Suicidal Ideation and Behavior

Sexual SE's (delayed ejaculation, anorgasmia, decreased libido)

Anorexia->wt loss->wt gain

Bruxism

SIADH

Long QT syndrome

D/C syndrome (N/V/D, agitation, anxiety, impaired coordination, insomnia, anorexia, flu-like illness)

Nausea, dizziness, insomnia, constipation

Dose-dep bp increase

Less sexual SE's than SSRI's

D/C syndrome (more severe than SSRI D/C)

Serotonin syndrome

N/D

Same ADR's as SSRI's

HA

Anxiety or insomnia early on

Contraindicated in pts with seizure hx (b/c it's a seizure threshold lowering drug)

Minimal sexual dysfcn, sedation and wt gain

Sedation

Postural hypotension

QTc prolongation

Priaprism

Hepatotoxicity

Sedation at lower doses

Increased appetite->wt gain

Dry mouth

Less sexual dysfcn?

Orthostatic hypotension

Sedation

Anticholinergic effects

Gynecomastia

Libido changes

SIADH

Dizziness

Xerostomia

Nausea

HA

Abrupt cessation=delirium, agitation, myoclonic jerks and insomnia

Dizziness

Sedation

*Dose-related sedation, dizziness, confusion, ataxia

*Potential for teratogenicity (esp 1st trimester)=Cat D

*Withdrawal sx's (sz, increased temp/bp/pulse/RR, delirium, tremulousness) with agents that have shorter t1/2 

*Abuse Potential (esp alprazolam and diazepam)

*N/V/D

*Tremor (new onset tremor means toxicity at 1.5-2mEg/L)

*Wt gain

*Polyuria 

*Polydipsia

*Longer term-renal impairment (renal tubular acidosis), cardiac dysrhythmia, hypothroidism>>hyperthyroid

*Postural hypotension

*Sedation

*EPS

*NMS

*QTc prolongation

*Increased prolactin (lactation, gynecomastia, amenorrhea)

*Sedation

*Postural hypotension

*Prolactin elevation

*Wt gain/dysliipdemia/DM

*Dose-dep EPS

*Dose-dep seizure risk

*Potentially life-threatening agranulocytosis

*Anorexia or appetite disturbances

*Sleep disturbances

*Wt loss

*Infrequent ADR's=emotional lability, new onset or increase in frequency of tics, may slow growth rate in kids, may lower seizure threshold

*HA

*insomnia

*suicidal ideation

*xerostomia

*N/V

*Anorexia

*Somnolence

*Hypotension

*Sedation

*Irritability

*Emotional Flattening

*Possibly depression

*INsomia

*Nightmares

*Tolerance/dependence/withdrawal/abuse much less than BZD's

*Next day sedation less than other classes (Eszo>Zolpidem>Zal)

*Complex sleep-related behavior (anterograde amnesia)

*Severe allergic rxns (anaphylaxis and angioedema)

*don't take with ETOH!

*Fairly well tolerated

*Long-term use currently unknown

*Lethargy

*Sedation

*Dizziness

*Blurred or double vision

*HA

*Rash (SJS/TEN) esp in Northern Europeans and Asians

*Vit D deficinecy and hypocalcemia

*Hyponatremia (rare) b/c it stimulates ADH release

*Leukopenia

*Aplastic anemia

*Teratogen (spina bifida)

*similar to CBZ but better tolerated

*30% of pts with skin rxns to CBZ may react to oxcabazepine

*More hyponatremia than CBZ

*Effects not r/t concentration=gingival hypertrophy, rash, Vit D deficiency, hypocalcemia, drug fever, hepatotoxicity, hypertrichosis, bone marrow suppression, peripheral neuropathy, drug-induced SLE

*Effects r/t concentation=>20mcg/mL far lateral nystagmus, >30 45degrees lateral gaze nystagmus and ataxia, >40 decreased mentation, >100 death

*IV infusion=hypotension, bradycardia, CV collapse, venous irritation, thrombophlebitis

*Fetal hydantoin syndrome

*Rash (SJS/TEN)

*Dizziness

*Somnolence

*Somnolence

*Dizziness

*Tremor/Ataxia

*HA
*Abn vision/diplopia

*Euphoria

*Small increase in the mean PR interval 

*Dizziness

*Somnolence

*confusion

*Abn thinking

*Ataxia

*carbonic anhydrase inhibitor->increase bicarb excretion-> metabolic acidosis possible (esp in kids)

*N/V

*Drowsiness

*Hyperactivity

*Bone marrow suppression

*Generally well-tolerated

*Somnolence

*Dizziness

*Dizziness

*Somnolence

*Wt gain

*Blurred vision or diplopia

*may cause euphoria/withdrawal

*Sedation

*Rash

*Bone marrow suppression

*Dizziness

*Somnolence

*Nervousness

*Tremor

*Difficulty concentrating

*new onset seizures and status epilepticus when taken for unlabeled indications

Vigabatrin ADR's-

*Potential for retinal toxicity

*Other ADR's similar to tiagabine

*Wt gain

*Pancreatitis

*Alopecia

*Decreased plt and easy bruising

*Rash (SJS/TEN)

*SIADH

*Somnolence

*Dizziness

*Tremor

*Ataxia

*Parkinsonism syndrome and cognitive decline

*Teratogen (spina bifida)

*Wt loss

*Decrease sweating/heat intolerance/hyperthermia

*Carbonic anhydrase inhibitor->metabolic acidosis'

*dizzines

*Ataxia

*Various ocular effects

*teratogen (oral clefts)

*Same ADR's as most other AED's

*Associated with fatal aplastic anemia and hepatic failure

*Fatigue

*Somnolence

*Dizziness

*Behavioral sx's (agitation, aggression, anxiety, apathy, depersonalization, depression, emotional lability, nervousness)

*Insomnia

*N/V/D

*N/V

*anorexia

*Orthostatic hypotension

*Vivid dreams, hallucinations, delusions, confusion, sleep disturbance

*L-dopa induced motor fluctuations (on-off syndrome) >5yrs after tx

*Wearing off phenomenon after <4h

*Nausea

*Somnolence

*Postural hypotension

*Hallucinations

*Compulsive gambling

*Nausea

*HA

*confusion

*HTN crisis when combined with tyramine-rich foods or levodopa (very low risk at usual doses)

*inhibition of salivary secretion (dry mouth)

*blockade of the ciliary muscle of the lens to cholinergic stimulation (blurred vision for near objects)

*tachycardia

*drowsiness

*decreased cognitive function

*inhibition of gut motility (constipation)

*urinary retention

*Sedation

*confusion

*Peripheral edema 

*Livedo reticularis (localized purple blotches)

*sudden withdrawal may cause severe exacerbation of PD sx's or NMS

*All of the above effects happen at higher doses

*chest pressure or heaviness

*flushing 

*weakness

*drowsiness

*dizziness

*malaise

*a feeling of warmth

*paresthesias that last 30min

*GI intolerance (metallic taste, mild anorexia, nausea, abd discomfort, soft BM, diarrhea)

*Peripheral neuropathy d/t decreased Vit B12

*Lactic acidosis (rare; more common in pt with AKI, CKD, or Liver dz)

*Hypoglycemia (glyburide>glimipiride>glipizide) more likely with deficient caloric intake, prolonged exercise, ETOH ingestion, >1glucose lowering drug

*Wt gain

*Chlorpropamide: may cause a disulfiram-like reaction after ETOH ingestion and may cause hyponatremia

*Hypoglycemia

*generally wt neutral!

*wt gain (dose and time dependent)

*Fluid retention

*decrease bone density and increase fx risk

*hepatotoxicity

*GI intolerance (N/V/D)

*Hypoglycemia

*Acute pancreatitis

*Ligraglutide: Thyroid C-cell Carcinomas

*Hypersensitivty rxns (urticara/facial edema)

*Acute pancreatitis

*might affect some immune cells

*Hypoglycemia

*Wt gain

*Hot flashes and leg cramps

*increased risk of VTE

*Nasal spray: rhinitis and epistaxis

*SQ/IM: injection site rxn, flushing, nausea

*PO: GI sx's (heartburn, esophagitis, abd pain, diarrhea)

*IV: transient flu-like febrile illness (need to premedicated these pts with NSAID or APAP)

*Osteonecrosis of the jaw and ocular effects (IV>PO)

*Atypical femur fx

*Fatigue

*Hypocalcemia

*Assoc with infections (cellulitis and UTI's)

*ONJ

*Nausea

*HA
*Dizziness

*Hypercalcemia

*Severe muscle cramps 

*ADR's are caused by overtx of hypothyroidism

*Sx's of hyperthyroidism (Palpitations, tremors, anxiety, wt loss, tachycardia, increased number of BM's)

*cardiac arrhythmias in pts with heart dz

*Osteoporosis

*Arthralgias

*Rash urticaria or macular rash)

*GI intolerance

*Agranulocytosis (this effect with PTU is independent of dose but dose-dep response in Methimazole)

*PTU>>Methimazole: ANCA positive vasculitis with ARF, arthritis, skin ulcerations, and vasculitic rash

*PTU: Allergy mediated hepatic failure

*Radiation thyroiditis (lower neck pain and release of preformed thyroid hormone from inflammed gland-> thyroid storm possible)

*risk for subsequent thyroid CA?