Psychopharmacology Side Effects

Question 1

HAM side effects

Answer 1

(antihistamine - sedation, weight gain; antiadrenergic - hypotension, antimuscarinic - dry mouth, blurred vision, urinary retention) Found in tricyclic antidepressants (TCAs) and low-potency antipsychotics.

Question 2

Serotonin Syndrome

Answer 2

Confusion, flushing, diaphoresis, tremor, myoclonic jerks, hyperthermia, hypertonicity, rhabdomyolysis, renal failure, and death. *occurs when there is too much serotonin, classically when SSRIs and MAOIs are combined. Tx: stop drugs

Question 3

Hypertensive Crisis

Answer 3

Caused by buildup of stored catecholamines. MAOIs plus foods with tyramine (red wine, cheese, chicken liver, cured meats) or plus sympathomimetics.

Question 4

Extrapyramidal side effects (EPS)

Answer 4

Parkinsonism - mask like face, cogwheel rigidity, pill-rolling tremor; akathisia - restlessness and agitation; dystonia - sustained contraction of muscles of neck, tongue, eyes, diaphragm

• Occurs with high-potency traditional antipsychotics
• Reversible
• Occurs within days of starting medication
• Can be life threatening (eg dystonia of the diaphragm causing asphyxiation)

Question 5

Hyperprolactinemia

Answer 5

Occurs with high-potency traditional antipsychotics and risperidone

Question 6

Tardive dyskinesia

Answer 6

Choreoathetoid muscle movements, usually of mouth and tongue.

• Occurs after years of antipsychotic use (particularly high-potency typical antipsychotics)
• Can be irreversible

Question 7

Neuroleptic malignant syndrome

Answer 7

Fever, tachycardia, hypertension, tremor, elevated creatine phosphokinase (CPK), “lead pipe” rigidity.

• Can be caused by all antipsychotics after short or long time (inc. with high-potency traditional antipsychotics)
• A medical emergency with 20% mortality rate

Question 8

Drug Interactions

Answer 8

Cytochrome P450 is a group of enzymes in the liver that metabolize many common drugs, including psychiatric drugs.

• Some induce the system, which means that they make the system metabolize drugs faster - drug levels decrease
• Some drugs inhibit the system, which mean that they make the system metabolize drugs more slowly - drug levels increase

Question 9

Common cytochrome P450 enzymes important in metabolizing psychiatric drugs include:

Answer 9

CYP3A4, CYP2D6, CYP1A2, CYP2C9, CYP2C19

Question 10

Important CYP450 inducers include:

Answer 10

• Smoking (1A2)
• Carbamazepine (1A2, 2C9, 3A4)
• Barbiturates (2C9)
• St. John’s Wort (2C19, 3A4)

Question 11

Important CYP450 inhibitors include:

Answer 11

• Fluvoxamine (1A2, 2D6, 3A4)
• Fluoxetine (2C19, 2C9,2D6)
• Paroxetine (2D6)
• Duloxetine (2D6)
• Sertraline (2C19)

Question 12

Anticholinergics are known to exacerbate…

Answer 12

Alzheimer disease

Question 13

Benzotropine

Answer 13

Drug of choice to treat the extrapyramidal symptoms produced by neuroleptics.

Question 14

Common side effect of anticholinergics..

Answer 14

Constipation

Question 15

Tardive dyskinesia:

Answer 15

Characterized by grimacing and tongue protrusion

Question 16

Acute dystonia:

Answer 16

Usually characterized by twisting and abnormal postures

Question 17

Akathisia:

Answer 17

Characterized by inability to sit still

Question 18

Bradykinesia:

Answer 18

Characterized by decreased or slow body movement