4th Year Pharmacology

Question 1

adverse psychiatric in steroids

Answer 1

can give you acute mania

Question 2

two categories of antipsychotics?

Answer 2

typicals (first generation)

atypicals (second generation)

Question 3

adverse in second generation

Answer 3

metabolic and weight gain

Question 4

which second generation antipsychotic has the most weight gain?

Answer 4

clozapine

Question 5

is clozapine anti-suicidal?

Answer 5

yes

Question 6

monitoring of clozapine

Answer 6

weekly for 6 months
then fortnightly for 6 months
then monthly

Question 7

side effects of clozapine

Answer 7

agranulocytosis
myocarditis
gastroparesis/ constipation/ perforation
weight gain
metabolic
sialorrhoea

Question 8

management of sialorrhoea

Answer 8

hyoscine

Question 9

clozapine toxicity

Answer 9

lethargy
confusion
tachycardia
hypersalivation

Question 10

how to restart clozapine if missed for >48 hours

Answer 10

12.5mg

Question 11

antipsychotic SE

Answer 11

acute dystonic reactions
NMS
hyperprolactinaemia
metabolic
prolonged QTc
elderly= stroke, VTE

Question 12

which antipsychotics have the most hyperprolactinaemia?

Answer 12

haloperidol

risperidone

Question 13

discontinuation symptoms

Answer 13

depressive symptoms
rebound anxiety
flu-like
dizziness
nausea 
sleep disturbance

Question 14

which SSRI has highest risk of discontinuation symptoms

Answer 14

paroxetine

Question 15

reason to stop antidepressant?

Answer 15

patient becomes manic

Question 16

which SSRI is most useful post-MI?

Answer 16

sertraline (less QTc prolongation)

Question 17

which SSRIs have the most dose-dependent QTc prolongation?

Answer 17

citalopram

escitalopram

Question 18

interactions with SSRIs

Answer 18

NSAIDs
warfarin/ heparin/ aspirin
triptans and MAOIs

Question 19

what do SSRIs in the elderly risk?

Answer 19

hyponatraemia

Question 20

why avoid NSAIDs and anticoagulants/ antiplatelets with SSRIs?

Answer 20

SSRIs are associated with increased risk of bleeding especially in people taking drugs that damage the GI mucosa or clotting

Question 21

what can venlafaxine exacerbate?

Answer 21

hypertension

Question 22

which SSRI has the longest half-life?

Answer 22

fluoxetine

Question 23

when is serotonin syndrome most likely to occur?

Answer 23

several hours after taking new treatment or increasing dosage
intentional overdose

Question 24

medications that increase the risk of serotonin syndrome

Answer 24

SSRIs
SNRIs
bupropion
tricyclics
MAOIs
carbamazepine
sodium valproate
triptans
opioids
lithium
ecstasy
cocaine
amphetamines
St John's wort
ondansetron
linezolid
ritonavir

Question 25

presentation of serotonin syndrome

Answer 25

``` tachycardia hypertension tachypnoea confusion seizures fever DIC renal failure ```

Question 26

what does serotonin have a role in?

Answer 26

``` brain to regulate attention, behaviour body temperature gut blood flow breathing ```

Question 27

management of serontonin syndrome

Answer 27

mild= stop drug | mod- severe= BZDs, oxygen, IV fluids, reduce HR/ BP, serotonin block (cyproheptadine), intubation, etc.

Question 28

role of BZDs

Answer 28

increase frequency of Cl- channels

Question 29

role of barbiturates

Answer 29

increase duration of Cl- channel opening

Question 30

what is zopiclone?

Answer 30

non-BZD hypnotic that stimulates GABA receptors