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MRCPsych Paper A: Clinical Psychopharmacology > Off-Target (Adverse) Effects and Management > Flashcards

Off-Target (Adverse) Effects and Management Flashcards

1
Q

What is the mechanism behind how antipsychotics cause postural hypotension?

A

Antagonist effect on alpha-1 adrenergic receptors (α1-blockade)

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2
Q

Which antipsychotics cause postural hypotension?

A
  1. Clozapine +++
  2. Quetiapnie ++
  3. Risperidone ++
  4. Olanzapine +
  5. Paliperidone +
  6. Ziprasidone +
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3
Q

Which antipsychotics should be used when postural hypotension is a probelm?

A
  1. Amisulpride
  2. Aripiprazole
  3. Haloperidol
  4. Sulpiride
  5. Trifluoperazine
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4
Q

What is the mechanism behind how antipsychotics cause sedation?

A

Antagonist effect on histamine H₁ receptors (H₁ blockade)

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5
Q

Which antipsychotics cause sedation?

A
  1. Clozapine +++
  2. Chlorpromazine
  3. Quetiapine ++
  4. Olanzapine ++
  5. Levomepromazine
    …
  6. Risperidone +
  7. Paliperidone +
  8. Loxapine +
  9. Ziprasidone +
  10. Asenapine +
    …
  11. Aripiprazole -
  12. Cariprazine -
  13. Lurasidone -
  14. Haloperidol -
  15. Amisulpride -
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6
Q

What is the mechanism behind how antipsychotics cause sexual dysfunction?

A

Different mechanism but mainly:
D2 receptor blockade

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7
Q

Which antipsychotics cause sexual dysfunction?

A
  1. Risperidone
  2. Paliperidone
  3. Haloperidol
  4. Clozapine
  5. Olanzapine
  6. Quetiapine
  7. Aripiprazole
  8. Asenapine
  9. Lurasidone
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8
Q

What is the mechanism behind how antidepressants cause sexual dysfunction?

A

5-HT2A stimulation:
- Seratonin overactivity inhibits dopamine release in the brain which is vital for sexual desire and orgasm

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9
Q

What is the mechanism behind how antipsychotics cause weight gain?

A
  1. Antagonist effect on histamine H₁ receptors (H₁ blockade)
  2. Antagonist effect on serotonin 5-HT₂C receptors (5-HT₂C blockade)
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10
Q

Which antipsychotics cause weight gain?

A
  1. Clozapine HIGH
    …
  2. Olanzapine MODERATE
  3. Chlorpromazine MODERATE
  4. Quetiapine MODERATE
  5. Risperidone MODERATE
  6. Paliperidone MODERATE
    …
  7. Amisulpride LOW
  8. Asenapine LOW
  9. Aripiprazole LOW
  10. Haloperidol LOW
  11. Sulpiride LOW
  12. Trifluoperazine LOW
  13. Ziprasidone LOW
  14. Lurasidone LOW
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11
Q

What is the mechanism behind how antidepressants cause weight gain?

A
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12
Q

Which antidepressants cause weight gain?

A

High Risk:
1. Mirtazapine
2. Paroxetine (SSRI)
3. Amitriptyline, Nortriptyline, Imipramine (TCAs)
4. Phenelzine (MAOI)
…
Moderate Risk
5. Citalopram, Escitalopram
6. Sertraline
7. Duloxetine, Venlafaxine (SNRIs)
…
Low risk / Weight-Neutral / May Cause Weight Loss
8. Bupropion (DA/NE reuptake inhibitor)
9. Fluoxetine (often causes mild early weight loss; may rebound)
10. Vortioxetine, Agomelatine (good metabolic profile)

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13
Q

What is the mechanism behind how antipsychotics cause QTc prolongation?

A

Blockage of potassium (K+ channels)

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14
Q

Which antipsychotics cause QTc prolongation?

A

HIGH risk:
Thioridazine
Ziprasidone
Haloperidol (IV especially)
Chlorpromazine
Pimozide
…
MODERATE risk:
Quetiapine
Risperidone
Paliperidone
Iloperidone
Asenapine
…
LOW risk:
Olanzapine
Lurasidone
Aripiprazole
Cariprazine
Brexpiprazole

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15
Q

What is the mechanism behind how antipsychotics cause EPSEs?

A

Dopamine D2 receptor blockade in the nigrostriatal pathway

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16
Q

Which antipsychotics cause EPSEs?

A

HIGH risk
1. Haloperidol
2. Fluphenazine
3. Perphenazine
4. Loxapine
…
MODERATE risk
5. Risperidone
6. Paliperidone
7. Ziprasidone
8. Olanzapine
…
LOW risk
9. Quetiapine
10. Aripiprazole
11. Cariprazine
12. Brexpiprazole
13. Clozapine

17
Q

What is the mechanism behind how antipsychotics cause neuroleptic malignant syndrome?

A

Sudden and severe D2 receptor blockade

18
Q

Which antipsychotics have the highest risk of neuroleptic malignant syndrome?

A
  1. Haloperidol
  2. Fluphenazine
  3. Chlorpromazine
19
Q

What is the mechanism behind how antidepressants cause serotonin syndrome?

A

Blocking the serotonin transporter (SERT)
→ prevents reuptake of serotonin
→ more serotonin stays in the synapse

20
Q

Which antidepressants have the highest risk of serotonin syndrome?

A
  1. MAOIs (e.g., phenelzine, tranylcypromine)
  2. SSRIs (especially fluvoxamine, paroxetine, fluoxetine)
  3. SNRIs (e.g., venlafaxine, duloxetine)
  4. TCAs (e.g., clomipramine, imipramine)
  5. Atypical antidepressants with serotonergic effects (e.g., trazodone, vilazodone, vortioxetine)
  6. Mirtazapine
  7. Bupropion
  8. Agomelatine
21
Q

Give examples of idiosyncratic psychiatric drug reactions

A
  1. Agranulocytosis from clozapine
  2. Hepatotoxicity/allergic hepatitis from sodium valproate, carbamazepine, phenothiazines
  3. Skin reactions e.g. SJS/TEN from lamotrigine (esp. rapid titration), carbamazepine
  4. Myocarditis/cardiomyopathy from clozapine (usually early in treatment)

MRCPsych Paper A: Clinical Psychopharmacology (18 decks)

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