Side Effects (General)

Question 1

What are HAM side effects? Which drugs cause them?

Answer 1

HAM - antihistamine, antiadrenergic, and antimuscarinic. Caused by tricyclic antidepressants (TCAs) and low-potency antipsychotics

Question 2

What are antihistamine side effects? (Name 2)

Answer 2

Sedation and weight gain

Question 3

What are antiadrenergic side effects? (Name 1)

Answer 3

Hypotension

Question 4

What are antimuscarinic side effects? (Name 4)

Answer 4

Dry mouth, blurred vision, urinary retention, constipation

Question 5

What are the symptoms of serotonin syndrome? (Name 10)

Answer 5

Confusion, flushing, diaphoresis, tremor, myoclonic jerks, hyperthermia, hypertonicity, rhabdomyolysis, renal failure, and death

Question 6

Which 2 medication classes when used in combination are associated with serotonin syndrome?

Answer 6

SSRIs and MAOIs

Question 7

What is the treatment for serotonin syndrome?

Answer 7

Stop medications, offer supportive care

Question 8

What 2 things can cause hypertensive crisis?

Answer 8

1. Sympathomimetics (cocaine)
2. Buildup of stored catecholamines, caused by combination of MAOIs with tyramine-rich foods (eg., red wine, cheese, chicken liver, cured meats)

Question 9

What are extrapyramidal side effects (name the 3 main classes)?

Answer 9

Parkinsonism, akathisia, and dystonia

Question 10

What are Parkinsonism extrapyramidal side effects? (Name 4)

Answer 10

Masklike face, cogwheel rigidity, bradykinesia, pill-rolling tremor

Question 11

What are akathisia EPS? (Name 3)

Answer 11

Restlessness, need to move, and agitation

Question 12

What are dystonia EPS? Which 4 body parts do they occur in?

Answer 12

Sustained, painful contraction of muscles of neck, tongue, eyes, and/or diaphragm

Question 13

Which medications cause EPS?

Answer 13

High-potency, typical (first generation) antipsychotics

Question 14

What is the typical presentation of EPS?

Answer 14

Reversible; occurs within hours to days of starting medications or increasing doses. Can be life-threatening in rare cases

Question 15

Which medications cause hyperprolactinemia?

Answer 15

High-potency, typical (first generation) antipsychotics and risperidone

Question 16

Define tardive dyskinesia

Answer 16

Choreoathetoid muscle movements, usually of the mouth and tongue (can affect extremities as well)

Question 17

Which medications cause tardive dyskinesia? What is the time course?

Answer 17

Occurs after years of antipsychotic use (more likely with high-potency first-generation antipsychotics). Usually irreversible

Question 18

What symptoms occur in neuroleptic malignant syndrome? (Name 7)

Answer 18

Mental status changes, fever, tachycardia, hypertension, tremor, elevated CPK, “lead pipe” rigidity

Question 19

Which medications cause neuroleptic malignant syndrome?

Answer 19

Caused by any antipsychotic after a short or long time (increased risk with high-potency, typical antipsychotics)

Question 20

If a medication induces Cytochrome P450, drug levels…

Answer 20

Decrease

Question 21

If a medication inhibits Cytochrome P450, drug levels…

Answer 21

Increase

Question 22

Tobacco affects CYP450 by:

Answer 22

Inducing CYP1A2

Question 23

Carbamazepine affects CYP450 by:

Answer 23

Inducing CYP1A2, CYP2C9, and CYP3A4

Question 24

Barbiturates affect CYP450 by:

Answer 24

Inducing CYP2C9

Question 25

St. John’s wort affects CYP450 by:

Answer 25

Inducing CYP2C19, and CYP3A4

Question 26

Fluvoxamine affects CYP450 by:

Answer 26

Inhibiting CYP1A2, CYP2C19, and CYP3A4

Question 27

Fluoxetine affects CYP450 by:

Answer 27

Inhibiting CYP2C19, CYP2C9, and CYP2D6

Question 28

Paroxetine affects CYP450 by:

Answer 28

Inhibiting CYP2D6

Question 29

Duloxetine affects CYP450 by:

Answer 29

Inhibiting CYP2D6

Question 30

Sertraline affects CYP450 by:

Answer 30

Inhibiting CYP2D6