Pharmacology Flashcards
(112 cards)
1
Q
Antipsychotic with best evidence for use in schizophrenia with substance misuse
A
Clozapine
2
Q
Best antidepressant for a breastfeeding mother
A
Sertraline
3
Q
ADTs with least sexual side effects
A
Bupropion, Agomelatine, Mirtazapine, Trintellix, Vilazodone. (Mnemonic: BAM TV)
4
Q
CANMAT 2009 guidelines for continuing ADTs
A
6-9 months after symptomatic remission or 2 years or more for those with risk factors for recurrence
5
Q
Cardiac defect in infants associated with lithium
A
Ebstein’s anomaly
6
Q
Increase lithium levels
A
Thiazide diuretics
Low sodium diet
Ibuprofen
7
Q
ADTs to reduce in renal impairment
A
Venlafaxine
Paroxetine
Mirtazepine
Bupropion
8
Q
Valproate is associated with pancreatitis T/F
A
T
9
Q
What does caffeine do to lithium levels
A
Reduces them bcs of diuresis
10
Q
Investigations before starting lithium
A
- Renal
- TFTs
- ECG if > 50
11
Q
Lithium range:
1) acute
2) maintenance
3) toxic
A
1) 1-1.5 mEq/L
2) 0.2-0.6 mEq/L
3) >2
12
Q
ADT for breastfeeding
A
SSRIs & SNRIs - sertraline, fluvoxamine, paroxetine
13
Q
Most acidic drugs (eg valproate) bind to what? And what do basic (eg phenothiazines, TCAs) bind to?
A
Acidic- Albumin
Basic- globulin
14
Q
What are the two phases of drug metabolism?
A
Phase I (oxidation) - most psych meds, CYP450
Phase II (glucoronidation, sulfation, acetylation, methylation) - Benzos, paliperidone, desvenlafaxine
15
Q
What’s the most important CYP450 enzyme
A
CYP3A4 metabolises 50% of drugs & accounts for 50% of cytochrome P450 enzyme in liver
16
Q
Genetic polymorphism is most common in which CYP450 enzyme?
A
CYP2D6
7% Caucasians are slow metabolisers
17
Q
ADTs with minimal effects on weight
A
Venlafaxine Fluvoxamine Sertraline Trazodone Moclobemide Fluoxetine Desvenlafaxine Bupropion
18
Q
ADTs that cause weight gain
A
Paroxetine
Mirtazepine
Doxepin
Amitriptyline
19
Q
ADTs cause weight gain on the whole yes or no
A
Yes > 5% increase in weight on average
20
Q
Peripheral anticholinergic side effects
A
- Decreased salivation
- Decreased bronchial secretions
- Decreased sweating
- Increased pupil size - (photophobia, precipitation of acute narrow angle glaucoma)
- Inhibition of accommodation - blurred vision
- Increased heart rate (MI)
- Difficulty urinating (AUR)
- Decreased GI motility (constipation)
- Flushed skin
- Hot
21
Q
Central anticholinergic side effects
A
- Impaired concentration
- Confusion
- Attention deficit
- Memory impairment
22
Q
Highly anticholinergic psychotropics
A
All >15pmol/mL
Atropine
Amitriptyline
Clozapine
Doxepin
Thioridazine
Tolterodine
23
Q
SSRIs do what to P450
A
Inhibit
24
Q
Normal QTc in men and women
A
M <430msec
W <450msec
25
Being female is a RF for QTc prolongation T/F
T
26
Being old is a RF for QTc prolongation T/F
T
27
ADTs with the highest risk of QTc prolongation
Tricyclics
Also citalopram >40mg
28
Citalopram in cardiac disease?
Avoid if poss- QTc prolongation
Get a cardiology consult if there are risk factors
Get an ECG before starting citalopram if there aren’t risk factors
29
Benzos are mainly metabolised where
Liver
30
Renally excreted- reduce dose in renal impairment
```
Paliperidone
Pregabalin & Gabapentin
Risperidone
Topiramate
Venlafaxine
Vortioxetine (not rec in renal failure)
Z hypnotics
```
31
Lithium excreted where?
Kidney
32
Psychotropic drugs with Health Canada warnings in liver disease (2)
1. Valproic acid
| 2. Duloxetine
33
Excretion of gabapentin
Renal
| Fine in liver disease
34
Is serotonin associated with bleeding
Yes, released by plts to promote aggregation
| SSRIs inhibit 5HT transporter & cause 5HT depletion in platelets- reduces aggregation
35
Classic triad of serotonin syndrome
1. Excitation (clonus, hyperreflexia)
2. Autonomic NS excitation
3. Altered mental state
nb can lead to hyperthermia, rhabdomyolysis, DIC, acute resp distress
Rapid onset (cf NMS which is days)
36
Clinical features of NMS
Hypersalivation
Diaphoresis
Pallor
Stupor
Mutism
Coma
Lead pipe rigidity
Bradyreflexia
Slower onset over days
37
Clonus with agitation or diaphoresis in a patient on ADTs- what's going on?
Serotonin syndrome
38
Management of serotonin syndrome
1. Stop offending drug
2. Hydrate & monitor closely
3. Consider cyproheptadine in moderate to severe cases
4. Benzos for sedation if severe
Usually resolves within one week
39
The signs that characterise NMS
1. Fever
2. Autonomic instability
3. Rigidity
4. Tremor
5. Elevated CK
6. Leukocytosis
7. Mental status change
40
Management of NMS
1. Supportive
2. Dantrolene 1-2.5 mg/kg iv then 1mg/kg q6h
3. Bromocriptine (dopamine agonist)
4. Benzos
5. ECT
Usually resolves in 1-2 weeks
41
Contraindications to disulfiram
1. Severe CAD, MI, cerebral thrombosis
2. DM
3. Alcohol use
4. Metronidazole
42
How does clozapine cause sialorrhea?
Via agonism at M4
43
The neurotransmitter most often associated with alcohol & benzo a) intake and b) withdrawal
a) GABA b) Glutamate
44
Affect of lithium on psoriasis
Worsens it
45
Relationship between antipsychotic treatment and vulnerability to TD varies with age T/F
T
46
Risk factors for developing TD
1. Female
2. Older age
3. Prev brain injury or dementia
4. African origin
47
Management of TD
- Switching to clozapine an option
- Not much evidence for lowering antipsychotic dose
- No to benztropene
48
Which neurotransmitter is affected by LSD?
Serotonin
49
At which receptor site does naltrexone act?
Naltrexone is a mu-opioid antagonist
50
Benzos which are safe in liver failure
“LOT” Lorazepam, Oxazepam, Temazepam
51
Signs of TCA overdose
tachycardia, hypotension, dilated pupils, red, warm to touch - anticholinergic toxidrome
52
How is paliperidone cleared?
Renally
53
SSRI use in later pregnancy is associated with persistent pulmonary hypertension of the newborn T/F
T but not a strong association and no recommendation to discontinue SSRI in preg
54
What is the action of Wellbutrin?
It is a norepinephrine and dopamine reuptake inhibitor and a nicotinic receptor antagonist
55
Which side effect of Wellbutrin delayed it's development as a drug?
Seizures
56
Wellbutrin causes weight loss T/F
T- one trial showed 2.7kg loss relative to placebo over 6 months. It has a role in treatment of obesity.
57
Wellbutrin is used off label to treat hypoactive sexual desire disorder in women T/F
T
58
What is Level 1 evidence?
Meta-analysis with narrow confidence intervals and/or 2 or more RCTs with adequate sample size, preferably placebo controlled
59
What is level 4 evidence?
Expert opinion/consensus
60
Which drug for PTSD related nightmares?
Prazosin
61
Treatment for anticholinergic side effects
Physostigmine
62
Name two dose dependent side effects of clozapine
Drooling
| Seizures
63
How can you differentiate NMS from anticholinergic toxicity
Diaphoresis
64
SSRIs inhibit the serotonin transporter in platelets T/F
T
65
Which antipsychotic do you have to eat a meal with?
Lurasidone
66
Chinese people need lower doses of risperidone T/F
T
67
Seizures in TCA overdose are caused by what?
Sodium channel blockade
68
Buprenorphine mechanism of action
Opioid partial agonist
69
Valproic acid can cause pancreatitis T/F
T
70
Which cytochrome p450 interaction explains fluvoxamine's ability to enhance the serotonergic activity of clomipramine?
1A2 inhibition
71
MDMA (ecstasy) acts on which receptor for hallucinogenic effect?
Serotonin
72
Which receptor is responsible for withdrawal effects from alcohol and benzos?
Glutamate
73
What is the mechanism of action of Varenicicline?
Partial agonist of A4B2 nicotinic receptor
74
Phenelzine is contraindicated with pethidine (meperidine) T/F
T
75
The relative dose of a drug required to achieve certain effects is also known as what
Potency
76
The most anticholinergic TCA
Amitriptyline
77
GABA is an excitatory neurotransmitter T/F
F
78
using higher doses of antidepressants is related to a higher likelihood of relapse after discontinuation T/F
T
79
How is paliperidone cleared?
Renally
80
MAOIs inhibit intraneuronal metabolism T/F
T
81
What’s the minimum effective dose of ziprasidone?
80mg/ day
82
Pramipexole can induce gambling disorder T/F
T
83
Action potentials have an influx of K+ in the ascending phase T/F
F it’s Na
84
Interferon can cause psychosis T/F
T
85
Lamotrigine acts on voltage gated sodium channels T/F
T
86
What is the half life and peak plasma of sodium valproate
15hours half life, peak after 2-3 days
87
Giving up smoking results in a 30% increase in olanzapine levels T/F
T
88
Which CYP metabolises carbamazepine?
CYP3A3/4
89
The most sedating antidepressant
Mirtazepine
90
The most nauseating antidepressants
Fluvoxamine and venlafaxine
91
ADTs with minimal impact on weight
1. Venlafaxine
2. Fluvoxamine
3. Sertraline
4. Trazodone
5. Moclobemide
6. Fluoxetine
7. Desvenlafaxine
92
ADTs causing biggest weight gain
1. Paroxetine
2. Mirtazepine
3. Doxepin
4. Amitriptyline
5. Citalopram
6. Nortriptyline
7. Clomipramine
8. Desipramine
93
Two ADTs which are safer to use in SSRI induced hyponatremia
Mirtazepine and bupropion
94
How do antipsychotics affect the action potential to cause prolonged QTc?
Via the K ion channel
95
Risk factors for prolonged QTc
1. Female
2. Increased age
3. Electrolyte abnormalities
4. Congenital long QT
5. Structural cardiovascular disease
6. Other meds that prolong QTc
7. Metabolic inhibitors
96
Three antipsychotics with the highest risk for QTc prolongation
1. Thioridazine
2. IV haloperidol
3. Ziprasidone
97
Antipsychotic with minimal risk for prolonged QTc
Aripiprazole
98
Risperidone 50% reduction in renal impairment T/F
T
99
Having liver disease increases the risk of developing drug induced hepatotoxicity T/F
F
100
Pre-existing GI bleed is a risk factor for GI bleeding on SSRIs T/F
T
101
ADT with the lowest risk for a GI bleed
Mirtazepine
102
Which has the acute onset, serotonin syndrome or NMS?
Serotonin syndrome, onset is within 24hours. NMS is in days
103
Opioid analgesics eg pethidine, fentanyl release serotonin T/F
T
104
Bradyreflexia, serotonin syndrome or NMS?
NMS
105
Spontaneous clonus = what?
Serotonin syndrome
106
Drug used to treat serotonin syndrome and dose
Cyproheptadine 12mg followed by 2mg q2h max 32mg/day
107
Maintenance treatment with MAOIs can result in which deficiency?
Pyridoxine (B6). Typically patients taking MAOI are also prescribed pyridoxine simultaneously. Otherwise there is a risk of peripheral neuropathy
108
Aspirin increases lithium levels T/F
T
109
Quetiapine has a very low affinity for dopamine receptors T/F
T
110
ADT which is a super potent H1 antagonist
Mirtazepine
111
Lithium toxicity can occur with normal levels T/F
T
112
Phenobarbital can precipitate attacks of porphyria T/F
T
