Neuro/Psych/Rheumatology drug SE Flashcards
9 Valproate?
Interaction?
Alopecia Encephalitis Liver failure/Pancreatitis Weight gain Tremor Thrombocytopaenia Teratogenic Oedema Ataxia
Interaction - P450 inhibitor
4 Lamotrigine?
Breastfeeding?
Rash
Steven Johnson syndrome
Tremor
Agitation
Avoid in breastfeeding - risk of SJS in kid
5 Carbamazepine?
Interaction?
Worsening of generalised epilepsy Leucopaenia Drowsiness Double vision Impaired balance
Interaction - P450 inducer
1 Levetiracetam?
Depression/mood swings
3 Topiramate?
Sedation
Dysphasia
Weight loss
Phenytoin - 6 chronic SE?
Interaction
Gingival hyperplasia Hirsutism Megaloblastic anaemia Osteomalacia Lymphadenopathy Aplastic anaemia
Interaction - P450 inducer
Phenytoin - 5 acute toxicity?
Cerebellar signs - confusion, drowsy, ataxia, nystagmus, slurred speech
Lithium - 7 chronic SE?
Drugs to avoid?
Fine tremor Metallic taste/dry mouth Weight gain Hypothyroidism QT prolongation Renal function decline - diabetes insipidus Teratogenic - Ebstein's anomaly
Avoid: ACEI, NSAIDs, Diuretics
Lithium - 5 toxicity?
D&V Coarse tremor Myoclonus Confusion & drowsiness Kidney failure
General SSRI?
GI upset Vivid dreams GI bleeding - give with PPI, avoid NSAIDs Sexual dysfunction Transient worsening of symptoms Hyponatraemia in elderly
TCA?
Sedation Weight gain QT prolongation Postural hypotension Dry mouth, urinary retention, blurred vision etc
MOAI? (4)
What to avoid with?
Reversible and Irreversible?
Hypertensive crisis if have cheese, red wine, game meat
(Rx: phentolamine infusion)
Also anticholinergic effects, seizures and hepatic impairment
Avoid with other antidepressants/sedatives e.g. barbiturates (P450 inhibitor - potentiates them)
Reversible - Moclobemide (less SE but less effective)
Irreversible - Phenelzine
Mirtazapine?
Weight gain
Sedation (caution with other sedatives)
Rarely, blood dyscrasias or seizures
Trazodone:
- MOA
- Use?
SARI - Serotonin/NA reuptake inhibitor and antagonist
Can be used to augment SSRI
Typical antipsychotics?
EPSE:
- Acute dystonia (procyclidine)
- Akathisia (propranolol)
- Parkinsonism (levodopa/stop drug)
- Tardive dyskinesia (tetrabenazine symptomatically)
Atypical antipsychotics:
Metabolic syndrome - insulin resistance/high BP, obesity, high cholesterol Drowsiness Hyperprolactinaemia Sexual dysfunction Risk of stroke in elderly
Clozapine?
Agranulocytosis (bloods weekly for 6 months, then 2 weekly for 6 months, then 4 weekly)
Myocarditis (ECG 3 monthly)
Aripiprazole?
Postural hypotension
Constipation
Headache
What SSRI is:
- safest in cardiac problems?
- safest in epilepsy?
- assoc w QTc prolongation?
- more alerting?
- assoc w anticholinergic SE? (e.g. drowsiness)
- used post-MI?
safe in cardiac - sertraline
safe in epilepsy - citalopram
assoc w QTc prolongation - citalopram
more alerting - fluoxetine
anticholinergic - paroxetine (drowsiness)
post-MI - sertraline
Who to avoid TCA in? (4)
Recent MI or cardiac problems
Older people
Suicidal ideation (cardiotoxic)
Mania
Antidepressant best for atypical depression?
MAOI
Indications for ECT?
Depression:
- life-threatening poor fluid intake
- strong suicidal ideation
- psychotic features
- antidepressants not working
Established Mania
Schizophrenia:
- catatonia
- positive psychotic symptoms
- schizoaffective disorder
SE of ECT?
Memory loss
Confusion, headache, nausea, muscle pain
ECG changes that can occur with:
- TCA?
- Lithium?
TCA - QT prolongation, ST elevation
Lithium - T-wave flattening/inversion
Monitoring of Lithium?
prior, initiation, 3 monthly, 6 monthly
Prior: U&E, TFT, ECG
Initiation: Li level 12 hour post-dose and every 5 days until level stable
3 monthly: Li and U&E
6 monthly: TFT
What to check prior to initiation of valproate?
PLT count
LFT
What receptors does Clozapine work on?
5-HT2
D4
Effects of anti-psychotics blocking:
- alpha-adrenergic receptors?
- cholinergic?
- Histamine?
- 5HT2c?
postural hypotension
Dry mouth, blurred vision, constipation, urinary retention
Sedation & weight gain
Weight gain (mainly Olanzapine and Clozapine)
What antipsychotics are most likely to cause weight gain?
Olanzapine
Clozapine
(due to 5-HT2c blockade)
What antipsychotic is most likely to cause:
- QT prolongation?
- EPSE/neuroleptic malignant syndrome?
- blue-grey discolouration?
QT - Haloperidol
EPSE/Neuro mal - Typicals
Blue-grey - chlorpromazine
Within atypical psychotics, what drugs does EPSE happen in higher doses?
Risperidone, olanzapine
uncommon with aripiprazole, rare with clozapine
What antipsychotic to use for:
- avoidance of EPSE?
- least sedating?
- most sedating?
- avoid weight gain?
- treatment-resistant?
- depot? (poor compliance)
avoid EPSE - atypicals
least sedating - Haloperidol, Risperidone
Most sedating - Olanzapine, Chlorpromazine
Avoid weight gain - Aripiprazole, Haloperidol
Treatment-resistant - Clozapine
Depot - Risperidone
Methotrexate SE? (4)
Pulmonary fibrosis
Liver cirrhosis
Teratogenic
Marrow suppression
Prednisolone SE? (8)
Osteoporosis impaired glucose tolerance hypertension cushingoid features adrenal suppression AVN femoral head immunosuppression glaucoma/cataracts
Anti-TNF drugs?
Etanercept?
Infliximab?
TB reactivation
Etanercept - demyelination
Infliximab - given IV
Sulfasalazine?(1)
reduced sperm
hydroxychloroquine?(1)
Irreversible retinopathy
Corneal deposits
leflunomide? (1)
interstitial lung disease
IM gold? (2)
proteinuria
peripheral neuropathy
Penicillamine? (5)
Rash myasthenia syndrome goodpastures proteinuria anaemia
Azathioprine? (1)
Marrow suppression (aka myelosuppression)
Which rheumatoid drugs are teratogenic?
Methotrexate - both male and female stop 3 months before pregnancy
Leflunomide
