side effects

Question 1

epival

Answer 1

i. common side-effects of valproate include: gastrointestinal side-effects, sedation, tremor, ataxia, dysarthria, weight gain, elevated liver tests (in up to 40%), and hair loss (in up to 10%)
ii. the hair loss is temporary and can be treated with zinc and selenium

common side effects: GI irritation, nausea, sedation, tremor, weight gaun, hair loss

• uncommon: vomiting, diarrhea, ataxia, dysarthria, persistent elevation of transaminases
• rare: fatal hepatotoxicity (mainly in kids), reversible thrombocytopenia, coagulation problems, edema, pancreatitis, agranulocytosis, resp failure, coma, encephalopathy

Question 2

topiramate

Answer 2

i. the most common side effects of topiramate are sedation, dizziness, ataxia, speech problems, psychomotor slowing, abnormal vision, memory problems, paresthesias, and diplopia
ii. there is a risk of nephrolithiasis
iii. topiramate levels increase when it is combined with carbamazepine or with valproate
iv. topiramate can cause angle-closure glaucoma; it should be discontinued if there is ocular hyperemia or periorbital pain

Question 3

clonidine

Answer 3

side effects (dose-related): dry mouth and eyes (40%), fatigue (4%), sedation (10%), dizziness (16%), nausea, hypotension (3%), constipation (10%), sexual dysfunction (3%), weight gain (1%)
so wt gain is rare
Sz arenot evenmentioned

Question 4

buspirone

Answer 4

• buspirone does not have sedative, hypnotic, muscle-relaxant or anticonvulsant effects
  
  • low potential for abuse; not associated with withdrawal
  • agonist or partial agonist on 5-HT1A; also active at 5-HT2 and D2
  • takes 2-3 weeks to exert therapeutic effect

Question 5

carbamazepine

Answer 5

carbamazepine can cause peripheral polyneuropathy.
most common neurological adverse effects include dizziness, sedation, ataxia, and diplopia. These effects can largely be minimized or avoided with slow, gradual titration of the dosage. Carbamazepine may also produce mild peripheral polyneuropathies and involuntary movements.
Carbamazepine also causes GI disturbances - including constipation
Carbamazepine has been associated with agranulocytosis and aplastic anemia
Clinical Handbook of Psychotropics Drugs. pag 148

• carbamazepine can cause aplastic anemia, agranulocytosis, thrombpcytopenia, leucopenia
• minior risk of hepatotoxicty, LFT should be done q3-6 months
3368 e-book
• mild Gi (nause, vomiting, anorexia, gastric distress, constipation, diarrhea) and CNS (ataxia, drowsiness) are most common
• does not appear to cause weight gain
• because of autoinduction side effects may improve
• hematologic effects are not dose related
• 10-15% develop maculopapular rash within first 3 weeks of treatment, can become life threatening SJ syndome, TEN, erythema mulriforme, exfoliative dermatitis
• risk of rash equal to valproate for first two months then much higher for CBZ
• can cause SIADH
• decreases cardiac conduction
• T4 and T3 may be decreased without an increase in TSH