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Psychiatry > Pharmacology > Flashcards

Pharmacology Flashcards

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1
Q

A patient attends the GP complaining of agitation, nausea and general feeling of being fed up with life. He recently stopped taking SSRI’s 2 weeks ago.

what is the diagnosis?

A

discontinuation syndrome

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2
Q

what is the main side effect you have to be aware of when prescribing tricyclic antidepressants?

A

prolongation of QT interval

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3
Q

what are the side effects of tricyclic antidepressants?

A

anticholinergic
antihistaminic
antiadrenergic
prolongation of QT interval

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4
Q

what are the side effects from monoamine oxidase inhibitors?

A 
dry mouth
sedation
weight gain
sexual dysfunction
sleep disturbance
orthostatic hypotension
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5
Q

what are the side effects of amitryptilline?

A

anticholinergic - dry mouth, dry eyes, constipation, memory deficit, delirium

antiadrenergic - sedation, orthostatic hypotension, sexual dysfunction

antihistaminergic - weight gain, sedation

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6
Q

what type of drug is nortryptiline and what are its side effects?

A

secondary tricyclic antidepressant
often metabolite of tertiary TCA
same side effects as tertiary TCA i.e. antiadrenergic, antihistaminergic, anticholinergic, but less severe

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7
Q

what is serotonin syndrome?

A

complication of taking monoamine oxidase inhibitors with meds that increase serotonin levels i.e. SSRI

therefore if switching from SSRI to MOI, you have to wait for 2 weeks before starting MOI (exception with fluoxetine - wait 5 weeks)

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8
Q

what is the presentation of serotonin syndrome?

A 
abdominal pain 
diarrhoea
sweats
tachycardia
hypertension
myoclonus
irritability
delirium
hyperpyrexia
shock
death
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9
Q

what SSRI is most likely to induce mania than any other SSRI?

A

fluoxetine

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10
Q

what is the maximum dose of citalopram and why?

A

30 - 40mg/day
this can cause severe QT prolongation

QT prolongation occurs at doses of 10-30mg !

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11
Q

what SSRIs can cause QT prolongation and at what doses is this side effect likely to occur?

A

citalopram

escitalopram

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12
Q

name 2 serotonin noradrenaline re-uptake inhibitors (SNRI).

A

venlafaxine

duloxetine

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13
Q

what are the main side effects of venlafaxine?

A

QT prolongation
increase diastolic blood pressure (10-15mmHg)
Discontinuation syndrome
sexual side effects

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14
Q

name 2 novel antidepressants.

A

buproprion

mirtazapine

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15
Q

what class of drug is mirtazapine and what are the side effects?

A

Novel antidepressant

weight gain
increase in cholesterol
sedating

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16
Q

what class of antidepressant is the first line of choice in a new patient who has been diagnosed with depression?

A

SSRI

i.e. fluoxetine, citalopram, sertraline

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17
Q

what factors determine a good response to lithium?

A

family history of positive response to lithium
pure mania
mania followed by depression

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18
Q

at what blood level should you aim lithium to be?

A

0.6 - 1.2

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19
Q

before starting lithium what baseline tests would you carry out?

A

TSH
U&E
b-HCG in women

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20
Q

how frequent is a patient on lithium monitored?

A

every 3 months for blood levels

every 6 months - creatinine and TSH

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21
Q

what are the side effects of lithium ?

A 
GI distress
thyroid abnormalities
nonsignificant leukocytosis
polyuria/polydypsia
hair loss
acne 
reduces seizure threshold, cognitive slowing and intention tremor
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22
Q

what are the symptoms of lithium poisoning?

A 
vomiting
diarrhoea
ataxia
dizziness
anorexia
slurred speech
nystagmus
blurred visions
clonic climb movements
delirium 
oligouria
seizures
renal failure
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23
Q

before starting a patient on sodium valproate, what baseline tests should you cary out?

Study These Flashcards
A

FBC
LFT’s
b-HCG in women

24
Q

before starting sodium valproate, what supplement would you put a a female patient on and why?

Study These Flashcards
A

folic acid

risk of neural tube defects

25
what tests are carried out to monitor a patient on sodium valproate?
FBC | LFTs
26
what are the side effects of sodium valproate?
``` thrombocytopenia and platelet dysfunction nausea, vomiting weight gain sedation tremor hair loss neural tube defect ```
27
what is the first line treatment for acute mania and mania prophylaxis?
carbamazepine
28
what baseline tests should be carried out before starting a patient on carbamezapine?
LFTs FBC ECG
29
when monitoring a patient who is on carbamazepine, what tests are carried out?
FBC | LFT
30
what are the side effects of carbamazepine?
``` low sodium levels / hyponatraemia nystagmus rash ataxia aplastic anaemia and agranulocytosis drug-drug interactions sedation dizziness confusion ```
31
what are the side effects of lamotrigine?
toxic epiderimal necrolysis / SJS nausea/ vomiting blood dyscrasia
32
what are the side effects of low potency antipsychotic drugs?
anticholinergic (dry mouth, dry eyes, constipation, memory deficit, delirium) cardiotoxic
33
give 3 examples of atypical antipsychotics.
olanzapine, risperidone, quetiapine
34
what are the adverse effects associated with typical antipsychotics?
tardive dyskinesia (involuntary muscle movements) neuroleptic malignant syndrome (muscle rigidity) extrapyramidal side effects (dystonia, parkinson symptoms, akathisia)
35
what is the difference in the action between typical and atypical antipsychotics?
typical = D2 dopamine receptor antagonist atypical = serotonin-dopamine 2 antagonist
36
what basic blood wok should be carried out before starting a patient on antipsychotics?
fasting lipid profile fasting blood glucose LFTs FBC
37
if a patient is requiring an antipsychotic but on baseline testing they show a high cholesterol, what medication do you chose?
risperidone don't use olazapine or quetiapine.
38
what disorders is benzodiazepine used to treat?
insomnia parainsomnia anxiety
39
what are the side effects of benzodiazepines?
``` dependancy somnolence cognitive deficits amnesia disinhibition ```
40
what's the main difference in the effects of benzodiazepine vs buspirone?
buspirone won't give an effect to a patient who has previously been on benzos as buspirone doesn't give a sedation affect
41
what is the minimum length of time antidepressants should be continued after a response?
6 months
42
what mood stabiliser (anticonvulsant) can cause TEN/SJS?
lamotrigine
43
you see a patient who has had 5 episodes of elevated mood, irritability and impulsivity. what medication is best to give?
sodium valproate / valproic acid | - rapid cycling bipolar = 4 or more episodes of mania and/or depression within 12 months
44
what is tardive dyskinesia?
involuntary movements of the facial and body muscles | results in involuntary facial expressions i.e. sticking out tongue, frowning etc
45
what are the extrapyramidal effects associated with adverse effects of antipsychotics?
parkinsonism akathisia - don't feel comfortable in skin, agitation acute dystonia - abnormal muscle tone resulting in muscle spasms and involuntary movements neuroepileptic malignant syndrome tardive dyskinesia - inapprpriate muscle movement i.e. sticking out tongue, lip smacking
46
what are the consequences of severe lithium toxicity? at what level does this occur at?
> 2.5 oliguria renal failure (distal tubular acidosis) generalised convulsions
47
what are the symptoms of lithium poisoning?
``` ataxia dizziness nystagmus blurred vision slurred speech nausea / vomiting anorexia confusion, delirium syncope clonic limb movements convulsions oliguria and renal failure ```
48
what type of drug is olanzapine and what are the side effects?
atypical antipsychotic ``` weight gain hyperglycaemia hypertriglyceridemia hypercholesterolaemia hyperprolactinaemia abnormal LFTs ```
49
what are the side effects of clozapine?
``` agranulocytosis sedation weight gain abnormal LFTs hypertryglyceridemia hypercholesterolaemia hyperglycaemia nonketonic hyperosmolar coma and death ```
50
what are the side effects of risperidone?
weight gain sedation hyperprolactinaemia extrapyramidal effects
51
what are the side effects of quetiapine?
``` weight gain hyperglycaemia hypertriglyceridemia hypercholesterolaemia orthostatic hypotension ```
52
dual therapy with clozapine and what drug will increase risk of seizures
lithium
53
a patient presents with fever, confusion and severe muscle rigidity. he is on chlorpromazine for schizophrenia. his WCC, CK and LFTs are elevated. what is your diagnosis?
neuroepileptic malignant syndrome
54
what its he treatment for akathisia?
anxiolytic (i.e. benzodiazepines) or propranolol
55
what is the main side effect of clozapine?
agranulocytosis

Psychiatry (13 decks)

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