lecture - pharm Flashcards by RK Splendid

who would prescribe drugs such as lithium and sodium valproate?

psychiatrists or gp

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when are mood stabilisers used?

BPAD
Recurrent depression
Schizoaffective disorder

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what are the mood stabiliser drugs?

Lithium - gold standard!!

Anti-epileptics: lamotrigine, carbamazepine, sodium valproate

Atypical antipsychotics

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what are the mood stabiliser drugs?

Atypical antipsychotics; olanzipine, quetiapine
(1st line acute mania)

Lithium - gold standard!!

Anti-epileptics: lamotrigine, carbamazepine, sodium valproate

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List some uses of lithium?

BPAD

Schizoaffectivee

Depression - treatment resistant

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ebsteins anomaly is caused by? what it affect?

lithium

affects tricuspid valve

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list some complications of lithium use

Common:
Fine tremor
Sedation - sleepiness
Metallic taste in mouth - lithium is a metal lol
GI upset
Weight gain

Hypothyroid -  check bloods
Hyperparathyroid
polyura + polydipsia 
Nephrogenic diabetes inspipidus
Chronic renal failure - check bloods
Hair texture changing; curly/thinning

Arrythmia - monitro ECG
Teratogen

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what ecg changes may you see with lithium use?

t wave flattening

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what are the signs of lithium toxicity?

management?

Coarse tremor - instead of fine
ataxia
renal failure - AKI
dysarthria
eepileptic seizures
nystagmus
impaired conscious - low gcs

marked GI upset - eg continuous throwing up
coma, DEATH

these guys need ITU, when lithium about 2 maybe.

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what to do if patient complains of the metallic taste ?

tell them it often will just go by itself

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what to do before prescribing lithium?

Bloods;
FBC, UEs (renal function),
Calcium (parathyroid function), 
TFT (thyroid function),
ECG - baseline

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how to monitor lithium?

what advice to give to patient?

initially weekly

once stable; 3 monthly checks of;
UEs, eGFR, Lithium levels, TFTs

Advice:
stay hydrated
tell doctor if get febrile illness, diarrhoea or vomiting or travelling to a hot country.

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which drugs have interactions with lithium?

NSAIDs

Diuretics eg ACEi, loop diuretics

they cannot take these drugs!!

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which is the only licensed drug for BPAD treament?

Olanzipine

others are used off licence; eg quetiapine

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which m stabiliser can be used in acute treatment AND prophylaxis of bpad

valproate
olanzapine
lithium

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whats the effect of valproate on bone?

thrombocytopaenia

leucopaenia

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curly hair, ankle swelling are complications of?

s valproate

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fever
blisters; mouth, genitals
rash; macullopapular, bullae etc

are sx of? what drug is associated with this?

what advice to give to a patient about to go on this drug?

Steven johnson syndrome

Lamotrigine - sjs is rare though
advice to patients; if you get a fever or rash, stop taking this drug straight away and go to AnE and tell them youre taking lamotrigine.

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when is lamotrigine used as a mood stabiliser?

as prophylaxis - slowly titrated

never for acute treatment

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patient presents with acute manic episode.
psh: BPAD
is on lithium but no other prescribed drugs.
been stable on lithium 3 years till now.

what do you want to know/do to guide your next steps?

what treatment would you advise?

collateral hx - speak to gp or family, has he stopped taking meds?

any new medications - over the counter perhaps?

check lithium levels

urine drug screen - any illicit drugs?

does he think he needs the drug?

treatment:
lithium wouldve been good but issues are now oral intake and need for monitoring - doubt he can keep up.
cant give valproate as injection.

best option;
Mood stabiliser - Olanzipine injection
-very acutely: lorazepam to calm down

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what are options for tretment for acute mania presentatoin in someone with known BPAD?

FIRST LINE - increase dose of mood stabiliser

augment with antipsychotic ; consider adding quetiapine, haloperidol, olanzpine etc
ECT - last resort

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if someone has cod, which drug should you NOT give?

Lithium

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what monitoring is needed for antipsychotic prescription?

blood pressure, liver function, lipid profile and glucose. These parameters should be checked every 1–3 months initially, then annually.

due to cvd and dm risk

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what monitoring is needed for clozapine?

FBC - Weekly; looking for agranulocytosis - neutropenia

blood pressure, liver function, lipid profile and glucose.

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Which levels of lithium are considered toxic?

therapeutic limit is 1.2mmol toxicity is 1.5-2+ at 2 it is sever & life threatening

what type of drug is Memantine and what is it used for?

* NMDA receptor antagonist (anti-glutamate) | * Recommended for mod-severe Alzheimers or those who cannot tolerate AChEi

what are the treatments for vascualr and FTLD dementia?

Vascular dementia- managing vascular risk factors Frontotemporal dementia- no drug licensed

in the management of behavioural and psychological symptoms of dementia, if you have to prescribe, an antipsychotic what do you have to remember about the choice and what must you inform the family?

Risperidone is licensed for short term use only (12 weeks). Discuss with family etc and explain 3X increase risk of stroke.

a kid taking methylphenidate for ADHD at school is experiencing bullying for it. what are his other options

change to Concerta XL which is a long acting formulation of methylphenidate 1 dose per day lasts 12hours

boy with adhd develops ticks on methylphenidate. should he continue med? other options?

even if well controlled, he can just change to Atomoxetine (or clonidine)

List some side effects of Atomoxetine?

Palpitations Loss of appetite Dyspepsia Suicidal ideation postural hypotension

List some side effects of methylphenidate?

Growth restriction - hence drug holidays Tachycardia Palpitations Tics Loss of appetite Insomnia

list some side effects of clozapine?

hyper salivation Intestinal obstruction - severe constipation Myocarditis/cardiomyopathy - high HR, etc agranulocytosis

which medication is REALLY good for treating the negative symptoms of schizophrenia?

Clozapine

what are the symptoms of a cannabinoid novel psychoactive substance intoxication?

``` psychosis confusion aggressive behaviour COLLAPSE! vomiting ```

PHARM LECTURE 2

Repeat; How do you manage a patient on psych ward who is seems to pose a potential threat to others on ward?

Verbal de-escalation: sometimes just ask them why they aree agitated, may bee simply. chemical restraint: rapid tranquillisation - follow local protocols! - consider allergy, other meds, age - Benzo's 1st line (safer than antipsychotics, shorter acting, neuroleptic naivety,) - Antipsychotics 2nd line - do ecg first physical restraint seclusion rooms

potential side effcts of Benzodiazepines ? who must you bee careful prescribing benzos to?

Sedation - dont drive/operate heavy machinery Falls - due to hypotension Respiratory depression - so monitor them; resp rate! Dependency + tolerance conditions to be careful: 1. Liver diseases 2. COPD - careful response depression 3. Sleep apnoea

why is lorazepam usually the first line benzo in rapid tranq?

shortest acting?

why is IM olanzipine and lorazepam not given together?

Can cause Low BP - post injection syndrome

what is the MOA of sedatives?

enhance effects of GABA - GABA-A agonist

which recreational drugs are GABA-A agonists (positive allosteric modulators)? what side effects can they all therefore have?

alcohol - also binds gaba-a GHB (illicit drug) Baclofen Z drugs - zopiclone, zolpidem SEs: tolerance, dependence, withdrawal symptoms - can be lethal (seizures etc)

list some indications of benzodiapines?

short-term anxiolytic - for severe anxiety sedation: acute mania/psychosis, acute agitation , anaesthesia short term insomnia Epilepsy prophylaxis Alcohol withdrawal - chlordiazepoxide msucle spasm

list some long acting and short acting benzos?

Long acting: chlordiazepoxide diazepam Short acting: lorazepam midazolam

name the drug used in Benzo overdose - or gaba-a potentiator drug overdoses?

Flumazenil give IV every minute (short burst due to short half life)

what is the MOA of barbituates???

binds GABA-A, at a diff site to benzo's and GABA-B

name some other hypnotics

promthezine - antihistamine w/anticholinergic effects pregabalin - 3rd line GAD

list some rating sclaes used in kids and adult ADHD?

Kids: Conners rating scale Adults: Adult ADHD self reporting scale

what is lisdexamphetamine?

pro-drug to dexamphetamine reduces chane of abuse

when methylphenidate is prescribed what must be monitored closely?

BP - hypertension risk Growth stunting - usually due to anorexia Cardiac risk - arrhythmias

how is restless legs syndrome treated pharmacologically?

dopamine agosnists eg Pramipexole and Ropinirole

what are the differences between typical and atypical antipsychotics in terms of receptor binding?

typical: D2 receptor antagonists atypical: D2 antagonists - but dissocaite very quickly 5HT2A - antagonists 5HT1A agonist (some)- eg clozapine, quetiapine

what is ther order or risk of teratogenecity with mood stabilisers?

valproate > carbamazepine > lithium there is a risk in lithium but it is low compared to the other 2

How is Premenstual syndrome managed - NICE?

Mild: healthy eating, stress reduction, regular sleep and regular exercise, particularly during the luteal phase. Moderate: The oral contraceptive pill, ibuprofen and CBT Severe: SSRIs

which psych theerapy is gold-standard recommended in EUPD?

Dialectical behavioural therapy

insomnia, anxiety, loss of appetite tremor, tinnitus, sweating, visual disturbance are sx associated with withdrawl from which drug?

Benzodiazepines

name a street name for some benzos?

Valium - diazepam | rohypnol

what are some street names for PCP - phenylcyclidine

angel dust rock fuel elephant tranquilliser wack, ozone, peace pill

difference between methadone and heroin? - if a patient asks?

comes in liquid form for consumption orally. are injectable forms as well same effects as heroin though less intense but prolonged

what is the medical name for the date rape drug/liquid X? What effects does it have? what is the antidote and how do we test a patient for it?

GHB - Gamma hydroxybutaric acid effects at high dose: respiratory depression, bradycardia, seizures, hypothermia, coma, death antidote: none test: doesnt show in urine

according to ICD-10, what do you need to diagnose dependency syndrome?

3+ of the following in 12 months: - strong desire/compulsion to drink - problems abstaining/stopping - neeglect in other activities - withdrawal - tolerance

lecture - pharm Flashcards

(61 cards)