Medication Side Effects

Question 1

First Generation Antipsychotic (FGA) Side Effects

Answer 1

a) anticholinergic side effects: most likely with low potency FGAs (e.g., chlorpromazine and thioridazine) and include dry mouth, blurred vision, urinary retention, constipation, tachycardia

b) extrapyramidal side effects: most likely with high-potency FGAs (e.g., haloperidol and fluphenazine) and include parkinsonism, dystonia, akathisia, and tardive dyskinesia

c) Neuroleptic Malignant Syndrome (NMS)

Question 2

Second Generation Antipsychotic (SGA) Side Effects

Answer 2

anticholinergic effects, neuroleptic malignant syndrome, and metabolic syndrome

Question 3

SSRI Side Effects

Answer 3

mild anticholinergic effects, gastrointestinal disturbances, insomnia, anxiety, and sexual dysfunction; abrupt cessation of an SSRI can cause discontinuation syndrome; combining an SSRI with an MAOI, lithium, or other serotonergic drug can cause serotonin syndrome

Question 4

SNRI Side Effects

Answer 4

Because of their effects on norepinephrine, they can elevate blood pressure and may be contraindicated for patients with hypertension or heart problems. Like the SSRIs, they can cause discontinuation syndrome when abruptly stopped and serotonin syndrome when combined with other serotonergic drugs.

Question 5

Bupropion (Wellbutrin/Zyban) Side Effects

Answer 5

skin rash, decreased appetite and weight loss, agitation, insomnia, dizziness, and seizures; bupropion and other antidepressants that increase levels of norepinephrine and dopamine have an energizing effect, which means they’re useful for patients who have low energy and motivation but not for those who have insomnia or are very anxious.

Question 6

TCA Side Effects

Answer 6

Cardiovascular effects (e.g., hypertension, tachycardia, orthostatic hypotension), anticholinergic effects, sedation, weight gain, and sexual dysfunction; because they’re cardiotoxic and lethal in overdose, the TCAs must be prescribed with caution for patients who have heart disease or are suicidal.

Question 7

MAOI Side Effects

Answer 7

anticholinergic effects, orthostatic hypotension, sedation, and sexual dysfunction; they may also produce a hypertensive crisis when taken in conjunction with certain drugs (e.g., amphetamines, antihistamines) or food containing tyramine (e.g., aged cheese and meat, soy products, beer, red wine, sauerkraut, fava beans, ripe bananas).

Question 8

Benzodiazepine Side Effects

Answer 8

The most common side effects are drowsiness and sedation; others include weakness, unsteadiness, impaired memory and concentration, anticholinergic effects, sexual dysfunction, and, in older adults, disorientation and confusion. These drugs can have a paradoxical effect and cause excitability and anxiety, and chronic use can result in tolerance, dependence, and withdrawal symptoms, which may cause rebound anxiety and depression, anorexia, delirium, and seizures. Combining a benzodiazepine with alcohol can have a synergistic depressant effect that can be lethal.

Question 9

Buspirone (BuSpar) Side Effects

Answer 9

dizziness, dry mouth, sweating, nausea, and headache

Question 10

Narcotic-Analgesic (Opioid) Side Effects

Answer 10

Side effects include dry mouth, nausea, pupil constriction, postural hypotension, drowsiness, dizziness, constipation, and respiratory depression, and an overdose can cause convulsions, coma, and death. Chronic use leads to dependence, tolerance, and withdrawal symptoms. Initial withdrawal symptoms are similar to the flu (e.g., runny nose, watery eyes, nausea, muscle aches, fever, and yawning); these are followed by insomnia, abdominal cramps, vomiting, diarrhea, rapid heartbeat, and elevated blood pressure.

Question 11

Propranolol (Inderal) Side Effects

Answer 11

hypotension, decreased sex drive, insomnia, nausea and vomiting, dry eyes, dizziness, and depression; abrupt discontinuation is contraindicated because it can cause rebound hypertension, tremors, headaches, confusion, and cardiac arrhythmia.

Question 12

Lithium Side Effects

Answer 12

Common side effects include nausea, vomiting, diarrhea, a metallic taste, increased thirst, weight gain, hand tremor, fatigue, and impaired memory and concentration. Lithium levels must be regularly checked to avoid lithium toxicity, which can cause seizures, coma, and death.

Question 13

Anticonvulsant Drug Side Effects

Answer 13

Side effects include nausea, dizziness, sleepiness, lethargy, ataxia, tremor, visual disturbances, and impaired concentration. Blood levels must be monitored to avoid liver failure when taking valproic acid or carbamazepine and to avoid agranulocytosis (low white blood cell count) and aplastic anemia when taking carbamazepine.

Question 14

Psychostimulant Side Effects

Answer 14

Common side effects are insomnia, nervousness, decreased appetite, weight loss, and abdominal pain. These drugs can also suppress growth in children, but this can be reversed with “drug holidays” during school vacations.

Question 15

Anticholinergic side effects

Answer 15

side effects which can occur from low potency FGAs as well as SGAs, SSRIs, TCAs, MAOIs, and benzodiazepines. They include dry mouth, blurred vision, urinary retention, constipation, and tachycardia.

Question 16

Neuroleptic malignant syndrome (NMS)

Answer 16

a rare life-threatening side effect of FGAs and SGAs. Its symptoms include muscle rigidity, a high fever, autonomic dysfunction (e.g., unstable blood pressure, tachycardia, excessive sweating), and an altered mental state (e.g., confusion, combativeness). Treatment involves having the person stop taking the drug at the first sign of symptoms and providing him/her with supportive therapy (e.g., hydration, cooling).

Question 17

Extrapyramidal side effects

Answer 17

side effects which can occur from high-potency FGA use and include parkinsonism (resting tremor, muscle rigidity, slowed movement), dystonia (uncontrollable muscle contractions), akathisia (a sense of inner restlessness), and tardive dyskinesia.

Question 18

Tardive Dyskinesia

Answer 18

An extrapyramidal side effect often occurring from high-potency FGA use. It starts with involuntary, rhythmic movements of the tongue, face, and jaw and, over time, may also affect the limbs and trunk. It is irreversible for some patients and is treated by gradually withdrawing the drug, administering a benzodiazepine, or switching to a second-generation antipsychotic. It can be potentially life threatening, begins after long-term drug use, and is more common in women and older adults.

Question 19

Metabolic Syndrome

Answer 19

Side effect of SGA use. It involves substantial weight gain, high blood pressure, insulin resistance, hyperglycemia, and increased risk for diabetes mellitus and heart disease.

Question 20

Agranulocytosis

Answer 20

a potentially life-threatening condition that involves a dangerously low white blood cell count and requires regular white blood cell monitoring. It can be a side effect of SGAs and anticonvulsant drugs.

Question 21

Discontinuation Syndrome

Answer 21

involves headaches, dizziness, mood lability, impaired concentration, sleep disturbances, and flu-like symptoms. It can be cause by abrupt cessation of an SSRI.

Question 22

Serotonin Syndrome

Answer 22

is potentially fatal and involves extreme agitation, confusion, autonomic instability, hyperthermia, tremor, seizures, and delirium. It occurs by combining an SSRI with an MAOI, lithium, or other serotonergic drug. Treatment requires immediate withdrawal of the serotonergic drugs and providing appropriate medical interventions for its symptoms.

Question 23

Hypertensive Crisis

Answer 23

Symptoms of a hypertensive crisis include a severe throbbing headache, neck pain or stiffness, rapid heart rate, nausea and vomiting, sweating, sensitivity to light, confusion, and delirium. A hypertensive crisis can occur when an MAOI is taken in conjunction with certain drugs (e.g., amphetamines, antihistamines) or food containing tyramine (e.g., aged cheese and meat, soy products, beer, red wine, sauerkraut, fava beans, ripe bananas).