Pharmacology Flashcards
(94 cards)
1
Q
What kind of drugs cross the BBB
A
Lipophilic/hydrophobic drugs
2
Q
What are indications for anti depressants
A
Mod/severe depression Dysthymia Premenstrual dysphoric disorder Generalised anxiety disorder Panic disorder Bulimia nervosa Neuropathic pain
3
Q
Which drugs act on the 5HT pathway
A
MAOI
SSRIs
Tricyclics
Dual reuptake inhibitors
4
Q
Which drugs act on NA pathway
A
MAOI
Tricyclics
SNRIs
5
Q
Give examples of MAOI
A
Phenelzine (irreversible)
Moclobemide (reversible)
6
Q
What are side effects of MAOI
A
Cheese reaction/hypertensive crisis from increased unmetabolised tyramine Postural hypotension Insomnia Peripheral oedema Drug-drug interactions
7
Q
Give types of reuptake inhibitors
A
SSRIs
SNRIs
Tricyclics
Others
8
Q
Give examples of SSRIs
A
Fluoxetine Citalopram Escitalopram Sertraline Paroxetine
9
Q
What are side effects of SSRIs
A
Nausea Headaches Sweating Vivid dreams Worsened anxiety sexual dysfunction hyponatraemia in elderly transient increase in suicidal ideation DISCONTINUATION SIDE EFFECTS
10
Q
Give examples of tricyclics
A
Imipramine
Amitriptyline
Doselepin
Lofepramine
11
Q
What are side effects of tricyclics
A
Anticholinergic: dry mouth, constipation, postural hypotension, urinary retention, blurred vision…
Weight gain
Sedation
Cardiotoxicity
12
Q
Which group of people do you avoid giving tricyclics to
A
Those with heart disease: IHD, recent MI…
13
Q
Give examples of dual reuptake inhibitors
A
Venlofaxine
Duloxetine
14
Q
Give an example of an atypical antidepressant
A
Mirtazapine
15
Q
Side effects of mirtazapine
A
Weight gain and sedation
16
Q
How long to antidepressants take to work
A
Several weeks
Can see some improvement after 10-14 days
17
Q
Give examples of mood stabilisers
A
Lithium
Antipsychotics
Anticonvulsants
Antidepressants
18
Q
Lithium has a wide therapeutic index, TRUE or FALSE
A
FALSE
It has a very narrow TI
19
Q
List side effects of lithium
A
Dry mouth / metallic taste Polydipsia Polyuria hypothyroidism hyperparathyroidism and hypercalcaemia long term renal damage nephrogenic diabetes insipidus weight gain exacerbation of skin conditions eg psoriasis teratogenic
20
Q
List toxic effects of lithium
A
vomiting drowsiness ataxia diarrhoea convulsions coma
21
Q
List tests required for lithium monitoring
A
Li levels FBC U+E LFTs TFTs Ca2+
22
Q
Does lithium have hepatic metabolism
A
No, it is an element and so does not undergo hepatic metabolism
23
Q
Lithium is indistinguishable from Na in the kidneys in terms of dehydration, true or false
A
True
24
Q
Examples of anticonvulsants
A
Na valproate –> teratogenic
Carbamazepine –> CVS, ataxia, induce hepatic enzymes
Lamotrigine –> SJS, least teratogenic
25
Examples of antipsychotics
Quetiapine
Aripiprazole
olanzapine
lurasidone
26
What can Lithium NOT be prescribed with
NSAID or ACEI
27
What is Electroconvulsive Therapy ECT
Brief induction of seizure
28
ECT indications
Depression
Bipolar
Schizophrenia
Catatonia
29
examples of monoamines
dopamine
noradrenaline
serotonin
30
examples of amino acids
glutamate
| GABA
31
How do MAOI work
inhibit monoamine oxidase and increase concentration of 5HT, NA and dopamine in the synaptic cleft
32
which antidepressant is cardiotoxic in overdose
tricyclic antidepressants
33
how can management of bipolar disorder be categorised
acute treatment of symptoms - mania/depression
| long term treatment
34
how do you pick the best antidepressant for someone
if they have previously responded to a certain drug/class, stick to that one
35
which drug is considered to probably be the best all round SSRI
escitalopram
36
which SSRI has a good cardiac safety profile
sertraline
37
what should be checked if there is no response to treatment
concordance
right diagnosis
substance misuse
physical illness
38
what should be done to medication if there is no response to treatment
increase dose
swap
combine
augment
39
when should you review someone after starting antidepressants
1-2 weeks
40
timing for relapse prevention
1st episode of depression - continue antidepressant for 6 months post full recovery
>=2nd episode - continue antidepressant for at least 1-2 years post full recovery
41
if someone has had 3 or 4 episodes of depression, how long should they be on antidepressants after recovery
lifetime
42
management of mod/severe depression
risk assessment
sleep hygiene, diet, exercise
CBT
Drugs - 1st SSRI, 2nd SSRI, 3rd SNRI / TCA / MAOI
43
management of acute hypomania in bipolar disorder
antipsychotics
maximise antimanic dose
stop antidepressant
44
PO is always preferred over IM, true or false
true
45
what role do benzodiazepines have
symptomatic relief eg agitation, insomnia
46
in bipolar disorder, you can prescribe antidepressants alone, true or false
FALSE
| never prescribe them alone, always prescribe antidepressants with antipsychotics
47
which drug is used for bipolar maintenance
lithium carbonate
48
in the elderly which drugs should you be cautious of prescribing
tricyclics - anticholinergics and sedation
| SSRIs - hyponatraemia
49
how often do you get ECT
twice weekly
50
absolute contraindications for ECT
MI in last 3 months
recent CVA
^ICP
phaeochromocytoma
51
side effects of ECT
headache
memory problems
muscle aches
confusion
52
what are different kinds of psychological therapy
Cognitive behavioural therapy CBT
Interpersonal therapy IPT
Eye movement desensitisation and reprocessing EMDR
53
what are the 4P's of formulation
Predisposing
Precipitant
Prolonging
Protective
54
tuberoinfundibular
PRL release
55
nigrostriatal
extrapyramidal system
56
mesolimbic
motivation and reward
57
what types of antipsychotic drugs are there
typical
| atypical
58
list typical antipsychotics
```
chlorpromazine
haloperidol
thioridazine
fluphenazine
zuclopentixol
```
59
what is the main defining factor for typical antipsychotics
D2 inhibition/antagonism
60
features of atypical antipsychotics
less likely to cause extrapyramidal side effects
| more serotonin antagonism than dopamine
61
list atypical antipsychotics
```
olanzapine
risperidone
quetiapine
clozapine
aripiprazole
amisulpride
```
62
side effects of typical antipsychotics
EPSE - extrapyramidal side effects
63
side effects of antipsychotics
```
Acute dystonic reaction
Parkinsonism
Akathesia
Tardive dyskinesia
Hyperprolactinaemia
```
64
what is acute dystonic reaction and its management
acute involuntary distressing painful muscle spasms
| stop antipsychotic and start anticholinergic
65
Features of drug induced parkinsonism and its management
bilateral symptoms
| change antipsychotic or give anticholinergic
66
what is akathesia
| what is the management
severe involuntary internal restlessness
| stop/reduce antipsychotic
67
what is tardive dyskinesia
how long does it take to develop
what is the management
repetitive involuntary purposeless odd orofacial movements
takes years to develop
its hard to get rid of once you have got it, sometimes removing antipsychotic may make it worse
68
how is hyperprolactinaemia a side effect of antipsychotics
| what are the features
antipsychotics antagonise dopamine which means there is no inhibitory control on PRL
amenorrhoea, infertility, galactorrhoea, sexual dysfunction, osteoporosis
69
side effects of atypical antipsychotics
metabolic syndrome
histamine blockade
alpha adrenergic blockade
muscarinic blockade
70
features of metabolic syndrome
5HT blockade results in weight gain, CVD, stroke, high cholesterol
71
features of histamine blockade
sedation
| increased appetite
72
features of alpha adrenergic blockade
postural hypotension
dizziness
fainting
73
features of muscarinic blockade
```
dry mouth
urinary retention
constipation
blurry vision
sedation
```
74
indication for clozapine
3rd line treatment for resistant schizophrenia
75
clozapine side effects triad
sedation
weight gain
hypersalivation
76
rare side effect of clozapine and what should be done
agranulocytosis
| routine FBC
77
other side effects of clozapine
myocarditis
| paralytic ileus
78
what is neuroleptic malignant syndrome
rare condition caused by antipsychotic drugs or stopping anti-Parkinson medication
79
features of neuroleptic malignant syndrome
fever/hyperthermia
rigidity
autonomic dysfunction
altering consciousness
80
what is GABA and what is its effect
inhibitory neurotransmitter
| calming tranquilising effect
81
mechanism of benzodiazepines
binding of BZD to its receptor increases affinity of GABA to the GABA receptor indirectly which causes Cl- influx and hyperpolarisation
82
benzodiazepines increase frequency/duration of GABA receptor opening
frequency
83
examples of BZDs
chlordiazepoxide
diazepam
lorazepam
84
side effects of BZDs
sedation
dizziness
decreased concentration
reduced motor coordination
85
indications for BZDs
convulsions
anxiety
agitation
86
mechanism of barbiturates
bind to GABAa receptor and enhance effect of GABA at GABA receptor directly
87
barbiturates increase the frequency/duration of opening of GABA receptors
duration
88
examples of barbiturates
phenobarbitol
| pentobarbitol
89
mechanism of non-benzodiazepine hypnotics
bind to alpha subunit of GABAa receptor leading to Cl- influx
90
indication of B blocker
| does it have an effect on anxiety
tremor
| no
91
which atypical antipsychotic is most likely to cause metabolic syndrome
olanzapine
92
what should be monitored in someone taking vanlafaxine
BP
93
what should be monitored prior to starting citalopram/escitalopram
ECG for QT prolongation
94
what should be co prescribed with SSRIs and why
PPIs because of increased risk of GI bleeding
