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Pharmacology Flashcards

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1
Q

What is Quetiapine?

A 
Atypical antipsychotic
Sedating
Anxiolytic at low dose
Used in bipolar depression (anti-mania)
Increased suicide rates if used for depression in under 25's
Avoid in cerebrovascular disease
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2
Q

What is Propranolol?

A 
ß-blocker
Avoid in asthma, heart failure
Anxiety symptoms
Migraine prophylaxis
Angina, MI, essential tremor
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3
Q

What is pregabalin?

A

Anti-convulsant for epilepsy
Neuropathic pain
GAD

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4
Q

What is sertraline?

A

SSRI, depression, social anxiety, panic, OCD, PTSD

SE: pancreatitis, hepatitis, tachycardia, bleeding

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5
Q

What is vortioxetine?

A

Serotonin receptor modulator
Major depression
Less impact on sexual function, discontinue if manic
SE: increased seizures,

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6
Q

What is olanzapine?

A

Atypical antipsychotic
Used in schizophrenia, severe anxiety, bipolar for mania
Weight gain and diabetes risks
Avoid in bone marrow disorders, cardiac issues

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7
Q

What is flupentixol deconoate? (depixol)

A 
Typical antipsychotic
Schizophrenia
Mood stabiliser in bipolar
Psychotic depression
SE: hypersalivation, dyspnoea, hyperglycaemia
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8
Q

What is zopiclone?

A

Z drug anxiolytic and hypnotic (insomnia)
Use for up to 4 weeks
Caution in respiratory insufficiency
Drowsiness the next day

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9
Q

What is clozapine?

A

Atypical antipsychotic
Used in treatment resistant schizophrenia
Treats negative symptoms
Less extrapyramidal side effects
Decreases fertility, nausea, agranular cytosis, cardiomyopathy, hypersalivation, hypotension

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10
Q

What is sodium valproate?

A 
Anti epileptic
Bipolar
Migraine prophylaxis
Monitor liver function
SE: weight gain, tremor, extrapyramidal, hair loss
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11
Q

What is chlordiazepoxide?

A

Anxiolytic

Anxiety, panic disorder, alcohol withdrawal (short term)

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12
Q

What is fluoxetine?

A

SSRI, major depression, bulimia nervosa, OCD

SE: bleeding, sexual dysfunction

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13
Q

What is diazepam?

A

Long acting benzodiazepine
Anxiety, sedative (only short term use)
Dependence, tolerance
Avoid in elderly-> confusion

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14
Q

What are extrapyramidal symptoms?

A

Parkinsonianisms caused by lack of dopamine in nigrostriatal pathway
Can be caused by D2 antagonists (eg antipsychotics)

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15
Q

Name 7 parkinsonianisms

A 
Cogwheeling and increased tone
Bradykinesia
Freezing, festinating gait (shuffling)
Pill rolling resting tremor
Blank face and quiet speech (hypomimia)
Postural instability and flexed posture
Orthostatic hypotension-> falls
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16
Q

What drugs are most likely to cause extrapyramidal SE?

A

Fluphenazine
Perphenazine
Haloperidol

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17
Q

Treatment of bipolar?

A

Cognitive behavioural therapy, interpersonal therapy or behavioural couples therapy
Anti manic therapy (Olanzapine/haloperidol/quetiapine) or anti-depressant fluoxetine depending on presentation
2nd line: Lithium + Valproate
Lamotrigine for prevention
Physical health monitoring (weight, BP, blood glucose, thyroid function, FBC, renal and liver function)

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18
Q

Treatment of bipolar in children

A

In children, Risperidone is used for grandiosity, no evidence for antidepressants or lithium. Sodium valproate is commonly used.

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19
Q

Treatment of anxiety

A

• CBT (16-20 sessions) is first line treatment
• Medication of an SSRI is 2nd line (higher dose than for depression, continued for at least 1yr)
• Self help and reading groups is 3rd line
Benzodiazepines in crisis

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20
Q

Treatment of mild depression

A

Watch and wait for 2 weeks
Psychological therapy (6-8 session)
SSRI, for 6 months after remission

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21
Q

Treatment of moderate depression

A

SSRI, for 6 months after remission
CBT 16-20 session
Add another drug (eg another SSRI, quetiapine, serotonin receptor modulator)

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22
Q

Treatment of severe depression

A

SSRI +CBT
Add another drug (mirtazipine, quetiapine, serotonin receptor modulator, lithium)
ECT

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23
Q

Treatment of depression in children?

A

Fluoxetine is only medication
Young children: family therapy, art therapy, play therapy, address triggers/problems surrounding child
Teenagers: CBT

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24
Q

Risk factors for poor prognosis in depression

A 
Early age of 1st episode (<20 years) 
Multiple previous episodes 
Chronic Dysthymia 
Comorbid substance misuse 
Severe psychotic depression
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25
Treatment of schizophrenia
``` Atypical antipsychotic (eg olanzapine, risperidone) as first line. Psychotherapy and social support is also necessary. If 2 atypicals don’t work, clozapine has superior efficacy. However careful monitoring is needed due to SE including agranularcytosis. ECT has similar efficacy as clozapine ```
26
Basic management of SSRI prescription
* Antidepressants should be taken every day for at least 6 months after resolution of symptoms. * SSRIs and SNRIs increase the risk of self harm and suicide in the under 30s when first taken. Therefore these patients should be seen after a week of initiating treatment. * After 3-4 weeks with no effect, the dose can be increased of SSRIs or the medication can be switched.
27
What drugs can affect anxiety?
``` o B2 agonists (salbutamol) o Corticosteroids o Alcohol o Caffeine o Nicotine ```
28
Treatment of insomnia if coupled with depression
Sedating antidepressants include mirtazapine and trazodone
29
Treatment of insomnia
Sleep hygeine If fails, short courses of Z-drug hypnotics (eg zopiclone) Agomelatine can restore circadian rhythm
30
Guidelines for rapid tranquilisation
* Offer oral before parenteral * Use lowest effective dose * Benzodiazepines are first line (monitor temp, bp, hr) * Only use antipsychotic if a psychotic illness is present * Recent ECG MUST be available if haloperidol is being prescribed * Diazepam reached peak quickest out of the oral options but has the longest elimination half life * Olanzapine takes longest to reach peak
31
Which antipsychotics are most likely to cause raised prolactin and sexual dysfunction?
Amisulpride & risperidone
32
Which antipsychotic is least likely to cause EPSE and sexual dysfunction
Quetiapine
33
Which antipsychotic is most likely to cause weight gain and impaired glucose tolerance?
Olanzapine
34
Which antipsychotic is the least sedating?
Aripriprazole- alerting not sedating
35
What can help with the hypersalivation caused by clozapine?
Atropine eye drops Hyoscine pills Absorbent pillows
36
What in the social and PM history may affect dose of clozapine?
Coffee drinkers need less Smokers need more (CytP450) Macrolide antibiotics should be avoided
37
What happens is a dose of clozapine is missed?
Missed for more than 48hrs? | Start at 12.5mg and work up again
38
How long do you treat someone with antipsychotics after an acute episode of schizophrenia?
5 years | High risk of relapse if stopped 1-2 years after
39
What must be considered when prescribing an antidepressant in bipolar?
Antidepressants may precipitate mania Should be prescribed with a mood stabilising drug Discontinue antidepressant if pt present in an acute manic episode
40
What needs to be considered when treating a pregnant woman with bipolar?
Lithium and valproate are both teratogenic
41
Treatment of panic disorder
SSRI CBT TCAs if SSRIs are ineffective
42
Name 3 typical antipsychotics
Chlorpromazine Haloperidol Fluoentixol
43
Which antipsychotics can be given by IM depot injection?
Fupentixol (typical) Fluphenazine (typical) Risperidone (atypical)
44
Which antipsychotics are licensed for acute mania?
Risperidone Olanzapine Quetiapine
45
Name some anticholinergic SE of antipsychotics
Dry mouth Urinary retention Constipation Confusion
46
Name some antihistamine SE of antipsychotics
Sedation, weight gain
47
Name some antiadrenergic SE of antipsychotics
Postural hypotension (esp chlorpromazine) Impotence Dizziness
48
What is neuroleptic malignant syndrome?
``` Hyperpyrexia Autonomic instability Confusion Increased muscle tone Increased creatine phosphokinase Incontinence Profuse sweating Ataxia and convulsions if severe ```
49
What cardiac SE are there with antipsychotics?
Prolonged QT interval Arrythmias 2x risk of sudden cardiac death esp with haloperidol and pimozide
50
What can be given to patients with extrapyramidal dystonia and parkinsonism SE?
Procyclidine (anticholinergic)
51
What can be given to patients with tardive dyskinesia?
Reduction of cessation of anticholinergics Cessation of typical antipsychotics where possible Clozapine?
52
What is part of the physical health monitoring done for people on antipsychotics?
BMI + waist circumference ECG FBC, U+Es, lipid profile, LFTs, glucose, HBA1c, prolactin
53
Name 2 SNRIs and main SEs
``` Venlafaxine Duloxetine Suicidal ideation BP changes Sexual dysfunction, headache, anorexia ```
54
Name 2 TCAs and main SEs
``` Amitriptyline Imipramine Anticholinergic (eg dry mouth, urinary retention) Antiadrenergic (eg postural hypotension) Cardiac arrhythmias Seziures ```
55
Name a MAOi and main SEs
Phenelzine Anticholinergic (eg dry mouth, urinary retention) Antiadrenergic (eg postural hypotension) Tyramine reaction
56
What is St John's Wort?
Herbal preparation Similar to a MAOi Lots of interactions
57
How to MAOi work?
Inhibit breakdown of serotonin at synaptic cleft
58
When is lithium prescribed?
``` Prophylaxis of bipolar Acute mania Augmentation of antidepressants in resistant depression Schizoaffective illness The control of aggression ```
59
What needs to be monitored in lithium prescribing?
Serum lithium levels (0.4-1mmol/L) Thyroid and renal function (dehydration and diuretics can lead to toxicity) Pregnancy avoidance
60
Signs of lithium toxicity
``` D+V Coarse tremor Slurred speech Ataxia Drowsiness and confusion Convulsions and coma ```
61
When are benzodiazepines used? Mechanism?
``` GABA agonist Insomnia Short term crisis in GAD Alcohol withdrawal states Control of violent behaviour ```
62
Treatment of ADHD
Methylphenidate | Atomoxetine
63
What must be taken into consideration when prescribing for someone with learning difficulties?
``` Some medications (eg antipsychotics) are proconvulsant Avoid polypharmacy as pts might not be able to communicate SEs ```
64
Main SEs of dexamphetamine
``` • Common - appetite decrease - sleep onset delay - abdominal pain - headache • Uncommon-rare - angina - sweating - visual disturbances ```
65
What needs to monitored in a child taking dexamphetamine
Growth (height and weight) Appetite Sleep BP
66
Name 2 old antidepressant classes and 2 examples
5-HT 2 antagonist and reuptake inhibitor (trazodone) | Noradrenaline and specific serotonergic antagonist (mirtazapine)
67
4 uses of bezodiazepines and method of administration
- Anxiolysis with low dose of long-acting compound - Sleep induction with high dose of short-acting compound - IV use in treatment of status epilepticus (diazepam, clonazepam) - IV use in anaesthetic pre-medication (lorazepam, diazepam)
68
Adverse effects of bezodiazepines
Dangerous when combined with alcohol, barbiturates Memory disturbance Impaired driving ability Tolerance to hypnotic effect Discontinuation symptoms on stopping Risk of dependence in vulnerable patients Recommended for short-term treatment (4 weeks) only
69
SE of lithium
``` Thirst, polydipsia, polyuria Fine tremor, weight gain Mild impairment of attention and memory Hypothyroidism (5%) Impaired renal tubular function (5-10%) Lithium toxicity ```
70
When is the effect of antidepressants seen by?
2 weeks

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