Pinksheet-0609

ANTIPSYCHOTIC SIDE EFFECT SHEET
Adult / SOM
Structural
Symptom
Trade Name
Generic Name
Maximum Dose (mg)
Classification
Pos/Neg
Clozaril
Risperdal
Seroquel
Extrapyramidal effects (EPS, EPR) - reversible
Akinesia - lack or poverty of movement
Akathisia - inability to remain still, constant movement or fidgeting, insomnia, “inner anxiety”
Dyskinesia - jerking or spastic movement of the arm, eye, face, leg, neck, or torso
Dystonia - altered posture, shift in body alignment, muscle cramping
Oculogyric crisis - backward rolling of the eyes
Opisthonus - spasms of the back muscles causing bending of the torso, often painful
Parkinsonism - resting tremor, mask-like facies, shuffling gait, drooling, slowness of movement, lack of
arm swing, pill rolling, lead-pipe or cogwheel rigidity, balance disturbances, a “running” walk, Pisa syndrome – leaning to one side
Rabbit syndrome – fine tremor of lower lip
Torticollis – twisting movement of the neck
Treatment: Dosage reduction of the antipsychotic, change to another antipsychotic, anticholinergic or
antiparkinsonian agents (trihexyphenidyl (Artane), benztropine (Cogentin), diphenhydramine (Benadryl), amantadine (Symmetrel). Emergency – Benadryl I.M.
Denervation supersensitivity – often irreversible
Tardive dyskinesia – involuntary movement of the tongue, jaw, lips, neck, or extremities. “fly catching” tongue
movements, facial grimaces, sucking or smacking of lips, swallowing or chewing difficulty Treatment: Remove or reduce antipsychotic agent (if feasible), change to newer atypical antipsychotic agents.
Investigational: Clozaril, Vitamin E. Last resort: increase antipsychotic to mask symptoms.
Neuroleptic malignant syndrome – emergency situation
Single or combination occurrence of the following: irregular pulse or blood pressure (autonomic dist.), EPS, hyperthermia, rigidity, altered mental status, catatonia, acute respiratory+renal failure Treatment: Emergency room, support for autonomic symptom Orthostatic hypotension
Treatment: Antipsychotic dosage reduction, Florinef, ephedrine, ProAmatine, Prozac, Parnate, Epogen, DHE
• Metabolic disorders - hyperglycemia, hyperlipidemia, weight gain
• Vascular disorders - 2% increase in risk for stroke, heart attack in demented elderly
Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart
failure, sudden death) or infectious (e.g., pneumonia) in nature
- DIAGNOSES -
schizophrenia, schizoaffective, bipolar, depression, delusional disorder, psychotic mood disorder acute psychotic disorder, brief reactive psychosis, schizophreniform, atypical psychosis, Tourette’s, Huntington’s, organicmental syndromes, nausea, hiccups, ADD, delirium, migraine, mania pacific point consultants version 0609 ANTIDEPRESSANT SIDE EFFECT SHEET
Adult Maximum
OBRA
Category
Trade Name
Generic Name
Dose(mg)
High-risk
SSRI
SNRI
Serotonin antagonist
NE negative feedback antagonist
Dopamine reuptake inhibitor
Cyclic
MAOI
Stimulant
- SIDE EFFECTS -
SSRI – excitement, nervousness, anxiety, tremor, sweating, dizziness, lightheadedness, anorexia, nausea, small initial and withdrawal weight loss, long-term weight gain, seizure Desyrel: fatigue, muscle pain, headache, confusion, orthostatic hypotension, drowsiness, dizziness Effexor: headache, nervousness, somnolence, insomnia, anorexia, diaphoresis, dry mouth, constipation,Remeron: somnolence, increased appetite, dry mouth, myalgia, edema, dyspnea, constipationSerzone: appetite stimulation, diarrhea, headache, nausea/vomiting, confusion,Wellbutrin: headache, seizures, insomnia, sedation, tachycardia, auditory disturbances, dry mouth, constipation, nausea, anorexia, vomiting, weight loss or gain, diaphoresis Cyclic – anticholinergic (dry mouth, blurred vision, urinary retention, constipation), confusion, sedation, tachycardia, MAOI - hypertensive crisis (tyramine interaction – Chianti wine, aged cheeses, soy sauce, sour cream, chocolate, sausages, dried fish, avocados, bananas, yeast, alcohol, caffeine, and sympathomimetics phenylpropanolamine, ephedrine, pseudophedrine]).
Stimulant – excitement, wakefulness, tachycardia, insomnia, nervousness, drowsiness, stomach pain, suicidal ideation
Serotonin Syndrome – Symptom: confusion, agitation, hypomania, anxiety, coma, sinus tachycardia, hypertension
hypotension, nausea, diarrhea, abdominal pain, motor abnormalities, myoclonus, hyperreflexia, muscle rigidity, restlessness, tremor, ataxia/incoordination, shivering, nystagmus, seizures, diaphoresis, unreactive pupils, tachypnea, hyperpyrexia - DIAGNOSES -
Depression, obsessive-compulsive disorder, eating disorders, anxiety, borderline personality disorder, orthostatichypotension, autism, enuresis, fibromyalgia, peripheral neuropathy, obesity, PMS, migraine Black-Box Warning: Increased risk of suicide in persons < 25 years of age. pacific point consultants version 1108
ANXIOLYTIC SIDE EFFECT SHEET
Adult / SOM
OBRA
Trade Name
Generic Name
Category
Maximum dose
high-risk
- SIDE EFFECTS -
Benzodiazepines – sedation, drowsiness, dizziness, confusion, headache, incontinence,
psychomotor agitation, irritability, paradoxical excitation, delerium, ataxia, addiction Buspirone - drowsiness, dizziness, confusion, headache, tremor, urinary retention,
Antihistamines – anticholinergic (dry mouth, blurred vision, urinary retention, constipation),
sedation, restlessness, photosensitivity Barbiturates – anxiety, depression, dizziness, drowsiness, weakness, physical dependence, irritability
- DIAGNOSES -
anxiety, panic disorder, generalized anxiety disorder, panic disorder, simple phobia, post-traumatic disorder, anxiety associated with depressive symptoms, anxiety not otherwisespecified, organic mental syndromes MOOD STABILIZER SIDE EFFECT SHEET
Adult \ Geriatric
Trade
Generic
Maximum Dose (mg)
- SIDE EFFECTS -
Anticonvulsants – fatigue, somnolence, dizziness, ataxia, tremor, incoordination, sedation, hepatic enzyme
elevations, blood dyscrasia, confusion, myalgia, increased appetite Antihypertensives – hypotension, bradycardia, dizziness, falls,
Benzodiazepines – sedation, drowsiness, dizziness, confusion, headache, incontinence,
psychomotor agitation, irritability, paradoxical excitation, delirium, ataxia, addiction Lithium – nausea, vomiting, taste disturbance, confusion,
Black-Box warnings:
Depakote/valproic acid: Hepatic failure and pancreatitis resulting in fatalities has occurred in patients receiving
valproic acid and its derivatives. Serious or fatal hepatotoxicity may be preceded by non-specific symptoms such
as malaise, weakness, lethargy, facial edema, anorexia, and vomiting.
Lamictal: Serious rashes requiring hospitalization and discontinuation of treatment have been reported.
Tegretol: Aplastic anemia and agranulocytosis have been reported.
DIAGNOSES -
Schizophrenia, schizoaffective, bipolar, major depression, delusional disorder, psychotic mood disorderacute psychotic disorder, brief reactive psychosis, schizophreniform, atypical psychosis, Tourette’s, Huntington’s,organic mental syndromes, nausea, hiccups, ADD, delirium, migraine, mania, peripheral neuropathy, diabeticneuropathy,

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