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MJ- Mental Health EOR > Side effects, MOA, CI > Flashcards

Side effects, MOA, CI Flashcards

1
Q

What are the 4 main side effects of clozapine

A
  • Agranulocytosis
  • seizures
  • myocarditis
  • increased mortality in elderly patients w/ dementia related psychosis
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2
Q

Which SSRI can prolong QT interval with increasing blood levels

A

citalopram

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3
Q

Which 2 SSRIs have a greater risk of insomnia/agitation

A

sertraline

fluoxetine

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4
Q

Which SSRI has more frequent diarrhea and GI complaints

A

sertraline

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5
Q

Which 2 SSRIs have withdrawal sxs if not tapered

A

paroxetine

fluvoxamine

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6
Q

Side effect of Venlafaxine

A

increased BP (primarily diastolic) and HR with increasing doses

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7
Q
A
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8
Q

What are the 3 contraindications for haldol

A

parkinson disease

anticoagulant use

severe cardiac disorder

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9
Q

MOA of 1st gen antipsychotics

A

blocks dopamine (D2) receptors

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10
Q

MOA of 2nd gen antipsychotics

A

Dopamine D4 receptor and serotonin (5HT2) antagonists

EPS less common b/c weakly bind to D2 receptors

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11
Q

6 side effects of 2nd gen antipsychotics in general

A
  1. EPS (less common than 1st gen)
  2. Increased prolactin levels
  3. hyperglycemia
  4. hyperlipidemia
  5. weight gain
  6. NMS
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12
Q

What are 2 side effects of olanzapine

A

weight gain

DM

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13
Q

9 side effects of 1st gen antipsychotics

A
  1. EPS (dystonic rxns aka dyskinesia, tardive dyskineia, parkinsonism)
  2. Neuroleptic malignant syndrome
  3. QT prolongation
  4. Cardiac arrhythmias
  5. Sedation
  6. Anticholinergic side effects
  7. Dermatitis
  8. Blood dyscrasias
  9. Incr. prolactin (more than 2nd gen)
  10. weight gain
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14
Q
A
  1. Mental status changes
  2. Extreme muscle rigidity
  3. tremor
  4. autonomic instability
    1. tachycardia
    2. tachypnea
    3. hyperthermia/fever*
    4. ​profuse diaphoresis

**LIFE THREATENING- caused by D2 inhibition**

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15
Q

When does NMS usually occur

A

within 90 days of initiation/dose increase

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16
Q

When do sxs of dystonic reactions (dyskinesia) usually occur

A

hours-days after initiation of typical antipsychotic

due to disruption of Dop-Ach balance (excess Ach)

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17
Q

What sxs are commonly seen in dyskinesia (EPS of antipsychotics)- 5

A
  • intermittent
  • spasms
  • sustained involuntary muscle contractions
    • trismus
    • protrusions of tongue
    • facial grimacing
    • torticollis
    • difficulty speaking
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18
Q

MOA of risperidone and ziprasidone

A

partial D2 receptor and serotonin 5-HT1A receptor antagonist, 5-HT2 receptor antagonist

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19
Q

6 side effects of risperidone and ziprasidone

A
  • EPS
  • Increased prolactin
  • sedation
  • weight gain
  • hypotension
  • prolonged QT
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20
Q

MOA of aripiprazole

A

D2 receptor and serotonin (5-HT2 & 5-HT1) receptor antagonist

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21
Q

MOA of lithium

A

Increases norepinephrine and serotonin receptor sensitivity

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22
Q

3 contraindications to lithium use

A
  1. pregnancy
  2. severe renal disease
  3. cardiac disease
23
Q

side effects of lithium

A
  1. hypothyrodism
  2. sodium depletion
  3. increased urination and thirst
  4. diabetes insipidus
  5. Hyperparathyroidism/hypercalcemia
  6. Seizures
  7. tremor
  8. Headache
  9. Sedation
  10. arrhythmias
  11. N/V/D
  12. weight gain
24
Q

8 common side effects of SSRIs

A
  1. GI upset
  2. sexual dysfunction
  3. HA
  4. Changes in energy level (fatigue, restlessness)
  5. anxiety
  6. insomnia
  7. weight changes
  8. SIADH
25
Q

Avoid citalopram in patients with what condition?

A

long QT syndrome

26
Q

do patients with serotonin syndrome have mydriasis or miosis

27
Q

SNRIs have similar side effects as SSRIs (like hyponatremia and noradrenergic sxs), what are 2 other side effects?

A
  1. Hypertension
  2. Dizziness
28
Q

What are 5 CI/cautions of SNRIs

A
  1. MAOI use
  2. Renal/hepatic impairment
  3. Seizures
  4. Avoid abrupt discontinuation
  5. Caution in patients w/ HTN
29
Q

Increased risk of serotonin syndrome when you combine SNRIs with what?

A

St. John’s Wort

30
Q

MOA of Tricyclic antidepressants

A

inhibits reuptake of serotonin and norepinephrine

31
Q

4 side effects of tricyclic antidepressants

A

1 .anticholinergic effects

  1. sedation
  2. weight gain
  3. prolonged QT interval (best indicator of overdose)
32
Q

What is the best indicator of TCA overdose

A

prolonged QT interval

33
Q

4 sxs of TCA overdose

A
  1. wide complex tachycardia
  2. Neuro symptoms
  3. ARDS
  4. SIADH
34
Q

3 contraindications of TCAs

A
  1. Use of MAOIs
  2. Recent MI
  3. Seizure history
35
Q

MOA of mirtazapine

A

enhances central noradrenergic and serotonergic activity

36
Q

5 side effects of mirtazapine

A
  1. sedation
  2. dry mouth
  3. constipation
  4. weight gain
  5. agranulocytosis

*less sexual dysfunction side effect

37
Q

MOA of bupropion

A

inhibits the neuronal uptake of dopamine and norepinephrine

38
Q

8 side effects of bupropion

A
  1. seizures
  2. agitation
  3. anxiety
  4. restlessness
  5. weight loss
  6. HTN
  7. HA
  8. Dry mouth

***less GI distress and sexual dysfunction compared to SSRIs***

39
Q

5 contraindictions for bupropion

A
  1. Seizure disorder**
  2. eating disorders (ex. bulimia, anorexia)
  3. MAOI use
  4. patients undergoing drug/ETOH detox

**avoid abrupt withdrawal**

40
Q

What is the MOA of MAOIs

A

blocks breakdown of neurotransmitters (dopamine, serotonin, epinephrine, norepinephrine) by inhibiting monoamine oxidase

41
Q

6 side effects of MAOIs

A
  1. Hypertensive crisis (must avoid tyramine contining foods- aged/fermented cheese, wine, beer, smoked meats, chocolates, coffee or tea)
  2. insomnia
  3. anxiety
  4. orthostatic hypotension
  5. weight gain
  6. sexual dysfunction
42
Q

What foods must you avoid when taking MAOIs

A

tyramine containing foods:

  • aged/fermented cheeses
  • wine
  • beer
  • chocolate
  • aged foods
  • smoked meats
  • cofee
  • tea
43
Q

MAOI + TCA may cause what

A

delirium and hypertension

44
Q

MOA of trazadone

A

serotonin antagonist and reuptake inhibitor

antidepressant, anti-anxiety and hypnotic effects

45
Q

3 side effects of trazadone

A
  1. sedation
  2. cardiac arrhythmias
  3. priapism (rare)
46
Q

What are the 3 SNRIs

A

venlafaxine

desvenlafaxine

duloxetine

47
Q

What are the 6 tricyclic antidepressants

A
  1. amitriptyline
  2. nortriptyline
  3. clomipramine
  4. desipramine
  5. doxepin
  6. imipramine
48
Q

what are the 3 nonselective MAOIs

(MAO A &B)

A

Phenelzine

Tranylcypromine

Isocarboxazid

49
Q

Which is the selective MAOI? (MAO B)

A

Selegiline

50
Q

Which MAOI has less chance of HTN crisis induced by tryamine

A

selegiline

51
Q

MOA of dextroamphetamine

A

releases dopamine, norepinephrine and serotonin from the presynaptic neuron, increasing levels at the synaptic cleft

52
Q

Side effects of dextroamphetamine (6)

A
  1. Growth suppression (eventually normalize)
  2. insomnia
  3. appetite suppression
  4. weight loss
  5. GI upset
  6. HA
  7. anticholinergic effects
  8. cardiac arrhythmia
  9. Raynauds phenomenon
  10. Reduced seizure threshold

etc

MJ- Mental Health EOR (4 decks)

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