Adverse Drug Reactions Flashcards Preview

MRCPsych Part A > Adverse Drug Reactions > Flashcards

Flashcards in Adverse Drug Reactions Deck (433)
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1
Q

Define tolerance

A

The need to use increased doses of a drug to maintain a clinical effect.

2
Q

What can lead to tolerance of a drug?

A

Down-regulation
Up-regulation
Reduced responsitivity without alterations in receptor numbers

3
Q

What is down-regulation?

A

Decreased sensitivity of target receptors due to decreased numbers due to agonists

4
Q

What is up-regulation?

A

Increase in numbers of receptors due to antagonists

5
Q

What is cross-tolerance?

A

When drugs with similar pharmacological actions can lead to tolerance of the other drug

6
Q

What is reverse tolerance?

A

When sensitivity to a drug effect increases over time.

7
Q

Give an e.g. of downregulation which leads to a therapeutic effect.

A

When SSRIs are used, the 5HT1A autoreceptors in somatodendritic zones undergo down-regulation secondary to increased serotonin availability when reuptake is blocked; this leads to increase in serotonergic tone of neurons.

8
Q

Define withdrawl

A

When drugs are administered for reasonable period of time, physiological adaptation develops which on withdrawl of drug can get disturbed and leads to withdrawl symptoms.

9
Q

What type of drug leads to withdrawl symptoms?

A

Abrupt withdrawl of treatment for an agent with short eliminatino half-life

10
Q

Which has longer half-life; methadone or heroin?

A

Methadone

11
Q

Why does methadone lead to less withdrawl than heroin?

A

Methadone has a longer half-life

12
Q

Why does Paroxetine lead to withdrawl?

A

It has anticholinergic properties; withdrawl causes rebound symptoms
Paroxetine inhibitis its own metabolism via CYP2D6, so withdrawl leads to loss of inhibition, excessive paroxetine breakdown, sudden steep drop in levels and then withdrawl symptoms.

13
Q

Why does Fluoxetine produce fewer withdrawl symptoms?

A

Its active metabolite, norfluoxetine, has a long half-life

14
Q

What is the advice of benzodiazepine reducing regime?

A

10% dose reduction every 2 weeks.

15
Q

Why must you wait 72 hours before prescribing naltrexone for an opioid detoxified patient?

A

Prescribing an antagonist can precipitate withdrawl symptoms.

16
Q

Which cause more withdrawl; full or partial agonists?

A

Full

17
Q

What kinetics do sustained release formulations affect?

A

Absorption kinetics

18
Q

Do depot or oral preparations have more withdrawl potential?

A

Oral

19
Q

Does XL or plan preparation of a drug lead to more withdrawl symptoms?

A

Neither; both same

20
Q

Which receptors cause side effect of agitation?

A

Alpha 2 blockade
5HT2A/2C stimulation
DRI

21
Q

Which receptors cause side effect of akathisia?

A

D2 blockade

5HT2A stimulation

22
Q

Which receptors cause side effect of delirium?

A

Antimuscarinic

23
Q

Which receptors cause side effect of EPSE?

A

D2 blockade reduces with 5HT2A antagonism

24
Q

Which receptors cause side effect of hyperthermia?

A

Antimuscarinic action

In serotonin syndrome may be due to 5HT2A/2C.

25
Q

Which receptors cause side effect of insomnia?

A

Alpha 1 stimulation

5HT2A stimulation

26
Q

Which receptors cause side effect of amnesia?

A

Anticholinergic effect

GABAa stimulation

27
Q

Which receptors cause side effect of hyperprolactinaemia?

A

D2 blockade

5HT1A stimulation

28
Q

Which receptors cause side effect of disrupted slow wave sleep?

A

Slow wave sleep is maintained by 5HT2A inhibition; hence 5HT2A stimulation disrupts this.

29
Q

Which receptors cause side effect of sweating?

A

Cholinergic effect

Increases with noradrenaline reuptake inhibition

30
Q

Which receptors cause side effect of postural hypotension?

A

Alpha 1 antagonism

31
Q

Which receptors cause side effect of appetite loss?

A

5HT2A stimulation

32
Q

Which receptors cause side effect of increased appetite?

A

Antihistamine

33
Q

Which receptors cause side effect of GI discomfort/nausea?

A

5HT3 stimulation

34
Q

Which receptors cause side effect of weight gain?

A

Antihistamine

5HT2C antagonism

35
Q

Symptoms of anticholinergic effects?

A
Blurred vision
Delirium
Constipation
Tachycardia
Dry secretions
Decreased sweating
Urinary retention
Hyperthermia
36
Q

What conditions do anticholinergics increase risk of?

A

Narrow-angle glaucoma

Photophobia due to mydriasis

37
Q

Which receptors cause side effect of anorgasmia?

A

Alpha 1 antagonism

5HT2A/C stimulation

38
Q

Which receptors cause side effect of retrograde ejaculation?

A

Alpha 1 block
Anticholinergic
Antihistamine

39
Q

Which receptors cause side effect of tardive dyskinesia?

A

Supersensitivity of dopamine receptors which develops due to prolonged therapy with dopamine blocking drugs

40
Q

Which receptors cause side effect of impotence?

A

Alpha 2 blockade

5HT2A/C stimulation

41
Q

Which receptors cause side effect of priapism?

A

Alpha 1 blockade

42
Q

Which receptors cause side effect of obsessions?

A

5HT1D stimuation

43
Q

Which receptors cause reduced OCD?

A

5HT1A/2A

44
Q

Which receptors cause side effect of pathological gambling?

A

Habituation of dopamine receptors on repeated use of dopamine agonists, leading to dopamine dysregulation syndrome

45
Q

Which drugs cause insulin resistance?

A

Valproate

Olanzapine

46
Q

Which polymorphism leads to weight gain?

A

Drugs with strong 5HT2C affinity used on patients with specific variant of polymorphism of 5HT2C receptor promotor regions

47
Q

What types of antipsychotics cause weight gain more than others?

A

Low-potency produce more weight gain than high potency.

48
Q

Give examples of EPSE

A
Acute dystonia
Akathisia
Parkinsonism
Tarde dyskinesia
Dystonia
Perioral tremor
49
Q

Which type of antipsychotics lead to EPSEs?

A

High potency

50
Q

Which EPSEs are due to late SEs and chronic use of antipsychotics?

A

Tardive dyskinesia
Dystonia
Perioral tremor

51
Q

What causes hyperprolactinaemia?

A

Blocking of D2 receptors on anterior pituitary mammotrophic cells that normally are tonically inhibited by dopamine produced in hypothalamic arcuate nucleus.

52
Q

Which antipsychotics induce Parkinsonism?

A
Trifluoperazine
Chlorpromazine
Raclopride
Haloperidol
Fluphenazine
Risperidone
53
Q

Why do some antipsychotics cause Parkinsonism?

A

They bind more tightly than the endogenous ligand dopamine to D2

54
Q

Which drugs are less likely to cause Parkinsonism and why?

A

Anticholinergics
Quetiapine
Clozapine
Bind more loosely to D2 than dopamine

55
Q

Difference between tightly bound and loosely bound antipsychotic drugs

A

Loosely bound:
Weaker potency, so need higher doses to be clinically effective but can be titrated faster.
Less chance of EPSEs

56
Q

Which type of antipsychotics are more likely to lead to relapse?

A

Loosely bound antipsychotics as may dissociate from D2 receptor rapidly

57
Q

When is drug-induced Parkinsonism seen?

A

Within 90 days of treatment

58
Q

Which characteristic of Parkinsons is not seen in its drug-induced form?

A

Pill-rolling tremor

Coarse tremor seen instead

59
Q

Who are at high risk of Parkinsonism from antipsychotics?

A

Elderly

Female

60
Q

At what D2 receptor occupancy by antipsychotics leads to EPSE?

A

Higher than 80%

61
Q

Why are atypical antipsychotics thought to have a lower chance of causing EPSEs?

A

Anticholinergic
HT2A antagonism
Less avidity of bindng i.e. hit and run profile (clozapine, quetiapine)

62
Q

What can you use to treat drug-induced Parkinsonism?

A

Anticholinergics for up to 6 weeks

63
Q

Why must anticholinergics used to treat drug-induced Parkinsonism be withdrawn after 4-6 weeks?

A

Tolerance can develop for EPSEs

Longer use of anticholinergics increases risk of Tardive Dyskinesia

64
Q

What are dystonias?

A

Brief or prolonged contractions of specific groups of muscles

65
Q

Give e.g. of dystonias

A
Oculogyric crises
Tongue protrusion
Trismus
Torticolis
Blepharospasm
66
Q

When in the course of treatment do dystonias occur?

A

Early

67
Q

Who is more likely to get dystonias?

A

Young men starting high-dose of high potency medications, especially IM.

68
Q

What can be used to treat dystonias?

A

Reassurance

Anticholinergics

69
Q

What causes akathisia?

A

Higher D2 occupancy in striatum

70
Q

Symptoms of Akathisia?

A

Inability to relax
Pacing
Rocking with alternation of sitting and standing

71
Q

What drugs can cause akathisia?

A

Neuroleptics
Antidepressants
Sympathomimetics

72
Q

Treatment for Akathisia?

A

Dose reduction
Changing drug
Adding beta blocker/anticholinergic drug/benzo/cryoheptadine

73
Q

Risk factors for Tardive Dyskinesia

A

Female
Elderly
Diabetes
Previous brain damage
Affective illness rather than pure psychosis
Children
Learning difficulties
Afro-carribean
Long-term co-precription of anticholinergics
Frequent drug holidays - will lead to high dose prescription with each relapse

74
Q

When does tardive dyskinesia occur?

A

At least 6 months, often 1-2 years of treatment.

75
Q

What is tardive dyskinesia?

A

Abnormal, involuntary, irregular choreaoathetotic movements of muscles of head, limbs and trunk.

76
Q

Most common type of tardive dyskinesia?

A

Perioral movements

77
Q

What exacerbates Tardive dyskinesia?

A

Stress

Absent on sleep

78
Q

What is particularly striking in Tardive Dyskinesia patients?

A

Absence of insight

79
Q

Treatment of Tardive Dyskinesia?

A
Spontaneously resolve - unlikely in elderly.
Clozapine
Dose reduction
Withdrawl of drug
Switch to atypicals
Add clonazepam
80
Q

When can neuroleptic malignant syndrome occur?

A

Anytime during treatment

81
Q

Symptoms of NMS?

A
Extreme hyperthermia
Severe muscular rigidity
Confusion
Autonomic fluctuations (BP, HR)
Akinetic/mute
82
Q

Blood test values of NMS

A

High WCC, CK, LFTs, plasma myoglobin

Myoglobinuria

83
Q

Onset of NMS?

A

24-72 hours

84
Q

How long does NMS last if untreated?

A

10-14 days

85
Q

When is NMS more common?

A

Young men
After agitation
Using high potency drugs, especially rapid tranq
Dopaminergic drugs on withdrawl

86
Q

Mechanism underlying NMS?

A

Dopamine blockade or hypothalamic sympathetic dysregulation

87
Q

Mortality rate of NMS?

A

20-30% if untreated

Higher if depot used

88
Q

Management of NMS?

A

Fluid replacement & prevent renal failure secondary to myoglobinuria
Prevent aspiration pneumonia
Stop antipsychotic

89
Q

Which drugs can be used to treat NMS?

A

Dantrolene
Bromocriptine
Amantadine

90
Q

What antipsychotics need to be considered after NMS occurs?

A

Low potency or atypical

91
Q

How many patients on clozapine develop agrunulocytosis?

A

1 in 100

92
Q

When is risk of agrunulocytosis at maximum on clozapine?

A

Between 4-18 weeks

93
Q

Main SE of clozapine related to dose?

A
Salivation
Sedation
Weight gain
Fatigue
Lowering of seizure threshold
94
Q

Which SE of clozapine are not dose realted?

A

Arganulocytosis

Myocarditis

95
Q

What happens if yellow result occurs on someone on clozapine?

A

Monitoring frequency must increase until green signal obtained

96
Q

Which drug may precipitate clozapine-associated neutropenia?

A

Paroxetine

97
Q

Effect of increased dopaminergic transmission on sexual function?

A

Enhances sexual arousal

Penile erection

98
Q

Effect of hyperprolactinaemia on women?

A

Amenorrhoea
Reduced sexual desire
Hirsutism

99
Q

How do antipsychotics lead to reduced sexual function?

A

Reduce dopamine transmission

Inducing hyperprolactinaemia

100
Q

Which drugs cause ejaculatory problems?

A

Neuroleptics

101
Q

Which drugs are linked to priapism?

A
Risperidone
Chlorpromazine
Clozapine
Olanzapine
Thioridazine
Trazodone
102
Q

Is priapism drug-dependent or duration-dependent?

A

Neither

103
Q

What can priapism lead to if untreated?

A

Permanent impotance

104
Q

What is used to treat sexual dysfunction in men due to hyperprolactinaemia?

A

Bromocriptine

105
Q

How does Bromocriptine work?

A

Dopamine agonist

106
Q

What drugs lower seizure threshold?

A

Low potency antipsychotics

Dose-dependent

107
Q

Which antipsyshotic is the most sedating?

A

Chlorpromazine - due to H1 antihistamine

108
Q

Which drugs are more likely to cause anticholinergic syndrome; high or low potency drugs?

A

Low

109
Q

Impact of neuroleptics on cardiac function?

A

Reduce cardiac contractility
Increase circulating catecholamines
Prolong atrial and ventricular conduction time

110
Q

Which drugs are more cardio-toxiac; low or high potency?

A

Low potency

111
Q

ECG changes with neuroleptics?

A

QT and PR prolongation
Blunting of T waves
ST depression

112
Q

Which psychiatric medications can cause Torsades de Pointes?

A

Thioridazine

Droperidol

113
Q

What leads to antipsychotic related sudden death?

A

Cardiac arrhythmias
Seizures
Asphyixation
Malignant hyperthermia

114
Q

Which types of drugs cause postual drop?

A

Low potency drugs

115
Q

Skin side effects on antipsychotics?

A

Allergic dermatitis and photosensitivity on low-potency drugs.

116
Q

What is the skin SE of Chlorpromazine?

A

Blue-gray discoloration in areas exposed to light - reversible.

117
Q

Which eye condition is a known SE of Thioridazone?

A

Irreversible retinal pigmentation if used >1000mg a day

Early symptom: nocturnal confusion due to difficulty with night vision.

118
Q

Effect of Chlorpromazine on eyesight?

A

Pigmentation of anterior lens and posterior cornea; white-brown stellate granular deposits.
Benign.

119
Q

Which antipsychotic can lead to cholestatic jaundice?

A

Chlorpromazine

120
Q

When does drug-induced obstructive jaundice occur?

A

First month of treatment

121
Q

What is associated with drug-induced jaundice?

A

Rash

Eosinophilia

122
Q

Treatment for drug-induced jaundice?

A

Immediately stop antipsychotic

Avoid rechallenge

123
Q

Signs of Haloperidol OD on EEG?

A

Diffuse slowing and low voltage

124
Q

Which typical antipsychotic is safest in an OD?q

A

Haloperidol isone

125
Q

What mediates QTc?

A

Blockade of rapid component of delayed rectifier potassium current responsible for repolarisation of cardiac Purkinje cells and myocardial cells.

126
Q

How do drugs cause prolonged QTc?

A

Bind to delayed rectifier K+ channgel and thereby decrease outward movement of K+

127
Q

Which antipsychotics have greater risk of causing prolonged QTc?

A

Droperidol
Pimozide
Sertindole
Thioridazine

128
Q

What are the symptoms of inadvertent intravascular injection event/postinjection delirium sedation syndrome?

A
Sedation
Confusion
Dizziness
Dysarthria
Somnolence
129
Q

When does inadvertent intravascular injection event/postinjection delirium sedation syndrome occur?

A

20min - 3 hours after injection of olanzapine pamoate (long-acting depot)

130
Q

Treatment for inadvertent intravascular injection event/postinjection delirium sedation syndrome?

A

Supportive medical care; symptoms alleviate within 3-72 hours

131
Q

What is inadvertent intravascular injection event/postinjection delirium sedation syndrome linked to?

A

Accidental punctures of vessel or injects into capillary bed leaking

132
Q

What is Metabolic syndrome composed of?

A
Obesity
Dyslipidaemia
Glucose intolerance
Insulin resistance
HTN
133
Q

WHO criteria for metabolic syndrome

A

Insulin resistance and /or impaired fasting glucose and/or impaired glucose tolerance and two or more of the following:
Waist-hip ratio >0.9 (mean), >0.85 (women) or BMI 30
Triglyceride level 1.7 or high-density lipoprotein M0.9 (men) or <1 (women)
BP 140/90 or treated HTN
Microalbuminuria

134
Q

Prevalence of Diabetes on schizophrenics?

A

Twice as prevalent than in general population

135
Q

Drugs that are most linked with metabolic syndrome/

A
Olanzapine
Clozapine
Quetiapine
Risperidone
Aripiprazole
(worst at top)
136
Q

Which gender have higher risk of metabolic syndrome if schizophrenic?

A

Females

137
Q

What type of study was the CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness)?

A

Double-blind pragmatic RCT

138
Q

What drugs were looked at in CATIE?

A
Olanzapine
Quetiapine
Risperidone
Ziprasidone
Perphenazine
139
Q

Which antipsychotic has lowest discontinuation rate?

A

Olanzapine

140
Q

What type of study was CUtLASS (Cost utility of latest antipsychotic drugs in schizophrenia study)?

A

Unblinded RCT comparing first-generation and second-generation antipsychotics

141
Q

Which 2nd-generation antipsychotics were used in CUtLASS?

A
Amsulpride
Olanzapine
Quetiapine
Risperidone
Clozapine (in second phase)
142
Q

Outcome of CUtLASS?

A

Those on 1st generation antipsychotics did relatively better.
Advantage of clozapine in symptom improvement over 1 year and patients preferred it.

143
Q

Long-term SE of Lithium

A

Hypothyroidism
Irreversible nephrogenic diabetes insipidus
Reduced GFR (chronic kidney disease)
Hyperparathyroidism

144
Q

Which diuretic has no effect on Lithium levels?

A

Loop diuretics

145
Q

What score is used to assess severity of Lithium toxicity

A
AMDISEN
0 - no signs
1 - mild
2 - moderate
3 - severe
146
Q

Which antipsychotic is best to treat negative symptoms?

A

Amisulpride

147
Q

Which SSRIs cause prolonged QTc?

A

Citalopram

148
Q

Which TCA is the most selective inhibitor of serotonin?

A

Clomipramine

149
Q

Which TCA is the most selective inhibitor of noradrenaline?

A

Desipramine

150
Q

Which TCAs have the least anticholinergic activity?

A

Amoxapine
Nortriptyline
Desipramine
Maprotiline

151
Q

Which TCAs have the most antihistaminic activity?

A

Doxepin

152
Q

Which TCA is associated with weight gain

A

Amitriptyline

153
Q

Cardiac SE of TCAs?

A

QT prolongation
Tachycardia
Flattened T waves
Depressed ST segment

154
Q

Effect of TCAs on overdose?

A

Cardiac arrhythmias
Anticholinergic delirium
May occur 3-4 days after due to long half-life

155
Q

Treatment for TCA overdose?

A

Lavage
QRS monitoring
No antidose

156
Q

Symptoms of anticholinergic delirium?

A
Confusion
Visual hallucinations
Hyperpyrexia
Loss of visual accommodation
Peripheral vasodilatation
Drying of mucous membranes
157
Q

Which TCA can cause hyperprolactinaemia?

A

Amoxapine

158
Q

SEs of all TCAs?

A
SIADH
Hyponatraemia
Fine rapid tremor
Dysarthria
Precipitate angle closure glaucoma
159
Q

What happens if TCAs are reduced too quickly?

A

Cholinergic rebound

160
Q

What is the best way to reduce TCAs?

A

Reduce 25-50mg per 2-3 days

161
Q

When can discontinuation reaction occur with TCAs?

A

48 hours - 2 weeks after

162
Q

Mechanism of serotonin syndrome

A

Excessive serotonergic transmission in brain. Most CNS symptoms due to 5HT 2A stimulation

163
Q

Features of serotonin syndrome

A
Diarrhoea
Myoclonus
Diaphoresis
Hyperactive reflexes
Ataxia
Hypomania/labile mood
Disorientation
164
Q

Which drugs are high risk of serotonin syndrome?

A

Combination of SSRI with MAOI/RIMA/Serotonergic TCAs/SNRI/Lithium/L-tryptophan
Combination of TCA and MAOI
Combining any of the above with Tramadol, pethidine, meperidine
Oxazolidionine antibacterial linezoloid
Tetrabenazine
Entacapone
Selegiline

165
Q

What is oxazolidinone antibacterial linezolid?

A

Reversible non-selective MAOI

166
Q

What is Tetrabenazine?

A

Acts via dopamine and serotonin depletion at nerve endings

167
Q

What is entacapone?

A

COMT inhibitor

168
Q

Treatment of serotonin syndrome?

A

Stop agent
Correct vital signs
Benzos
5HT2A antagonists

169
Q

Name some 5HT2A antagonists that can be used in the treatment of serotonin syndrome

A

Cyproheptadine
Atypical antipsychotics
Chlorpromazine

170
Q

Why do SSRIs cause anorexia when starting, then weight gain late during therapy?

A

Desensitization and down-regulation of receptors.

171
Q

What is fluoxetine associated with in particular?

A

Change in duration of menstrual period

172
Q

Effect of SSRIs on platelets?

A

Thrombasthenia - functional impairment of platelet aggregation

173
Q

Impact of Thrombasthenia?

A

Easy bruising
Prolonged bleeding
(in those with gastric ulcers or bleeding diathesis)

174
Q

In which patients is SIADH more likely who are on SSRIs?

A

Alcoholics

Elderly

175
Q

SEs of SSRIs

A
Nausea
Diarrhoea
Anorexia (initially)
Thrombasthenia
SIADH
Severe sweating
Nocturnal myoclonus
Restless legs
Acute angle-closure glaucoma
176
Q

Treatment for severe sweating from SSRI?

A

Terazosin

177
Q

What is nocturnal myoclonus?

A

Repetitive leg movement every 2-60 seconds; extension of large toe and flexion of angle, knee and hips.

178
Q

Treatment of nocturnal myoclonus?

A

Benzo

Levodopa

179
Q

Treatment for restless legs

A

Ropinirole
Benzo
Levodopa

180
Q

Which SSRIs/SNRIs cause acute angle closure glaucoma?

A
Duloxetine
Venlafaxine
Citalopram
Fluoxetine
Paroxetine
181
Q

Which SSRIs are associated with SSRI discontinuation syndrome?

A

Paroxetine - additional cholinergic rebound

Fluvoxamine - short half-life

182
Q

When does SSRI discontinuation syndrome occur?

A

If someone is on SSRI for 4-6 weeks at least, and it is stopped abruptly.

183
Q

Which SSRI is least likely to cause discontinuation syndrome?

A

Fluoxetine - long half-life

184
Q

Symptoms of SSRI discontinuation syndrome

A
2 or more of the following within 1-7 days of SSRI reduced/stopped after being taken for at least 1 mnoth:
dizziness
lightheadedness
Paresthesias
Diarrhoea
Fatigue
Gait instability
Headache
Insomnia
Nausea
Tremors
Visual Disturbances
185
Q

What is the link between SSRI and suicide risk?

A

Only in those up to age 24 if used between 4-16 weeks.

186
Q

How do SSRIs increase the risk of UGIB?

A

They inhibit uptake of serotonin into platelets, which is needed for haemostatic response of promoting platelet aggregation.
SSRIs increase gastric acid secretion.

187
Q

What increases risk of UGIB if on SSRI?

A

Elderly
NSAIDs
H. Pylori

188
Q

Which SSRIs are at higher risk of causing UGIB?

A
Those with high inhibition of serotonin reuptake:
Clomipramine
Paroxetine
Sertraline
Fluoxetine
189
Q

Which SSRIs are at lower risk of causing UGIB?

A

Those with low inhibition f serotonin reuptake;
Nortriptyline
Doxepin
Trazadone

190
Q

Which antidepressants are associated with lower risk of sexual dysfunction?

A
Bupropion
Mirtazapine
Moclobemide
Nefazodone
Reboxetine
191
Q

What drugs reverse sexual dysfunction due t SSRI use?

A

5HT2 antagonists - cyproheptadine, mirtazapine
5HT1A agonists - buspirone
Bupropion - dopamine reuptake inhibitor
Sildenafil - inhibits phosphodiesterase type 5

192
Q

Which patients must Sildenafil be avoided in?

A

Patients with arrhythmias, unstable angina / uncontrolled HTN

193
Q

In which antidepressant is sweating most common?

A

Venlafaxine

194
Q

SEs of Venlafaxine?

A
Sweating
Increase in diastolic BP if >300mg/day
Mydriasis
Exacerbation of ange closure glaucoma
Disctoninuation reaction (short half life)
195
Q

SEs of Duloxetine?

A

Similar to Venlafaxine but less likely to affect BP

196
Q

How to stop Venlafaxine?

A

Over 2-4 weeks

197
Q

How to treat priapism?

A

Intracavernosal injection of an alpha1 agonist

198
Q

E.g. of alpha1 agonist used in priapism?

A

Metaraminol

Epinephrine

199
Q

When is there risk of priapism?

A

Starting Trazadone (high risk) - early phases of treatment

200
Q

How does Nefazodone work?

A

Inhibits CYP3A4

201
Q

Why is Nefazodone not used as often?

A

Can cause serious hepatic damage

202
Q

Who is Trazadone and Nefazodone best for?

A

Elderly

Those with cardiac illness

203
Q

SEs of Bupropion

A
No anticholinergic effects
Exacerbates ADHD and Eating Disorders, panic attacks
Enhances sexual activity
Increases risk of seizures - dose-dependent
Dry mouth, tremor, headache
Psychotic symptoms
Delirium
Word-finding difficulties
204
Q

Why can Bupropion cause psychotic symptoms?

A

Dopaminergic

205
Q

Which antidepressants can cause agranulocytosis?

A

Mirtazapine

206
Q

Which combinations of Buspirone do you need to be careful with?

A

Haloperidol - increases conc of haloperidol

MAOI - causes serotonin syndrome

207
Q

Which drugs increase buspirone plasma conc?

A
CYP3A4 inhibitors:
Erythromycin
Itraconazole
Nefazodone
Grapefruit juice
208
Q

SEs of Mianserin and Mirtazapine

A

Drowsiness first few weeks of treatment

Increased weight gain and appetite

209
Q

Why is Mirtazapine preferred option to treat depression in chemotherapy?

A

5HT3 blockade - reduced vomiting and nausea

210
Q

What type of antidepressant is Reboxetine?

A

NARI

211
Q

Which patients is Reboxetine good for?

A

Elderly

Cardiac history

212
Q

What type of drug is Atomoxetine?

A

NARI

213
Q

What illness is Atomoxetine used in?

A

ADHD

214
Q

SEs of Reboxetine

A

Due to noradrenergic effect:

urinary hesitancy in males

215
Q

What can help with urinary hesitancy SE

A

Tamsulosin - peripheral alpha1 blocker

Doxazosin

216
Q

What type of drug is phenelzine?

A

MAOI

217
Q

SEs of MAOIs?

A
Orthostatic hypotension
Pedal oedema
Insomnia
Cheese reaction
Serotonergic syndrome - with SSRIs
Weight gain
Sexual dysfunction
218
Q

Why is it best to give MAOIs such as Phenelzine and Tranylcypromine at 6pm?

A

Can have stimulating effects leading to insomnia

219
Q

Explain the cheese reaction with MAOIs

A

MAOIs and tyramine rich foods cause cheese reaction.

Tyramine directly and indirectly (via vesicles) causes sympathomimetic actions 20min-1h after food.

220
Q

Signs of cheese reaction

A
Nausea
Apprehension
Chills
Sweating
Restlessness
Hypotension - with occipital headache, palpitations and vomiting
Dilated pupils
Fever
221
Q

Severe effect of cheese reaction?

A

Cerebral haemorrhage

222
Q

Which MAOIs are safest for severity of hypertensive crisis?

A

Reversible MAOIs

223
Q

Which foods must be avoided re tyramine-rich?

A
Stilton
Blue cheese
Old cheddar
Mozarella
Fish
Sausage
Cured meats
Mature poultry
Wild game
Liqueurs
Concentrated yeast extract
224
Q

How to treat MAOI-induced hypertensive crisis?

A

Alpha-adrenergic antagonists

225
Q

Give eg. of alpha-adrenergic antagonists for hypertensive crisis treatment?

A

Phentolamine

Chlorpromazine

226
Q

What can help reduce polyuria in Lithium use?

A

Once daily rather than twice daily dosing

227
Q

What causes polyuria with Lithium?

A

Functional antagonism of ADH

228
Q

What can help control polyuria due to Lithium?

A

K+ sparing diuretics

229
Q

What can lead to renal failure from Lithium?

A

Cumulative lithium use

230
Q

What renal damage is common with chronic lithium use?

A

> 10 years:

Interstitial fibrosis

231
Q

How does Topiramate work?

A

Weak inhibitor of carbonic anhydrase

Can cause renal stones

232
Q

What is Oxcarbazepine?

A

10-keto derivate of CBZ - less enzyme induction

233
Q

SEs of Oxcarbazepine?

A

More likely to cause hyponatraemia than CBZ

234
Q

ECG effects of Lithium?

A

Similar to low K+:
Flat T waves
Inverted T waves

235
Q

Which cardiac problem is Lithium CI in and why?

A

Sick sinus syndrome;

Lithium can depress sinus node activity

236
Q

Which thyroid problem can Lithium most commonly cause?

A

Benign hypothyroid state

237
Q

Who is thyroid deficiency SE of when Lithium is used?

A

Those with high risk for pre-existing antithyroid antibodies (middle-aged women)
First two years of treatment
Rapid cycling patients

238
Q

Which TFT dysfunction is seen in 1/3 of chronic Lithium patients, even in absence of symptoms?

A

High TSH

239
Q

Explain use of thyroxine in subclinical hypothyroid and mood disorder?

A

In resistant depression and non-responsive rapid cyclers with bipolar, thyroxine treating hypothyroidism can be beneficial for the mood disorder

240
Q

Which antimanic drug can increase risk of polycystic ovaries?

A

10%

241
Q

Why does valproate cause polycystic ovaries?

A

Valproate increases ovarian androgen production.
Can lead to weight gain and insulin resistance; risk factors.
In liver, it can increase unbound testosterone.

242
Q

When is oligomenorrhea likely to occur with valproate?

A

Within first year of treatment

243
Q

Which antimanic drugs result in leucocytosis?

A

Lithium

Carbamazepine - first 3 months of treatment

244
Q

Which antimanic drugs can lead to thrombocytopenia?

A

Valproate

Carbamazepine

245
Q

Which tremor is a sign of toxicity in Lithium use?

A

Coarse tremor

246
Q

Which tremor is a SE of lithium use?

A

fine tremor

247
Q

SEs of Lamotrigine?

A
Dizziness
Ataxia
Headache
Sedation
Tremor
248
Q

SEs of Topiramate

A

Renal stones
Anomia - word finding difficulties
Poor concentration

249
Q

SEs of Vigabatrin

A

Visual field defects

250
Q

What is Vigabatrin used for?

A

Anti-epileptic

251
Q

Effect of Valproate on liver?

A

Induces hepatic enzymes

Elevation in liver transaminases - asymmptomatic

252
Q

Which antimanic drugs can cause liver failure?

A

Valproate
Lamotrigine
Topirimate
Carbamazepine

253
Q

What risk factors lead to liver failure if on antimanic drugs?

A

Young age

Combination therapy

254
Q

What results in liver failure from antimanic drugs?

A
  1. Metabolic toxicity - due to 4-en valproate, a metabolite of valproate.
  2. Hypersensitivity - dose-independent effect is resulting in fulminant failure.
255
Q

When is severe hepatic disease seen in (with valproate)?

A

Those with learning disability when undiagnosed urea cycle disorders present (often less than 2 years of age)

256
Q

Which antimanic drug can cause acute pancreatitis?

A

Valproate

257
Q

Can dose-reduction of valproate reduce risk of pancreatitis?

A

No - this is a hypersensitivity reaction, not dose-dependent

258
Q

When can hyperammonaemia occur with antimanic drugs?

A

Carbamazepine

259
Q

How does Hyperammonaemia present?

A

Coarse tremor

260
Q

Treatment for hyperammonaemia?

A

L-carnitine

261
Q

Most common teratogenic effect of Lithium?

A

Ebsteins anomaly of tricuspid valves

262
Q

Risk of Ebsteins in lithium-exposed foetuses?

A

1 in 1,000 (20x risk of general population)

263
Q

Is Lithium more or less teratogenic than valproate and carbamazepine?

A

Less

264
Q

Which antimanic drug is excreted into breast milk?

A

Lithium

265
Q

Signs of lithium toxicity in infants?

A

Lethargy
Cyanosis
Sluggish neonatal reflexes

266
Q

Teratogenic effect of valproate?

A

Neural tube defects

267
Q

Risk of neural tube defects in mothers using valproate?

A

1-4%

268
Q

What can help reduce teratogenic risk of Valproate?

A

Folate-vitamin B complex supplementation

269
Q

Most common teratogenic effect of Valproate?

A

Learning disability

Low IQ

270
Q

Effect of Lithium on the skin

A

Acne
Psoriases
Alopecia - 5-10%

271
Q

Effect of Valproate on Endocrinology system?

A

Obesity
Hyperandrogenism
PCOD - hirutism

272
Q

Which drugs are most likely to cause anticonvulsant hypersensitivity syndrome?

A
Aromatic compounds:
Lamotrigine
Carbamazepine
Phenytoin
Phenobarbitone
273
Q

Common SE of aromatic compunds?

A

Rash

274
Q

Risk factors leading to skin reactions/rash with aromatic compounds?

A

Rapid initial dose escalation
Concurrent VPA
Age <16 years

275
Q

What happens if a rash occurs with aromatic compounds?

A

Stop drug - cannot tell if benign from serious

276
Q

Which antimanic drug can lead to Steven Johnson syndrome?

A

Lamotrigine - especially if combined with Valproate

277
Q

Why do valproate + lamotrigine together increase risk of Steven Johnson Syndrome?

A

Valproate has enzyme inhibiting effects which increase lamotrigine levels

278
Q

Initial signs of Steven Johnson syndrome?

A

Rash
Pharyngitis
Fever
Systemic involvement if drug not stopped

279
Q

Dose-related effects of Carbamazepine

A
Visual disturbances
GI disturbance
Cognitive impairment
Vertigo
Dizziness
280
Q

Dose-related effects of Valproate

A

Hyperammonaemia
Teratogenicity
Sedation
Thrombocytopenia

281
Q

Idiosyncratic reactions of Carbamazepine

A

Haematological reactions: agranulocytosis/aplastic anaemia, Steven Johnson, fulminant liver damage, pancreatitis
SIADH - elderly

282
Q

Idiosyncratic reactions of Valproate

A

Hepatotoxicity
Pancreatitis
Rash
Acute dermatitis (rare)

283
Q

Which antimanics cause weight gain?

A

Valproate - 70%

Carbamazine - 40%

284
Q

What causes weight gain with valproate?

A

Impaired beta-oxidation of fatty acids

285
Q

Which antimanic drug can be used to counteract weight gain caused by psychotropic drugs?

A

Topiramate

286
Q

Common SE of cholinesterase inhibitors

A

Nausea/vomiting
Diarrhoea
Insomnia
Muscle cramps

287
Q

What type of drug is Tacrine?

A

Cholinesterase inhibitor

288
Q

Why is Tacrine no longer used?

A

Fatal hepatotoxicity

289
Q

Important SEs of cholinesterase inhibitors due to increased cholinergic stimulation?

A
UGIB (esp if peptic ulcer/NSAIDS)
Bradycardia 
Exacerbate COPD
Urinary retention
Increase seizure risk
290
Q

In which patients is there a higher risk of bradycardia if on cholinesterase inhibitor?

A

Supraventricular conduction delay

291
Q

Which types of drugs can cholinesterase inhibitors prolong the risk of?

A

Succinylcholine-type muscle relaxants

292
Q

Where is Memantine excreted?

A

Mainly urine

293
Q

Is Rivastigmine metabolised by liver?

A

Rarely

294
Q

Does Memantine affect liver enzymes?

A

No

295
Q

SEs of stimulants used in ADHD

A
Anxiety
Irritability
Insomnia
Tachycardia
Cardiac arrhythmias
Dysphoria
Decreased appetite - tolerance develops
296
Q

Less common SE of stimulants used in ADHD?

A

Self-limited exacerbation of movement disorders (tics, dyskinesias)
Linked to growth suppression

297
Q

What is Pemoline?

A

Stimulant used in ADHD

298
Q

Why is Pemoline no longer used?

A

Associated with Hepatic failure

299
Q

Which drug used in ADHD can cause dependence (rare)?

A

Methylphenidate

300
Q

SEs of Atomoxetine?

A

Appetite loss
Sexual dysfunction
Dizziness
Severe liver injury

301
Q

Signs of Benzo OD?

A
Slurred speech
Incoordination
Unsteady gait
Nystagmus
Impairment in attention + memory
Stupor/coma
Inappropriate sexual/aggressive behaviour
Mood lability
302
Q

Which benzos cause anterograde amnesia?

A

High-potency

303
Q

Why is Triazolam banned in UK since 1991?

A

Disinhibition and aggression

304
Q

When can paradoxical disinhibition present with benzo use?

A

If patients have pre-existing brain damage

305
Q

Which type of patients can have respiratory impairment from benzo use?

A

COPD

Sleep apnoea

306
Q

Which patients should Benzos be avoided in due to risk of respiratory impairment?

A

Myasthenia Gravis
Head injury
Porphyria

307
Q

SE of Alprazolam?

A

Weight gain via appetite stimulation

308
Q

Teratogenic effects of Benzos?

A

Cleft palate and lips

309
Q

When is benzo withdrawl syndrome seen in neonates?

A

If used in third trimester

310
Q

SEs of Z-hypnotics?

A

Diarrhoea

Abdominal pain

311
Q

Unique SE of eszopiclone?

A

Unnpleasant taste

312
Q

What does benzo withdrawl syndrome depend on?

A

Half-life
Rate of tapering
Dose
Duration

313
Q

Signs of benzo withdrawl

A
Anxiety
Diaphoresis
Kinaesthetic hallucinations
Restlessness/irritability
Tremor
Insomnia
Autonomic hyperactivity
Weakness
314
Q

Severe SEs of benzo withdrawl?

A

Paranoia
Delirium
Grand mal seizures

315
Q

When does benzo withdrawl syndrome occur with long-acting benzos?

A

1-2 weeks after long-acting benzos stopped

316
Q

Which benzos are associated with immediate and severe withdrawl syndrome?

A

Alprazolam

Lorazepam

317
Q

At what point are prescribed benzos unlikely to cause withdrawl?

A

<4 weeks use

318
Q

Withdrawl rate in benzo use for 6-8 years?

A

75%

319
Q

Withdrawl rate in benzo use for 2 years?

A

25-45%

320
Q

Withdrawl rate for benzo use in 4 months?

A

5-10 mnoths

321
Q

How to taper benzos?

A

Rate of 25% per week
Use of longer acting agents when tapering
Avoid long-term use of short-acting benzos
Use carbamazepine to assist discontinuation

322
Q

Psych SEs of beta-blockers

A

Sedation
Nightmares
Dysphoria
Depression

323
Q

In which type of beta-blockers are psych SEs seen in?

A

Lipophilic compounds

e.g. metoprolol, propranolol

324
Q

Psych SEs of ACE inhibitors

A
Increased arousal
Anxiety
Fatigue
Insomnia
Increased psychomotor activity
325
Q

Psych SEs of Clonidine

A
Sedation
Anxiety
Agitation
Depression
Insomnia
326
Q

Psych SEs of nitrates?

A
Delirium
Psychosis
Anxiety
Restlessness/agitation
Hypomanaia
327
Q

Psych SEs of digoxin?

A

Depression

Delirium

328
Q

Psych SEs of statins?

A

Depression

329
Q

Psych SEs of corticosteroids?

A

Mania>depression
Agitation
Lethargy

330
Q

What makes corticosteroid-induced psych SEs more likely?

A

Dose-dependent
If >80mg/day
Symptoms start within 2 weeks
More common in females + those with past psych history

331
Q

Psych SEs of anabolic androgenic steroids?

A
Acute parnoia
Delirium
Mania
Homicidal rage
Aggression
Extreme mood swings
Increase in libido
Agitation
Anger
332
Q

What makes psych SEs more likely with anabolic androgenic steroid use?

A

Dose-dependent

333
Q

Psych SEs of GNRH agonists (e.g. leuprolide)?

A

Depression

334
Q

Psych SEs of interferon-alpha?

A

Depression - seen in first 12 weeks

335
Q

Psych SEs of penicillin?

A

Sedation
Anxiety
Hallucinations

336
Q

Psych SEs of cephalosporins?

A

Delirium

337
Q

Psych SEs of ciprofloxacin and ofloxacin?

A
Restlessness
Lethargy
Tremors
Insomnia
Mania
Depression
Psychosis
Delirium
Seizures
Catatonia
338
Q

Psych SEs of Isoniazid?

A

Delirium
Mania
Depression
Psychosis

339
Q

Psych SEs of Tetracyclines?

A

Depression
Insomnia
Irritability - at high doses

340
Q

Psych SEs of antihistamines and decongestants?

A

Atropine-like psychosis

341
Q

Psych SEs of PPIs & H2 antagonists?

A

Confusion
Agitation
Depression
Hallucinations

342
Q

Who are Psych SEs of PPIs and H2 antagonists more common in?

A

Elderly patients with impaired hepatic-renal function

343
Q

Psych SEs of Ondansetron?

A

Anxiety

344
Q

Psych SEs of Isotretinoin?

A

Severe depression and suicidal behaviour

345
Q

Psych SEs of aminophylline and salbutamol?

A

Agitation
Insomnia
Euphoria
Delirium

346
Q

Name some depressogenic drugs

A
Beta blocks
Ca channel blocks
Interferons (alpha>beta)
Steroids
Cyproterone, progesterone
Varenicline
Isotretinoin
Ezetimibe
347
Q

How does Rimonabant work?

A

CB1 receptor antagonist

348
Q

What is Rimonabant used for?

A

Anti-obesity; blockig central cannabinoid activity may reduce food intake

349
Q

Concerns regarding Rimonabant use?

A

Severe psychiatric SEs; 2.5x more depression, 3x more anxiety

350
Q

What do animal studies show about blockade of CB1 receptor?

A

Impairs anti-depressant reducing and anxiety-reducing actions of endocannabinoids

351
Q

Name some Class A drugs

A
Ecstacy
LSD
Heroin
Cocaine
Crack
Magic mushrooms
Merthylamphetamine
Other amphteamines if prepared for injection
352
Q

Penalty for possession of class A drug?

A

Upto 7 years in prison, unlimited fine or both

353
Q

Penalty for dealing Class A drug?

A

Upto lif in prison, unlimited fine or both

354
Q

Name some Class B drugs

A

Amphetamines
Methylphenidate
Pholcodine

355
Q

Penalty for possession of Class B drugs

A

Upto 5 years in prison or unlimited fine or both

356
Q

Penalty for dealing of Class B drugs

A

Upto 14 years in prison or unlimited fine or both

357
Q

Name some Class C drugs

A
Cannabis
Tranquilisers
Some pankillers
GHB
Ketamine
358
Q

Penalty for possession of class c drug

A

Upto 2 years in prison, unlimited fine or both

359
Q

Penalty for dealing Class C drug

A

Upto 14 years in prison, unlimited fine or both

360
Q

Class A, B, C drugs are under which Act?

A

2001 Misuse of Drugs Act UK

361
Q

Schedule 1, 2,3, 4 and 5 drugs are under which Act?

A

2001 Misuse of Drugs Regulations

362
Q

Examples of Schedule 1 drugs

A

Coca lef
Cannabis
LSD
Mescaline

363
Q

Regulations of Schedule 1 drugs?

A

No medicinal use.
Supply limited to research or other special purposes judged to be in public interest; requires home office license to possess

364
Q

Give some e.g. of Schedule 2 drugs

A
Diamorphine
Morphine
Dipipanone
Remifentanil
Pethidine
Secobarbital
Glutethimide
Amphetamine
Cocaine
365
Q

Regulations of Schedule 2 drug use?

A

Subject to special prescription requirements and safe custody requirements - except for secobarbital.
Stock drugs must be recorded in a register.
Regulations and drug stock must only be destroyed in presence of an appropriately authorized person.

366
Q

Name some examples of Schedule 3 drugs

A
Barbituates - except secobarbital
Buprenorphine
Diethylpropion
Mazindol
Meprobamate
Pentazocine
Phenter,ine
Temazepam
367
Q

Regulations of Schedule 3 drugs

A

Subject to special prescription requirements - except for temazepam, but not to safe custody requirements (except for buprenorphine, diethylpropion, flunitrazepam and temazepam) or to keep register.
Requirements for retention of invoices for 2 years.

368
Q

Give examples of some Schedule 4, Part 1 drugs

A

Benzos - except temazepam

Zolpidem

369
Q

Regulations for schedule 4 drugs?

A

Not subject to special prescription requirements or safe custody requirements.
No need to keep register
requirement for retention of invoices for 2 years

370
Q

Give examples of Schedule 4, Part 2 drugs

A
Androgenic and anabolic steroids
Clenbuterol
HCG
Non-human chorionic gonadotrophin
Somatotropin
Somatrem
Somatropin
371
Q

Name some examples of Schedule 5 drugs

A

Weak preparations of drugs usually in other schedules - e.g. morphine, codeine

372
Q

Regulations of Schedule 5 drugs?

A

Exempt from all controlled drug regulations except the need to keep invoices for at least 2 years

373
Q

Which drugs cannot be prescribed on repeat prescriptions?

A

Schedule 2 and 3 drugs

374
Q

How should patients collect controlled drugs?

A

In person, show ID on first occasion and sign back of prescription form

375
Q

Which drugs must be prescribed in daily instalments?

A

Substitute opioids

376
Q

What must prescription of instalments specify?

A

Number of instalments
Interval between instalments
Instructions for supplies at weekends/BH
Total quantity to provide treatment for a period (not exceeding 14 days)
Quantity to be supplied in each instalment along with duration of instalment to be set out on prescription

377
Q

Purpose of reporting adverse drug reactions?

A

Reduce hazards of medical prescribing

Trigger regulatory action to ensure patient safety

378
Q

Should adverse reaction be reported if reaction is well known?

A

Yes

379
Q

Should adverse reaction be reported if you are unsure whether the drug caused this reaction?

A

Yes

380
Q

Should adverse reaction be reported if it was a result of an overdose?

A

Yes

381
Q

Should an adverse reaction be reported if other drugs were given at the same time?

A

Yes

382
Q

Who can use the yellow card scheme to report adverse reactions?

A

Prescribers
Patients
Carers
Pharmacists

383
Q

What does the black triangle symbol mean?

A

Preparation is newly licensed and requires additional monitoring by the European Medicines agency

384
Q

What is the requirement for adverse reaction reporting if there is a black triangle symbol?

A

MHRA requires all suspected reactions, including those that are not serious, be reported.

385
Q

For drugs w/o the black triangle symbol, when are you expected to use the yellow card reporting system?

A

To report SE that are serious, medically significant or result in harm.
Also those reactions that occur due to a medication error

386
Q

For SEs, what does very common mean?

A

Greater than 1 in 10

387
Q

For SEs, what does common mean?

A

1 in 100 to 1 in 10

388
Q

For SEs, what does uncommon or less commonly mean?

A

1 in 1000 to 1 in 100

389
Q

For SEs, what does rare mean?

A

1 in 10,000 to 1 in 1000

390
Q

For SEs, what does very rare mean?

A

Less than 1 in 10,000

391
Q

What is the WHO Collaborating Centre for International Drug Monitoring?

A

International system for monitoring ADRs developed by WHO in 1971
Located in Uppsala Monitoring Centre, Sweden

392
Q

Which drugs cause EPSEs?

A

All neuroleptics - less for anticholinergic neuroleptics e.g. CPZ
Higher dose atypicals

393
Q

Which drugs cause delirium?

A

Anticholinergic TCAs

Anticholinergic antipsychotics

394
Q

Which drugs cause seizures?

A

Bupropion

Clozapine

395
Q

Which drugs cause tics?

A

Stimulants

396
Q

Which drugs cause hepatic damage?

A

Nefazodone
VPA
Tacrine

397
Q

Which drugs cause hepatic enzyme induction?

A

CBZ
Phenytoin
Barbituates

398
Q

Which drugs cause acute pancreatitis?

A

VPA

399
Q

Which drugs cause paralytic ileus?

A

Clozapine

400
Q

Which drugs can cause UGIB?

A

SSRIs

Acetylcholinesterase inhibitors

401
Q

Which drugs can cause weight gain?

A
All antipsychotics - less of Aripiprazole, ZPD
TCAs
Lithium
VPA
CBZ
402
Q

Which drugs cause weight loss?

A

Topiramate

Bupropion

403
Q

Which drugs cause renal damage?

A

Lithium

404
Q

Which drugs cause renal stones?

A

Topiramate

405
Q

Which drugs cause Priapism?

A

Trazadone

Risperidone

406
Q

Which drugs cause polycystic ovaries?

A

Valproate

407
Q

Which drugs cause erectile dysfunction?

A

All TCAs

Antipsychotics

408
Q

Which drugs caused anorgasm or delayed ejaculation?

A

SSRIs

409
Q

Which drug can lead to a rash?

A

CBZ

Lamotrigine

410
Q

Which drug can cause thrombocytopenia?

A

Valproate

411
Q

Which drug can cause sweating?

A

Particularly Venlafaxine
TCAs
SSRIs

412
Q

Which drug can cause psoriasis and acne?

A

Lithium

413
Q

Which drugs cause worsening of glaucoma?

A

Paroxcetine
Quetiapine
TCAs

414
Q

Which drug can cause retinitis pigmentosa?

A

Thioridazine

415
Q

Which drug can cause hypersalivation?

A

Clozapine

416
Q

Most common SE of clozapine?

A

Hypersalivation

417
Q

Which drug can cause corneal deposits?

A

CPZ

418
Q

Which drug can cause visual field defects?

A

Vigabatrin

419
Q

Which drugs can cause bruxism?

A

Stimulants

420
Q

Which drugs can cause hypothyroidism?

A

Lithium

421
Q

Which drugs can cause PE or myocarditis?

A

Clozapine

422
Q

Which drugs can cause prolonged QT?

A

All antipsychotics - especially thioridazine, pimozide, droperidol

423
Q

Which drugs can cause arrhythmias?

A

High dsoe TCAs

424
Q

Which drug s can cause hypertension?

A

VFX

TCAs

425
Q

Which drugs can cause fine tremors?

A

Therapeutic dose of Lithium, TCAs

426
Q

Which drugs can cause coarse tremors?

A

Lithium toxicity

Antipsychotic Parkinsonism

427
Q

Which drugs can cause osteoporosis?

A

Hyperprolactinaemic antipsychotics

428
Q

Which drugs can cause WCC suppression?

A
Clozapine
Olanzapine
Mirtazapine
Carbamazapine
Mianserin
429
Q

Which drugs can cause haemolytic anaemia?

A

Nomifensine

430
Q

Which drugs can cause Guillian Barre?

A

Zimeldine

431
Q

Which drug can cause pedal oedema?

A

MAOIs

432
Q

Which drugs can cause cramps?

A

Acetylcholinesterase inhibitors

433
Q

Which drugs can cause othostatic hypotension?

A

All TCAs

All antipsychotics