Pharmacology

Question 1

Name 3 first generation antipsychotic medications?

Answer 1

Haloperidol, Chlorpromazine, Prochlorperazine

Question 2

Haloperidol is in what class of drugs?

Answer 2

Antipsychotic (first gen- typical)

Question 3

What are the indications for prescribing a first generation antipsychotic?

Answer 3

Urgent treatment severe psychomotor agitation, Schizophrenia, Bipolar disorder, N+V (particularly in palliative)

Question 4

Anti-psychotics work by blocking the _____ post-synaptic receptors in the 3 main pathways?

Answer 4

Blocking dopamine D2 receptors

Question 5

What are the Extra-Pyramidal Side Effects (EPSEs)?

Answer 5

Acute dystonic reactions, Akathisia, Neuroleptic malignant syndrome

Question 6

What is meant by akathisia?

Answer 6

Feeling of inner restlessness

Question 7

What is tardive dyskinesia and what drug therapy can cause it?

Answer 7

Pointless, involuntary or repetitive movements such as lip smacking.

Develop months/years after long term treatment with antipsychotics

Question 8

Antipsychotics can prolong the QT interval. Name other drugs that also do this (drug interactions)?

Answer 8

Amiodarone, Macrolides (Abx), Quinine, SSRIs

Question 9

Routes of administration for antipsychotics?

Answer 9

Oral, Slow-release IM, IV (emergency only)

Question 10

4 examples of Second generation antipsychotics?

Answer 10

Quetiapine, Olanzapine, Risperidone, Clozapine

Question 11

Indications for second generation antipsychotics?

*what circumstances indicate second gen >first

Answer 11

Severe psychomotor agitation *that leads to dangerous/harmful behaviour.
Schizophrenia *ESPEs complicate use of first gen/negative symptoms present
Bipolar *acute episodes mania/hypomania

Question 12

Difference between first gen and second gen antipsychotic mechanism?

Answer 12

• Second generation have a higher affinity for other receptors (5-HT2A)
• Looser binding to D2 receptors.

Question 13

Which antipsychotic is particularly effective for treatment resistant schizophrenia?

Answer 13

Clozapine

Question 14

Give 6 side effect categories caused by second genetation antipsychotics?

Answer 14

Sedation, EPSEs, metabolic, cardiovascular, prolactin, agranulocytosis

Question 15

Metabolic SEs are common with second generation antipsychotics, what 3 changes might occur?

Answer 15

Weight change, developing DM and lipid changes.

Question 16

Agranulocytosis means what? This occurs in 1% of patients being treated with what antipsychotic?

Answer 16

Agranulocytosis= decreased white cell count. Occurs in 1% ptx.

CLOZAPINE

Question 17

Risperidone can have effects on prolactin secretion, what might the patient complain of?

Answer 17

Prolactin SEs= sexual dysfunction, breast changes

Question 18

What time of day is it best to take oral antipsychotic medication?

Answer 18

Bedtime

Question 19

Name the class of drug: 
Diazepam, Temazepam, Lorazepam, Midazolam, Chlordiazepoxide.

Answer 19

Benzodiazepine

Question 20

What are the indications for benzodiazepines?

Answer 20

• First line tx seizures and status epilepticus.
• Short term disabling Insomnia/Anxiety.
• Alcohol withdrawal.
• Sedation for interventional procedures instead of gen anaesthetic

Question 21

Which receptor does benzodiazepine act on and what is the effect?

Answer 21

GABAA receptor-
Chloride channel in the brain- binding causes it to open. Influx of chloride increases resistance to depolarisation and therefore decreases synaptic transmissions and excitability.

Benzodiazepines facilitate and enhance the binding of GABA to GABAA

Question 22

Give the 3 main side effect areas that can occur with benzodiazepines.?

Answer 22

Consciousness= Drowsiness, sedation, coma. 
Dependence= Abrupt cessation withdrawal reaction. 
Airways= Loss of airway reflexes-->  obstruction-->death.

Question 23

Patients taking benzodiazepines do not need to inform the DVLA- true or false?

Answer 23

Patients do not need to inform the DVLA
You should advise them not to drive/operate heavy machinery after taking the drug.

(they do if its being prescribed for a seizure)

Question 24

Which benzodiazepine is prescribed for alcohol withdrawal?

Answer 24

Chrodiazepoxide

+IV pabrinex

Question 25

``` Name the benzodiazepine prescribed for: seizures, alcohol withdrawal, interventional sedation, insomnia/anxiety? ```

Answer 25

Seizure= Lorazepam. Alcohol withdrawal= oral chlordiazepoxide. Interventional sedation = midazolam. Insomnia/anxiety= Temazepam.

Question 26

Give 3 examples of SSRIs?

Answer 26

Sertraline, Fluozetine, Citalopram

Question 27

What are the 3 indications for prescribing SSRIs?

Answer 27

Moderate-severe depression, Panic disorder, Obsessive compulsive disorder

Question 28

Why do the following patient groups need extra consideration/monitoring when prescribing SSRIs: Young patients, Patients with liver impairment Patients with epilepsy

Answer 28

Young- increased suicidal thoughts. Liver impairment- SSRIs are metabolised by the liver. Epilepsy- lower seizure threshold.

Question 29

Why are Monoamine Oxidase Inhibitors contraindicated with SSRIs?

Answer 29

MAOIs also increase serotonin (can be used in tx for atypical depression)

Question 30

Amitritptyline is what type of drug?

Answer 30

Tricyclic antodepressant

Question 31

Indication for tricyclic antidepressant?

Answer 31

Second line mod-severe depression (when SSRIs ineffective)

Question 32

Tricyclics inhibit neuronal uptake of…

Answer 32

Serotonin (5-HT) and noradrenaline

Question 33

Tricyclics block muscarinic receptors. What are the 4 side effects of this?

Answer 33

Dry mouth, Blurred vision, Constipation, Urinary retention.

Question 34

True or False. SSRIs have more SEs than Tricyclics

Answer 34

False. SE's: Tricyclics>SSRIs

Question 35

When coming off tricyclics there should be a slow reduction over the course of how long?

Answer 35

4 weeks

Question 36

What are valproates indicated for?

Answer 36

Epilepsy, Bipolar First line for generalised/absence seizure. Tx option for focal seizure

Question 37

Mechanism of valproates?

Answer 37

Weak inhibitors of neuronal Na+ channels: increasing membrane stability. Increase GABA levels in brain.

Question 38

What are the driving regulations in relation to epilepsy and anti-epileptic drugs such as valproate?

Answer 38

You shouldn’t drive within 12 months of a seizure or within 6 months of stopping or changing anti-epileptic drug