aid

44
Q

Side effects of mirtazapine

A

Mirtazapine (Remeron) = NaSSA

Side effects

  • sedation
  • increased appetite/weight gain

Serious AEs:
-Agranulocytosis and other blood abnormalities

45
Q

Which psychiatric medications have an association w/ agranulocytosis

A

(1) Clozapine = atypical antipsychotic
(2) Mirtazapine = NaSSA antidepressant
(3) Carbamazepine = mood stabilizer/anticonvulsant

46
Q

Side effects of SARIs

A

SARIs = Trazodone and nefazodone

Side effects:

  • sedation
  • nausea
  • dizziness
  • mania
47
Q

Which antidepressant could be used to avoid sexual dysfunction

A

SARIs (trazodone and nefazodone) b/c due to 5HT2A blockade sexual dysfunction is avoided

48
Q

Which antidepressant can cause priapism

A

Priapism (prolonged erection) is a rare, serious, AE of trazodone (SARI)

49
Q

Which antidepressant has a black box warning for liver toxicity?

A

Nefazodone (SARI)

50
Q

Which psychiatric meds can cause liver toxicity?

A
  • Nefazodone: SARI antidepressant
  • Carbamazepine: mood stabilizer/anticonvulsant
  • Valproic acid: mood stabilizer/anticonvulsant
  • Atomoxetine: novel CNS stimulant
51
Q

Side effects of bupropion

A
  • activation
  • insomnia
  • nausea
  • tremor

Serious AE: seizures at higher doses (hence why contraindicated in seizure d/o)

52
Q

Side effect profile of Vilazodone

A

Vilazodone = selective serotonin reuptake inhibition and serotonin partial agonist

-side effects similar to SSRIs, but theoretically lower risk of sexual dysfunction and weight gain

53
Q

Benefit of buspirone over alprazolam

A

Buspirone (5HT1A agonist nonbenzo anxiolytic) vs. alprazolam (benzo, Xanax)

Buspirone- doesn’t have sedation or addictive potential of benzos

54
Q

Are benzos lethal in OD?

A

Such a high therapeutic index that generally not lethal in OD, but can be if

  • preexisting cardiopulmonary compromise
  • mixed w/ other sedatives or EtOH
55
Q

Side effects of propranolol

A

Proproanolol (beta blocker) side effects:

  • dizziness
  • fatigue
  • bradycardia and hypertension
56
Q

Side effects of hydroxyzine

A

Hydroxyzine (nonbenzo anxiolytic for situation anxiety) side effects:

  • sedation
  • weight gain
  • anticholinergic side effects
57
Q

Side effects of buspirone

A
  • dizziness
  • headache
  • fatigue
  • GI distress

*doe NOT have the sedative or addictive potential of benzos

58
Q

Side effects of benzos

A
  • drowsiness
  • dizziness and ataxia
  • cognitive impairment/amnesia
  • tolerance
  • dependence
  • withdrawal
59
Q

Describe the withdrawal syndrome of benzodiazepines

A

Anxiety, insomnia, restlessness, agitation, irritability, muscle tenison

60
Q

Which two drugs can be lethal in withdrawal?

A

EtOH and Benzodiazepine withdrawal can be life-threatening

61
Q

Side effects of zolpidem

A

Zolpidem (Ambien, GABAergic for insomnia)

  • dizziness
  • N/V, GI distress
62
Q

Side effects of zaleplon

A

Zaleplon (Sonata, GABAergic for insomnia)

  • dizziness
  • dyspepsia
63
Q

Side effects of eszopiclone

A

Eszopiclone (Lunesta)

-headache

64
Q

Side effects of diphenhydramine

A

Diphenhydramine (Benadryl)

  • sedation
  • weight gain
  • anticholinergic side effects
65
Q

Side effects of Ramelteon

A

Ramelteon = melatonin receptor agonist to normalize circadian rhythm

  • dizziness
  • fatigue
66
Q

Main side effects of lithium

A
  • GI irritation
  • polyuria, polydipsia, nephrogenic diabetes insipidus
  • tremor**
  • benign leukocytosis
  • weight gain
  • subtle incoordination, cognitive blunting
67
Q

Signs of lithium toxicity

A

Nausea, diarrhea, vomiting

  • oligouria
  • ataxia, coarse tremors, increased DTRS
  • obtundation (altered level of consciousness)
  • seizure and death
68
Q

Serious adverse effects of lithium

A
  • lithium toxicity
  • thyrotoxicity
  • long term nephrotoxicity
  • cardiac arrhtyhmias and T-wave flattening
69
Q

Adverse effects of carbamazepine

A
  • N/V/D
  • sedation, light headedness, tremor
  • cognitive blunting
  • electrolyte abnormalities (hyponatremia)
  • anticholinergic side effects
  • rash (may progress to Stevens-Johnson syndrome)
  • weight gain
70
Q

Signs of carbamazepine overdose

A

Carbamazepine overdose => coarse tremor, coma, death

71
Q

What lab results are monitored on carbamazepine

A
  • Blood count (for blood dyscrasias)
  • liver fxn
  • metabolic fxn
72
Q

Serious adverse effects of carbamazepine

A
  • Blood dyscrasias: aplastic anemia, agranulocytosis, thrombocytopenia
  • hepatotoxicity
73
Q

What lab results are monitored on valproic acid?

A
  • serum level
  • blood count
  • liver and pancreatic fxn
74
Q

Serious adverse effects of valproic acid

A
  • thrombocytopenia (low platelet count)
  • hemorrhagic pancreatitis
  • hepatotoxicity
  • polycystic ovaries
75
Q

Signs of valproic acid overdose

A

Coarse tremor, coma, death

76
Q

General side effects of anticonvulsants

A
  • N,V,D
  • sedation, light headedness, tremor
  • cognitive blunting
  • weight gain
77
Q

What drug can commonly cause Stevens-Johnson syndrome?

A

Lamotrigine = anticonvulsant used as mood stabilizer

78
Q

Describe Steven Johnson syndrome

A

Type of toxic epidermal necrolysis in which cell death causes the epidermis to separate from the dermis

  • mortality rate of about 5%
  • can start w/ fever, sores, and fatigue => often misdiagnosed as infection
79
Q

Side effects of CNS stimulants

A
  • anxiety
  • insomnia
  • anorexia
  • tachycardia
80
Q

Serious AEs of CNS stimulants

A
  • drug dependence
  • hypertension
  • cardiac arrhythmias
  • cardiovascular collapse (rare)
81
Q

Serious AEs of atomoxetine

A

black box warning for severe liver injury

82
Q

AEs of atomoxetine

A
  • dyspepsia, N,V
  • anorexia
  • dizziness
  • insomnia
  • sexual dysfxn

Psychopharm (10 decks)

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