Medication Side Effects Flashcards
What are side effects of lithium?
- acne
- follicular and maculopapular eruptions
- cause and exacerbate psoriasis
- alopecia has been reported
- major side effects: gastrointestinal complaints, tremor, diabetes insipidus, hypothyroidism, weight gain, cardiac arrhythmia, and edema
How does lithium affect ADH?
Lithium decreases the kidney’s ability to respond to ADH, resulting in decreased fluid resorption from the distal tubules and increased urine output
What are side effects of Lamictal?
Anemia, SJS, thrombocytopenia, liver failure, and pancreatitis
What are side effects of oxcarbazepine?
- leukopenia
- thrombocytopenia
- SJS
How does risperidone increase the volume of pituitary adenomas?
blocking dopamine and increasing serum prolactin levels
- when an adenoma grows beyond 1.5cm it can encroach on the medial portion of both optic nerves outside of the sella turcica causing bitemporal hemianopsia
- treatment: stop drug and consider administration of bromocriptine
What are the most sedating TCAs
Amitriptyline, trimipramine and doxepin
What are the least sedating TCAs?
- desipramine
- protriptyline
What medications are not contraindicated with MAOIs?
lithium and phentolamine
Which can cause hypertensive crisis buproprion or venla?
venla
SSRI induced SIADH
- most common in elderly
- irritability, personality changes, decreased appetite, nausea, vomiting, weakness, confusion, hallucinations, severe: seizure, stupor, coma
- as ADH rises the body holds onto water-sodium levels drop
Side effects of phenytoin?
Notorious for causing hirsutism in women, facial dysmorphism, and gingival hypertrophy
- can also cause cerebellar atrophy when taken over a long period of time (ataxic gait, dysmetria of extremities)
What are the side effects of carbamazepine?
Induces own metabolism
SJS
Hyponatremia by an antidiuretic hormone-like effect
Leukopenia
Toxic hepatitis
Side effects of valproate?
- Leukopenia
- Liver failure
- Weight gain
- Hair loss
- Fetal neural tube defects such as spina bifida
- PCOS
Side effects of levetiracetam
Infrequent agitation and hyperactivity
What are symptoms of lithium toxicity?
ataxia, tremor, N/V, nephrotoxicity, muscle weakness, convulsions, coma, lethargy, confusion, hyperreflexia, nystagmus, nonspecific twave changes
TCAs act as what type of antiarrhythmics?
1A
so they can terminate ventricular fibrillation and increase collateral blood supply to ischemic heart tissue
Nortriptyline has a unique therapeutic window between 50 and 150. waht happens over 150
reduced efficacy
valproic acid levels as high as 125
thromocytopenia may occur
- get liver tests at start of treatment and every 6-12 months and valproic acid levels periodically
blockade of muscarinic cholinergic receptors
blurred vision, dry mouth, and difficulty urinating, confusion and delirium
retrograde ejaculation is seen with
thioridazine (very sedating, orthostatic hypotension, anticholinergic side effects, low rates of extrapyramidal symptoms)
desvenlafaxine
- orthostasis
- hyponatremia (especially in elderly)
- hypertension
- black box warning suicidality especially in teens (as with all ssri and snri)
mild to moderate lithium toxicity
- 1.5-2
- vomiting, abdominal pain, ataxia, dizziness, slurred speech, dry mouth, nystagmus
moderate to severe lithium toxicity
2-2.5
- anorexia, muscle fasiculations, clonic limb movements, hpyeractive deep tendon reflexes, choreoathetoid movements, convulsions, delirium, stupor, coma, circulatory failure(low bp, arrhythmia)
severe lithium toxicity
greater than 2.5
generalized convulsions, oliguria, renal failure, death
Does duloxetine have discontinuation withdrawal symptoms
yes and so does paroxetine
do doses of 600mg/ day of clozapine increase chance of seizures compared to lower doses
yes
- also adding lithium to clozapine increases risk of NMS
is clozapine agranulocytosis dose related
no
can smoking decrease clozapine levels
yes
dose dependent side effects for valproic acid
blurred vision, vertigo, GI distrubances, and task performance impairment
dose independent valproic acid side effects
agranulocytosis, SJS, aplastic anemia, hepatic failure, rash, pancreatitis
major side effect of carbamazapine especially in elderly
hyponatremia
- acts like a vasopressin agonist and has antidiuretic actions
eosinophilic collitis is associated with what med
clozapine
pancreatitis is associated with what med
valproic acid
interferon side effects
depression, si, insomnia, and cognitive insufficiency, fatigue
carbamazapine in preg
developmental delay, minor craniofacial abnormalities, spina bifida
babies being breast fed while on fluoxetine
- irritability, vomiting, diarrhea
valproic acid in pregnancy
- neural tube defects, limb and cardiac defects
late in pregnancy can cause clotting abnormalities
lithium in pregnancy
- ebsteins malformation-right ventricular hypoplasia, tricuspid insufficiency
- diureses in childburth can cause toxic lithium levels
