(Test Bank) Managing The Side Effects Of Psychotropic Medications Revised Edition

Goldberg,Ernst, 2

Biology

Test Bank

2nd Edition

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Test Bank for Managing The Side Effects Of Psychotropic Medications Revised Edition, The downloadable file consists of 618 pages, and the total size of the file is 12.21 MB. Purchase now only for highly discounted price.

Author(s): Goldberg, Ernst

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Managing the Side Effects of Psychotropic Medications Second Edition Managing the Side Effects of Psychotropic Medications Second Edition Joseph F. Goldberg, M.D., M.S. Clinical Professor of Psychiatry Icahn School of Medicine at Mount Sinai New York, New York Carrie L. Ernst, M.D. Associate Professor of Psychi atry and Medical Education Icahn School of Medicine at Mount Sinai New York, New York Note: The authors have worked to ensure that all information in this book is ac­ curate at the time of publication and consistent with gene ral psychiatric and medical standards, and that information concerning drug dosages, schedules, and routes of administration is accurate at the time of publication and consis­ tent with standards set by the U.S. Food and Drug Administration and the gen­eral medical community. As medical resear ch and practice continue to advance, however, therapeutic standards may change. Moreover, specific situations may require a specific therapeutic response no t included in this book. For these rea­ sons and because human and mechanical errors sometimes occur, we recom­ mend that readers follow the advice of ph ysicians directly involved in their care or the care of a member of their family. Books published by American Psychiatri c Association Publishing represent the findings, conclusions, and views of the individual authors an d do not necessarily represent the policies and opinions of Am erican Psychiatric Association Publish­ ing or the American Psychiatric Association. If you wish to buy 50 or more copies of th e same title, please go to www.appi.org/ specialdiscounts for more information. Copyright © 2019 American Psychiatric Association ALL RIGHTS RESERVED Manufactured in the United States of America on acid-free paper 22 21 20 19 18 5 4 3 2 1 Second Edition Typeset in The Mix and Book Antiqua. American Psychiatric Association 800 Maine Ave., SW Suite 900 Washington, DC 20024-2812 www.appi.org Library of Congress Cata loging-in-Publication Data Names: Goldberg, Joseph F., author. | Ernst, Carrie L., author. Title: Managing the side effects of psychotropic medications / Joseph F. Goldberg, Carrie L. Ernst. Description: Second editio n. | Washington, D.C. : American Psychiatric Association Publishing, [ 2019] | Includes bibliographical references and index. Identifiers: LCCN 2018023606 (pri nt) | LCCN 2018024418 (ebook) | ISBN 9781615372034 (ebook) | ISBN 9781585624881 (pbk. : alk. paper) Subjects: | MESH: Psychotropic Drugs—adverse effects Classification: LCC RM315 (ebook) | LCC RM315 (print) | NLM QV 77.2 | DDC 615.7/88—dc23 LC record available at https://lccn.loc.gov/2018023606 British Library Cataloguin g in Publication Data A CIP record is available from the British Library. To our children, Joshua, Brian, Hannah, and Jonah, for their patience, encouragement, and love; and to our parents, Arline and Robert Zinaman, Ethel Goldberg, and to the memory of Daniel Goldberg, for their commitment and omnipresence; and to each other, for everything in between Contents Foreword to the Second Edition . . . . . . . . . . . . . . . . . . . . xv Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii List of Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii List of Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxvii PART I General Considerations 1 The Psychiatrist as Physician . . . . . . . . . . . . . . . . . . . 3 Primary Care Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Differentiating Adverse Drug Effects From Primary Illness Symptoms or Nonpsychiatric The Nocebo Phenomenon and Proneness to Medical Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Adverse Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Negative Therapeutic Reactions . . . . . . . . . . . . . . . . . . . . . 20 Attribution and Causality . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Paradoxical Adverse Effects . . . . . . . . . . . . . . . . . . . . . . . . . 23 Extrapolating “Evidence-Based Research Findings” to “Real-World” Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Dose Relationships and Adverse Effects . . . . . . . . . . . . . . 28 FDA Warnings and Precautions . . . . . . . . . . . . . . . . . . . . . . 32 Risk-Benefit Analyses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 General Approach to Assessing Adverse Drug Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 2 Pharmacokinetics, Pharmacodynamics, and Pharmacogenomics . . . . . . . . . . . . . . . . . . . . . . . . . 47 Pharmacokinetics and Pharmacodynamics Enantiomeric Versus Racemic Agents, and Parent . . . . . . . . . . 47 Toxic Polypharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Gender and Racial Differences in Adverse Effects . . . . . 59 Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Brand Versus Generic Formulations . . . . . . . . . . . . . . . . . 62 Versus Metabolite Compounds . . . . . . . . . . . . . . . . . . . . . 63 Drug Blood Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Pharmacogenomic Predictors of Adverse Effects . . . . . 65 3 Vulnerable Populations . . . . . . . . . . . . . . . . . . . . . . 77 Patients’ Diverse Proneness to Drug Side Effects . . . . . 77 Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Medically Ill Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Older Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Patients Prone to Somatization . . . . . . . . . . . . . . . . . . . . . 85 4 Adverse Psychiatric Effects of Nonpsychotropic Medications . . . . . . . . . . . . . . . . 89 Analgesics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Anticholinergics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Anticonvulsants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Antimicrobials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Antineoplastics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Antiparkinsonian Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Antiviral and Antiretroviral Agents . . . . . . . . . . . . . . . . . . 95 Cardiovascular Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Dermatological Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Gastrointestinal Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Hormone Supplements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Immunosuppressants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Interferon- α . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Oral Contraceptives and Intravaginal Rings . . . . . . . . . 101 Smoking Cessation Aids . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Steroids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 5 Adverse Psychiatric Effects of Psychiatric Medications . . . . . . . . . . . . . . . . . . . . . 105 Activation and Mania/Hypomania or Mixed States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Anxiety and Panic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Clinical Trial Subjects With Psychiatric Illness . . . . . . . 108 Discontinuation Phenomena . . . . . . . . . . . . . . . . . . . . . . . 109 Disinhibition and Impaired Impulse Control . . . . . . . . 109 Emotional Dulling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Psychosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Suicidal Thinking or Behavior . . . . . . . . . . . . . . . . . . . . . . 111 6 What Nonmedical Therapists Should Know About Adverse Drug Effects . . . . . . . . . . . . 113 PART II Organ Systems 7 Cardiovascular System . . . . . . . . . . . . . . . . . . . . . 121 Arrhythmias and Palpitations . . . . . . . . . . . . . . . . . . . . . . 121 Cerebrovascular Accidents . . . . . . . . . . . . . . . . . . . . . . . . . 134 Edema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Myocarditis and Cardiomyopathy . . . . . . . . . . . . . . . . . . 140 Orthostatic Hypotension . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 8 Dermatological System . . . . . . . . . . . . . . . . . . . . . 145 Alopecia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Hyperhidrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Photosensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Pruritus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 Skin Rashes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 9 Ear, Nose, and Throat . . . . . . . . . . . . . . . . . . . . . . . 161 Bruxism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Dysarthria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Dysgeusia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 Oral Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 Sialorrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 Stomatodynia (Burning Mouth Syndrome) . . . . . . . . . 168 Tinnitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Xerostomia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 10 Electrolyte Abnormalities . . . . . . . . . . . . . . . . . . . 171 Hyponatremia and SIADH . . . . . . . . . . . . . . . . . . . . . . . . . 171 Metabolic Acidosis and Alkalosis . . . . . . . . . . . . . . . . . . . 174 11 Endocrinopathies . . . . . . . . . . . . . . . . . . . . . . . . . . 177 Hyperprolactinemia, Galactorrhea, and Menstrual Disturbances and Polycystic Ovary Bone Demineralization and Osteoporosis . . . . . . . . . . . 177 Gynecomastia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 Parathyroid Abnormalities . . . . . . . . . . . . . . . . . . . . . . . . 188 Thyroid Abnormalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190 12 Gastrointestinal System . . . . . . . . . . . . . . . . . . . . 193 Diarrhea, Hypermotility, and Constipation . . . . . . . . . 193 Gastrointestinal Bleeding . . . . . . . . . . . . . . . . . . . . . . . . . 195 Hepatic Impairment and Transaminitis . . . . . . . . . . . . 195 Hyperammonemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Malabsorption Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . 204 Nausea and Gastrointestinal Upset . . . . . . . . . . . . . . . . 205 Pancreatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206 13 Genitourinary and Renal Systems . . . . . . . . . . . . 209 Dysuria and Urinary Retention . . . . . . . . . . . . . . . . . . . . . 209 Enuresis and Urinary Incontinence . . . . . . . . . . . . . . . . . 210 Nephrotic Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211 Nephrotoxicity and Nephrogenic Diabetes Insipidus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212 Priapism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 Renal Calculi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217 Renal Insufficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217 Sexual Dysfunction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218 14 Hematological System . . . . . . . . . . . . . . . . . . . . . . 245 Myelosuppression: Agranulocytosis and Thrombocytopenia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245 Platelet Aggregation Disorder s and Bleeding Risk . . . 249 Red Blood Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 15 Metabolic Dysregulation and Weight Gain . . . . 253 Dyslipidemias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253 Glycemic Dysregulation and Diabetes Mellitus . . . . . . 264 Weight Gain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271 Weight Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 312 16 Musculoskeletal System . . . . . . . . . . . . . . . . . . . . 317 Joint Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317 Leg Cramps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318 Myalgias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319 17 Neurological System . . . . . . . . . . . . . . . . . . . . . . . 323 Cognitive Complaints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323 Delirium and Encephalopathy . . . . . . . . . . . . . . . . . . . . . . 328 Fatigue and Sedation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329 Headache . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334 Movement Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337 Tremor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 352 Muscle Twitching, Fasciculations, and Myoclonus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356 Nystagmus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357 Paresthesias and Neuropathies . . . . . . . . . . . . . . . . . . . . 358 Seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359 Yawning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361 18 Ophthalmological System . . . . . . . . . . . . . . . . . . . 363 Cataracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363 Diplopia, Blurred Vision, and Loss of Vision . . . . . . . . . 364 Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365 Retinopathies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366 19 Sleep Disturbances . . . . . . . . . . . . . . . . . . . . . . . . . 367 Hypersomnia and Sleep Attacks . . . . . . . . . . . . . . . . . . . . 367 Insomnia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369 Nightmares and Vivid Dreams . . . . . . . . . . . . . . . . . . . . . 376 Parasomnias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377 20 Systemic Reactions . . . . . . . . . . . . . . . . . . . . . . . . . 379 Allergic Reactions and Angioedema . . . . . . . . . . . . . . . . 379 Antiepileptic Hypersensitivity Reac tions . . . . . . . . . . . . 380 Body Temperature Dysregulation . . . . . . . . . . . . . . . . . . 381 Cancer and Excess Mortality . . . . . . . . . . . . . . . . . . . . . . . 382 Discontinuation Syndromes . . . . . . . . . . . . . . . . . . . . . . . 382 Drug-Induced Lupus Erythematosus . . . . . . . . . . . . . . . 384 Neuroleptic Malignant Syndrome . . . . . . . . . . . . . . . . . . 385 Serotonin Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 386 21 Pregnancy and the Puerperium . . . . . . . . . . . . . . 389 Breast-Feeding and Teratogenicity . . . . . . . . . . . . . . . . . 390 Growth Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 392 Withdrawal in the Newborn . . . . . . . . . . . . . . . . . . . . . . . 395 22 Emergency Situations . . . . . . . . . . . . . . . . . . . . . . 397 PART III Summary Recommendations 23 Summary Recommendations . . . . . . . . . . . . . . . . 421 The Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424 Appendix 1: Summary of Major Adverse Effects and Monitoring/Management Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425 Appendix 2: Self-Assessment Questions and Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 441 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 441 Answer Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455 Appendix 3 : Resources for Practitioners . . . . . . 483 Summary of Commonly Reported Adverse Effects of Psychotropic Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 484 Common Psychotropic Drug Interactions . . . . . . . . . . . . 490 Useful Web Sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 494 Rating Scales for Measuring Adverse Drug Effects . . . 495 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 497 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 533