Medication Side Effects

Question 1

St. John’s wort (mild to moderate depression)

Answer 1

— Avoid use with other psychoactive drugs
— May increase ADHD symptoms in patients taking methylphenidate
— May increase mania in bipolar patients
— May trigger psychosis in patients with schizophrenia
— Also interacts poorly with Xanax, amitriptyline, SSRIs

—May increase sensitivity to sunlight

Question 2

What happens if someone is on lithium and becomes dehydrated?

Answer 2

The blood level of lithium will increase, resulting in toxicity.
—Patients should drink 8-10 glasses of water per day and may increase fluids during hot weather.

Question 3

What adjustments for sodium should a patient taking lithium make in their diet? What happens if the sodium level is too high or too low?

Answer 3

Patients should maintain a fairly consistent level of sodium intake because lithium levels increase with lower sodium levels and decrease with higher sodium levels.

Question 4

What drug is used in alcohol abuse, and what happens if the patient drinks alcohol when it is taken?

Answer 4

—Disulfuram
—Patients must abstain from drinking for 12 hours before initiating treatment.
—Disulfuram interferes with breakdown of acetaldehyde from ethanol
—If alcohol is consumed, acetaldehyde builldup causes flushing, head/neck pain, vomiting, diaphoresis, tachycardia, hyperventilation, weakness, and blurred vision
—Severe: MI, heart failure, resp. depression

Question 5

What blood levels should be monitored before starting lithium?

Answer 5

—Kidney and liver
—TSH: lithium decreases production of thyroid hormones, so lithium-induced hypothyroidism can occur
—40-50% of patients on lithium develop goiter

Question 6

What drugs prolong QT?

Answer 6

Citalopram

Question 7

What are normal levels of T3, T4, and TSH?

Answer 7

T3: 1.2-3.4 nmol/L
T4: 50-165 nmol/L or 5-12 ug/dL
Free T4: 13-27 pmol/L or 1.0-2.1 ug/dL
TSH: 0.4 to 4.0 mIU/L

Question 8

What are the side effects of cholinesterase inhibitors?

Answer 8

Nausea/vomiting/diarrhea
Loss of appetite
Increased gastric acid secretion

Question 9

What is the benefit of using buprenorphine?

Answer 9

Ceiling effect reduces risk of overdose

Less likely to cause respiratory depression

Question 10

What are side-effects of ECT?

Answer 10

Nausea
Muscle aches
Headache
Short-term memory loss

Most memory problems will resolve within several weeks

Question 11

What medications may produce a rash?

Answer 11

Lamotrigine/Lamictal may produce Stevens-Johnson syndrome, which is a toxic necrolysis.

• Fever, sore throat, fatigue
• Ulcers in mucus membranes (mouth/lips)

Question 12

What is Stevens-Johnson syndrome?

Answer 12

A toxic necrolysis that may be a side effect of LAMOTRIGINE.

Fever, sore throat, fatigue.

Ulcers in mucus membranes (mouth, lips).

Question 13

What does anticholinergic toxicity look like?

Answer 13

DRY as a bone
HOT as a hare
RED as a beet
BLIND as a bat
MAD as a hatter

It is LIFE THREATENING and may result in seizures, stupor, and coma.

Question 14

A patient presents with flushed face, hyperthermia, blurred vision, and agitation. What is the cause?

Answer 14

Anticholinergic toxicity; treat with PHYSOSTIGMINE.

Question 15

What is anticholinergic toxicity treated with?

Answer 15

PHYSOSTIGMINE, which is a cholinesterase inhibitor.

Question 16

What is neuroleptic malignant syndrome?

Answer 16

— A rare but serious response to neuroleptics; most common in first generation antipsychotics

—Dystonia and rigidity, hyperthermia, autonomic instability (especially high HR and BP)
—Diaphoresis

—Treated with BROMOCRIPTINE

Question 17

A patient presents with hyperthermia, autonomic instability, dystonia/rigidity and diaphoresis. What is happening?

Answer 17

Neuroleptic malignant syndrome; treat with BROMOCRIPTINE.

Question 18

What drug is used to treat neuroleptic malignant syndrome?

Answer 18

BROMOCRIPTINE — a dopamine agonist that increases dopamine availability.