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MRCPsych Part A - Al-Rashid Hospital > Adverse Drug Reactions > Flashcards

Adverse Drug Reactions Flashcards

1
Q

Define tolerance

A

The need to use increased doses of a drug to maintain a clinical effect.

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2
Q

What can lead to tolerance of a drug?

A

Down-regulation
Up-regulation
Reduced responsitivity without alterations in receptor numbers

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3
Q

What is down-regulation?

A

Decreased sensitivity of target receptors due to decreased numbers due to agonists

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4
Q

What is up-regulation?

A

Increase in numbers of receptors due to antagonists

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5
Q

What is cross-tolerance?

A

When drugs with similar pharmacological actions can lead to tolerance of the other drug

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6
Q

What is reverse tolerance?

A

When sensitivity to a drug effect increases over time.

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7
Q

Give an e.g. of downregulation which leads to a therapeutic effect.

A

When SSRIs are used, the 5HT1A autoreceptors in somatodendritic zones undergo down-regulation secondary to increased serotonin availability when reuptake is blocked; this leads to increase in serotonergic tone of neurons.

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8
Q

Define withdrawl

A

When drugs are administered for reasonable period of time, physiological adaptation develops which on withdrawl of drug can get disturbed and leads to withdrawl symptoms.

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9
Q

What type of drug leads to withdrawl symptoms?

A

Abrupt withdrawl of treatment for an agent with short eliminatino half-life

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10
Q

Which has longer half-life; methadone or heroin?

A

Methadone

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11
Q

Why does methadone lead to less withdrawl than heroin?

A

Methadone has a longer half-life

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12
Q

Why does Paroxetine lead to withdrawl?

A

It has anticholinergic properties; withdrawl causes rebound symptoms
Paroxetine inhibitis its own metabolism via CYP2D6, so withdrawl leads to loss of inhibition, excessive paroxetine breakdown, sudden steep drop in levels and then withdrawl symptoms.

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13
Q

Why does Fluoxetine produce fewer withdrawl symptoms?

A

Its active metabolite, norfluoxetine, has a long half-life

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14
Q

What is the advice of benzodiazepine reducing regime?

A

10% dose reduction every 2 weeks.

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15
Q

Why must you wait 72 hours before prescribing naltrexone for an opioid detoxified patient?

A

Prescribing an antagonist can precipitate withdrawl symptoms.

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16
Q

Which cause more withdrawl; full or partial agonists?

A

Full

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17
Q

What kinetics do sustained release formulations affect?

A

Absorption kinetics

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18
Q

Do depot or oral preparations have more withdrawl potential?

A

Oral

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19
Q

Does XL or plan preparation of a drug lead to more withdrawl symptoms?

A

Neither; both same

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20
Q

Which receptors cause side effect of agitation?

A

Alpha 2 blockade
5HT2A/2C stimulation
DRI

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21
Q

Which receptors cause side effect of akathisia?

A

D2 blockade

5HT2A stimulation

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22
Q

Which receptors cause side effect of delirium?

A

Antimuscarinic

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23
Q

Which receptors cause side effect of EPSE?

A

D2 blockade reduces with 5HT2A antagonism

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24
Q

Which receptors cause side effect of hyperthermia?

A

Antimuscarinic action

In serotonin syndrome may be due to 5HT2A/2C.

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25
Q

Which receptors cause side effect of insomnia?

A

Alpha 1 stimulation

5HT2A stimulation

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26
Q

Which receptors cause side effect of amnesia?

A

Anticholinergic effect

GABAa stimulation

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27
Q

Which receptors cause side effect of hyperprolactinaemia?

A

D2 blockade

5HT1A stimulation

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28
Q

Which receptors cause side effect of disrupted slow wave sleep?

A

Slow wave sleep is maintained by 5HT2A inhibition; hence 5HT2A stimulation disrupts this.

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29
Q

Which receptors cause side effect of sweating?

A

Cholinergic effect

Increases with noradrenaline reuptake inhibition

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30
Q

Which receptors cause side effect of postural hypotension?

A

Alpha 1 antagonism

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31
Q

Which receptors cause side effect of appetite loss?

A

5HT2A stimulation

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32
Q

Which receptors cause side effect of increased appetite?

A

Antihistamine

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33
Q

Which receptors cause side effect of GI discomfort/nausea?

A

5HT3 stimulation

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34
Q

Which receptors cause side effect of weight gain?

A

Antihistamine

5HT2C antagonism

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35
Q

Symptoms of anticholinergic effects?

A 
Blurred vision
Delirium
Constipation
Tachycardia
Dry secretions
Decreased sweating
Urinary retention
Hyperthermia
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36
Q

What conditions do anticholinergics increase risk of?

A

Narrow-angle glaucoma

Photophobia due to mydriasis

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37
Q

Which receptors cause side effect of anorgasmia?

A

Alpha 1 antagonism

5HT2A/C stimulation

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38
Q

Which receptors cause side effect of retrograde ejaculation?

A

Alpha 1 block
Anticholinergic
Antihistamine

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39
Q

Which receptors cause side effect of tardive dyskinesia?

A

Supersensitivity of dopamine receptors which develops due to prolonged therapy with dopamine blocking drugs

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40
Q

Which receptors cause side effect of impotence?

A

Alpha 2 blockade

5HT2A/C stimulation

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41
Q

Which receptors cause side effect of priapism?

A

Alpha 1 blockade

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42
Q

Which receptors cause side effect of obsessions?

A

5HT1D stimuation

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43
Q

Which receptors cause reduced OCD?

A

5HT1A/2A

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44
Q

Which receptors cause side effect of pathological gambling?

A

Habituation of dopamine receptors on repeated use of dopamine agonists, leading to dopamine dysregulation syndrome

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45
Q

Which drugs cause insulin resistance?

A

Valproate

Olanzapine

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46
Q

Which polymorphism leads to weight gain?

A

Drugs with strong 5HT2C affinity used on patients with specific variant of polymorphism of 5HT2C receptor promotor regions

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47
Q

What types of antipsychotics cause weight gain more than others?

A

Low-potency produce more weight gain than high potency.

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48
Q

Give examples of EPSE

A 
Acute dystonia
Akathisia
Parkinsonism
Tarde dyskinesia
Dystonia
Perioral tremor
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49
Q

Which type of antipsychotics lead to EPSEs?

A

High potency

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50
Q

Which EPSEs are due to late SEs and chronic use of antipsychotics?

A

Tardive dyskinesia
Dystonia
Perioral tremor

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51
Q

What causes hyperprolactinaemia?

A

Blocking of D2 receptors on anterior pituitary mammotrophic cells that normally are tonically inhibited by dopamine produced in hypothalamic arcuate nucleus.

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52
Q

Which antipsychotics induce Parkinsonism?

A 
Trifluoperazine
Chlorpromazine
Raclopride
Haloperidol
Fluphenazine
Risperidone
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53
Q

Why do some antipsychotics cause Parkinsonism?

A

They bind more tightly than the endogenous ligand dopamine to D2

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54
Q

Which drugs are less likely to cause Parkinsonism and why?

A

Anticholinergics
Quetiapine
Clozapine
Bind more loosely to D2 than dopamine

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55
Q

Difference between tightly bound and loosely bound antipsychotic drugs

A

Loosely bound:
Weaker potency, so need higher doses to be clinically effective but can be titrated faster.
Less chance of EPSEs

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56
Q

Which type of antipsychotics are more likely to lead to relapse?

A

Loosely bound antipsychotics as may dissociate from D2 receptor rapidly

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57
Q

When is drug-induced Parkinsonism seen?

A

Within 90 days of treatment

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58
Q

Which characteristic of Parkinsons is not seen in its drug-induced form?

A

Pill-rolling tremor

Coarse tremor seen instead

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59
Q

Who are at high risk of Parkinsonism from antipsychotics?

A

Elderly

Female

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60
Q

At what D2 receptor occupancy by antipsychotics leads to EPSE?

A

Higher than 80%

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61
Q

Why are atypical antipsychotics thought to have a lower chance of causing EPSEs?

A

Anticholinergic
HT2A antagonism
Less avidity of bindng i.e. hit and run profile (clozapine, quetiapine)

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62
Q

What can you use to treat drug-induced Parkinsonism?

A

Anticholinergics for up to 6 weeks

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63
Q

Why must anticholinergics used to treat drug-induced Parkinsonism be withdrawn after 4-6 weeks?

A

Tolerance can develop for EPSEs

Longer use of anticholinergics increases risk of Tardive Dyskinesia

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64
Q

What are dystonias?

A

Brief or prolonged contractions of specific groups of muscles

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65
Q

Give e.g. of dystonias

A 
Oculogyric crises
Tongue protrusion
Trismus
Torticolis
Blepharospasm
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66
Q

When in the course of treatment do dystonias occur?

A

Early

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67
Q

Who is more likely to get dystonias?

A

Young men starting high-dose of high potency medications, especially IM.

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68
Q

What can be used to treat dystonias?

A

Reassurance

Anticholinergics

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69
Q

What causes akathisia?

A

Higher D2 occupancy in striatum

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70
Q

Symptoms of Akathisia?

A

Inability to relax
Pacing
Rocking with alternation of sitting and standing

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71
Q

What drugs can cause akathisia?

A

Neuroleptics
Antidepressants
Sympathomimetics

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72
Q

Treatment for Akathisia?

A

Dose reduction
Changing drug
Adding beta blocker/anticholinergic drug/benzo/cryoheptadine

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73
Q

Risk factors for Tardive Dyskinesia

A

Female
Elderly
Diabetes
Previous brain damage
Affective illness rather than pure psychosis
Children
Learning difficulties
Afro-carribean
Long-term co-precription of anticholinergics
Frequent drug holidays - will lead to high dose prescription with each relapse

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74
Q

When does tardive dyskinesia occur?

A

At least 6 months, often 1-2 years of treatment.

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75
Q

What is tardive dyskinesia?

A

Abnormal, involuntary, irregular choreaoathetotic movements of muscles of head, limbs and trunk.

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76
Q

Most common type of tardive dyskinesia?

A

Perioral movements

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77
Q

What exacerbates Tardive dyskinesia?

A

Stress

Absent on sleep

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78
Q

What is particularly striking in Tardive Dyskinesia patients?

A

Absence of insight

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79
Q

Treatment of Tardive Dyskinesia?

A 
Spontaneously resolve - unlikely in elderly.
Clozapine
Dose reduction
Withdrawl of drug
Switch to atypicals
Add clonazepam
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80
Q

When can neuroleptic malignant syndrome occur?

A

Anytime during treatment

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81
Q

Symptoms of NMS?

A 
Extreme hyperthermia
Severe muscular rigidity
Confusion
Autonomic fluctuations (BP, HR)
Akinetic/mute
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82
Q

Blood test values of NMS

A

High WCC, CK, LFTs, plasma myoglobin

Myoglobinuria

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83
Q

Onset of NMS?

A

24-72 hours

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84
Q

How long does NMS last if untreated?

A

10-14 days

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85
Q

When is NMS more common?

A

Young men
After agitation
Using high potency drugs, especially rapid tranq
Dopaminergic drugs on withdrawl

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86
Q

Mechanism underlying NMS?

A

Dopamine blockade or hypothalamic sympathetic dysregulation

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87
Q

Mortality rate of NMS?

A

20-30% if untreated

Higher if depot used

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88
Q

Management of NMS?

A

Fluid replacement & prevent renal failure secondary to myoglobinuria
Prevent aspiration pneumonia
Stop antipsychotic

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89
Q

Which drugs can be used to treat NMS?

A

Dantrolene
Bromocriptine
Amantadine

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90
Q

What antipsychotics need to be considered after NMS occurs?

A

Low potency or atypical

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91
Q

How many patients on clozapine develop agrunulocytosis?

A

1 in 100

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92
Q

When is risk of agrunulocytosis at maximum on clozapine?

A

Between 4-18 weeks

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93
Q

Main SE of clozapine related to dose?

A 
Salivation
Sedation
Weight gain
Fatigue
Lowering of seizure threshold
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94
Q

Which SE of clozapine are not dose realted?

A

Arganulocytosis

Myocarditis

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95
Q

What happens if yellow result occurs on someone on clozapine?

A

Monitoring frequency must increase until green signal obtained

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96
Q

Which drug may precipitate clozapine-associated neutropenia?

A

Paroxetine

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97
Q

Effect of increased dopaminergic transmission on sexual function?

A

Enhances sexual arousal

Penile erection

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98
Q

Effect of hyperprolactinaemia on women?

A

Amenorrhoea
Reduced sexual desire
Hirsutism

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99
Q

How do antipsychotics lead to reduced sexual function?

A

Reduce dopamine transmission

Inducing hyperprolactinaemia

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100
Q

Which drugs cause ejaculatory problems?

A

Neuroleptics

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101
Q

Which drugs are linked to priapism?

A 
Risperidone
Chlorpromazine
Clozapine
Olanzapine
Thioridazine
Trazodone
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102
Q

Is priapism drug-dependent or duration-dependent?

A

Neither

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103
Q

What can priapism lead to if untreated?

A

Permanent impotance

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104
Q

What is used to treat sexual dysfunction in men due to hyperprolactinaemia?

A

Bromocriptine

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105
Q

How does Bromocriptine work?

A

Dopamine agonist

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106
Q

What drugs lower seizure threshold?

A

Low potency antipsychotics

Dose-dependent

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107
Q

Which antipsyshotic is the most sedating?

A

Chlorpromazine - due to H1 antihistamine

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108
Q

Which drugs are more likely to cause anticholinergic syndrome; high or low potency drugs?

A

Low

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109
Q

Impact of neuroleptics on cardiac function?

A

Reduce cardiac contractility
Increase circulating catecholamines
Prolong atrial and ventricular conduction time

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110
Q

Which drugs are more cardio-toxiac; low or high potency?

A

Low potency

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111
Q

ECG changes with neuroleptics?

A

QT and PR prolongation
Blunting of T waves
ST depression

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112
Q

Which psychiatric medications can cause Torsades de Pointes?

A

Thioridazine

Droperidol

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113
Q

What leads to antipsychotic related sudden death?

A

Cardiac arrhythmias
Seizures
Asphyixation
Malignant hyperthermia

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114
Q

Which types of drugs cause postual drop?

A

Low potency drugs

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115
Q

Skin side effects on antipsychotics?

A

Allergic dermatitis and photosensitivity on low-potency drugs.

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116
Q

What is the skin SE of Chlorpromazine?

A

Blue-gray discoloration in areas exposed to light - reversible.

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117
Q

Which eye condition is a known SE of Thioridazone?

A

Irreversible retinal pigmentation if used >1000mg a day

Early symptom: nocturnal confusion due to difficulty with night vision.

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118
Q

Effect of Chlorpromazine on eyesight?

A

Pigmentation of anterior lens and posterior cornea; white-brown stellate granular deposits.
Benign.

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119
Q

Which antipsychotic can lead to cholestatic jaundice?

A

Chlorpromazine

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120
Q

When does drug-induced obstructive jaundice occur?

A

First month of treatment

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121
Q

What is associated with drug-induced jaundice?

A

Rash

Eosinophilia

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122
Q

Treatment for drug-induced jaundice?

A

Immediately stop antipsychotic

Avoid rechallenge

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123
Q

Signs of Haloperidol OD on EEG?

A

Diffuse slowing and low voltage

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124
Q

Which typical antipsychotic is safest in an OD?q

A

Haloperidol isone

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125
Q

What mediates QTc?

A

Blockade of rapid component of delayed rectifier potassium current responsible for repolarisation of cardiac Purkinje cells and myocardial cells.

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126
Q

How do drugs cause prolonged QTc?

A

Bind to delayed rectifier K+ channgel and thereby decrease outward movement of K+

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127
Q

Which antipsychotics have greater risk of causing prolonged QTc?

A

Droperidol
Pimozide
Sertindole
Thioridazine

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128
Q

What are the symptoms of inadvertent intravascular injection event/postinjection delirium sedation syndrome?

A 
Sedation
Confusion
Dizziness
Dysarthria
Somnolence
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129
Q

When does inadvertent intravascular injection event/postinjection delirium sedation syndrome occur?

A

20min - 3 hours after injection of olanzapine pamoate (long-acting depot)

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130
Q

Treatment for inadvertent intravascular injection event/postinjection delirium sedation syndrome?

A

Supportive medical care; symptoms alleviate within 3-72 hours

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131
Q

What is inadvertent intravascular injection event/postinjection delirium sedation syndrome linked to?

A

Accidental punctures of vessel or injects into capillary bed leaking

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132
Q

What is Metabolic syndrome composed of?

A 
Obesity
Dyslipidaemia
Glucose intolerance
Insulin resistance
HTN
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133
Q

WHO criteria for metabolic syndrome

A

Insulin resistance and /or impaired fasting glucose and/or impaired glucose tolerance and two or more of the following:
Waist-hip ratio >0.9 (mean), >0.85 (women) or BMI 30
Triglyceride level 1.7 or high-density lipoprotein M0.9 (men) or <1 (women)
BP 140/90 or treated HTN
Microalbuminuria

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134
Q

Prevalence of Diabetes on schizophrenics?

A

Twice as prevalent than in general population

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135
Q

Drugs that are most linked with metabolic syndrome/

A 
Olanzapine
Clozapine
Quetiapine
Risperidone
Aripiprazole
(worst at top)
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136
Q

Which gender have higher risk of metabolic syndrome if schizophrenic?

A

Females

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137
Q

What type of study was the CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness)?

A

Double-blind pragmatic RCT

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138
Q

What drugs were looked at in CATIE?

A 
Olanzapine
Quetiapine
Risperidone
Ziprasidone
Perphenazine
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139
Q

Which antipsychotic has lowest discontinuation rate?

A

Olanzapine

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140
Q

What type of study was CUtLASS (Cost utility of latest antipsychotic drugs in schizophrenia study)?

A

Unblinded RCT comparing first-generation and second-generation antipsychotics

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141
Q

Which 2nd-generation antipsychotics were used in CUtLASS?

A 
Amsulpride
Olanzapine
Quetiapine
Risperidone
Clozapine (in second phase)
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142
Q

Outcome of CUtLASS?

A

Those on 1st generation antipsychotics did relatively better.
Advantage of clozapine in symptom improvement over 1 year and patients preferred it.

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143
Q

Long-term SE of Lithium

A

Hypothyroidism
Irreversible nephrogenic diabetes insipidus
Reduced GFR (chronic kidney disease)
Hyperparathyroidism

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144
Q

Which diuretic has no effect on Lithium levels?

A

Loop diuretics

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145
Q

What score is used to assess severity of Lithium toxicity

A 
AMDISEN
0 - no signs
1 - mild
2 - moderate
3 - severe
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146
Q

Which antipsychotic is best to treat negative symptoms?

A

Amisulpride

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147
Q

Which SSRIs cause prolonged QTc?

A

Citalopram

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148
Q

Which TCA is the most selective inhibitor of serotonin?

A

Clomipramine

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149
Q

Which TCA is the most selective inhibitor of noradrenaline?

A

Desipramine

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150
Q

Which TCAs have the least anticholinergic activity?

A

Amoxapine
Nortriptyline
Desipramine
Maprotiline

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151
Q

Which TCAs have the most antihistaminic activity?

A

Doxepin

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152
Q

Which TCA is associated with weight gain

A

Amitriptyline

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153
Q

Cardiac SE of TCAs?

A

QT prolongation
Tachycardia
Flattened T waves
Depressed ST segment

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154
Q

Effect of TCAs on overdose?

A

Cardiac arrhythmias
Anticholinergic delirium
May occur 3-4 days after due to long half-life

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155
Q

Treatment for TCA overdose?

A

Lavage
QRS monitoring
No antidose

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156
Q

Symptoms of anticholinergic delirium?

A 
Confusion
Visual hallucinations
Hyperpyrexia
Loss of visual accommodation
Peripheral vasodilatation
Drying of mucous membranes
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157
Q

Which TCA can cause hyperprolactinaemia?

A

Amoxapine

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158
Q

SEs of all TCAs?

A 
SIADH
Hyponatraemia
Fine rapid tremor
Dysarthria
Precipitate angle closure glaucoma
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159
Q

What happens if TCAs are reduced too quickly?

A

Cholinergic rebound

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160
Q

What is the best way to reduce TCAs?

A

Reduce 25-50mg per 2-3 days

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161
Q

When can discontinuation reaction occur with TCAs?

A

48 hours - 2 weeks after

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162
Q

Mechanism of serotonin syndrome

A

Excessive serotonergic transmission in brain. Most CNS symptoms due to 5HT 2A stimulation

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163
Q

Features of serotonin syndrome

A 
Diarrhoea
Myoclonus
Diaphoresis
Hyperactive reflexes
Ataxia
Hypomania/labile mood
Disorientation
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164
Q

Which drugs are high risk of serotonin syndrome?

A

Combination of SSRI with MAOI/RIMA/Serotonergic TCAs/SNRI/Lithium/L-tryptophan
Combination of TCA and MAOI
Combining any of the above with Tramadol, pethidine, meperidine
Oxazolidionine antibacterial linezoloid
Tetrabenazine
Entacapone
Selegiline

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165
Q

What is oxazolidinone antibacterial linezolid?

A

Reversible non-selective MAOI

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166
Q

What is Tetrabenazine?

A

Acts via dopamine and serotonin depletion at nerve endings

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167
Q

What is entacapone?

A

COMT inhibitor

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168
Q

Treatment of serotonin syndrome?

A

Stop agent
Correct vital signs
Benzos
5HT2A antagonists

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169
Q

Name some 5HT2A antagonists that can be used in the treatment of serotonin syndrome

A

Cyproheptadine
Atypical antipsychotics
Chlorpromazine

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170
Q

Why do SSRIs cause anorexia when starting, then weight gain late during therapy?

A

Desensitization and down-regulation of receptors.

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171
Q

What is fluoxetine associated with in particular?

A

Change in duration of menstrual period

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172
Q

Effect of SSRIs on platelets?

A

Thrombasthenia - functional impairment of platelet aggregation

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173
Q

Impact of Thrombasthenia?

A

Easy bruising
Prolonged bleeding
(in those with gastric ulcers or bleeding diathesis)

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174
Q

In which patients is SIADH more likely who are on SSRIs?

A

Alcoholics

Elderly

175
Q

SEs of SSRIs

A 
Nausea
Diarrhoea
Anorexia (initially)
Thrombasthenia
SIADH
Severe sweating
Nocturnal myoclonus
Restless legs
Acute angle-closure glaucoma
176
Q

Treatment for severe sweating from SSRI?

A

Terazosin

177
Q

What is nocturnal myoclonus?

A

Repetitive leg movement every 2-60 seconds; extension of large toe and flexion of angle, knee and hips.

178
Q

Treatment of nocturnal myoclonus?

A

Benzo

Levodopa

179
Q

Treatment for restless legs

A

Ropinirole
Benzo
Levodopa

180
Q

Which SSRIs/SNRIs cause acute angle closure glaucoma?

A 
Duloxetine
Venlafaxine
Citalopram
Fluoxetine
Paroxetine
181
Q

Which SSRIs are associated with SSRI discontinuation syndrome?

A

Paroxetine - additional cholinergic rebound

Fluvoxamine - short half-life

182
Q

When does SSRI discontinuation syndrome occur?

A

If someone is on SSRI for 4-6 weeks at least, and it is stopped abruptly.

183
Q

Which SSRI is least likely to cause discontinuation syndrome?

A

Fluoxetine - long half-life

184
Q

Symptoms of SSRI discontinuation syndrome

A 
2 or more of the following within 1-7 days of SSRI reduced/stopped after being taken for at least 1 mnoth:
dizziness
lightheadedness
Paresthesias
Diarrhoea
Fatigue
Gait instability
Headache
Insomnia
Nausea
Tremors
Visual Disturbances
185
Q

What is the link between SSRI and suicide risk?

A

Only in those up to age 24 if used between 4-16 weeks.

186
Q

How do SSRIs increase the risk of UGIB?

A

They inhibit uptake of serotonin into platelets, which is needed for haemostatic response of promoting platelet aggregation.
SSRIs increase gastric acid secretion.

187
Q

What increases risk of UGIB if on SSRI?

A

Elderly
NSAIDs
H. Pylori

188
Q

Which SSRIs are at higher risk of causing UGIB?

A 
Those with high inhibition of serotonin reuptake:
Clomipramine
Paroxetine
Sertraline
Fluoxetine
189
Q

Which SSRIs are at lower risk of causing UGIB?

A

Those with low inhibition f serotonin reuptake;
Nortriptyline
Doxepin
Trazadone

190
Q

Which antidepressants are associated with lower risk of sexual dysfunction?

A 
Bupropion
Mirtazapine
Moclobemide
Nefazodone
Reboxetine
191
Q

What drugs reverse sexual dysfunction due t SSRI use?

A

5HT2 antagonists - cyproheptadine, mirtazapine
5HT1A agonists - buspirone
Bupropion - dopamine reuptake inhibitor
Sildenafil - inhibits phosphodiesterase type 5

192
Q

Which patients must Sildenafil be avoided in?

A

Patients with arrhythmias, unstable angina / uncontrolled HTN

193
Q

In which antidepressant is sweating most common?

A

Venlafaxine

194
Q

SEs of Venlafaxine?

A 
Sweating
Increase in diastolic BP if >300mg/day
Mydriasis
Exacerbation of ange closure glaucoma
Disctoninuation reaction (short half life)
195
Q

SEs of Duloxetine?

A

Similar to Venlafaxine but less likely to affect BP

196
Q

How to stop Venlafaxine?

A

Over 2-4 weeks

197
Q

How to treat priapism?

A

Intracavernosal injection of an alpha1 agonist

198
Q

E.g. of alpha1 agonist used in priapism?

A

Metaraminol

Epinephrine

199
Q

When is there risk of priapism?

A

Starting Trazadone (high risk) - early phases of treatment

200
Q

How does Nefazodone work?

A

Inhibits CYP3A4

201
Q

Why is Nefazodone not used as often?

A

Can cause serious hepatic damage

202
Q

Who is Trazadone and Nefazodone best for?

A

Elderly

Those with cardiac illness

203
Q

SEs of Bupropion

A 
No anticholinergic effects
Exacerbates ADHD and Eating Disorders, panic attacks
Enhances sexual activity
Increases risk of seizures - dose-dependent
Dry mouth, tremor, headache
Psychotic symptoms
Delirium
Word-finding difficulties
204
Q

Why can Bupropion cause psychotic symptoms?

A

Dopaminergic

205
Q

Which antidepressants can cause agranulocytosis?

A

Mirtazapine

206
Q

Which combinations of Buspirone do you need to be careful with?

A

Haloperidol - increases conc of haloperidol

MAOI - causes serotonin syndrome

207
Q

Which drugs increase buspirone plasma conc?

A 
CYP3A4 inhibitors:
Erythromycin
Itraconazole
Nefazodone
Grapefruit juice
208
Q

SEs of Mianserin and Mirtazapine

A

Drowsiness first few weeks of treatment

Increased weight gain and appetite

209
Q

Why is Mirtazapine preferred option to treat depression in chemotherapy?

A

5HT3 blockade - reduced vomiting and nausea

210
Q

What type of antidepressant is Reboxetine?

A

NARI

211
Q

Which patients is Reboxetine good for?

A

Elderly

Cardiac history

212
Q

What type of drug is Atomoxetine?

A

NARI

213
Q

What illness is Atomoxetine used in?

A

ADHD

214
Q

SEs of Reboxetine

A

Due to noradrenergic effect:

urinary hesitancy in males

215
Q

What can help with urinary hesitancy SE

A

Tamsulosin - peripheral alpha1 blocker

Doxazosin

216
Q

What type of drug is phenelzine?

A

MAOI

217
Q

SEs of MAOIs?

A 
Orthostatic hypotension
Pedal oedema
Insomnia
Cheese reaction
Serotonergic syndrome - with SSRIs
Weight gain
Sexual dysfunction
218
Q

Why is it best to give MAOIs such as Phenelzine and Tranylcypromine at 6pm?

A

Can have stimulating effects leading to insomnia

219
Q

Explain the cheese reaction with MAOIs

A

MAOIs and tyramine rich foods cause cheese reaction.

Tyramine directly and indirectly (via vesicles) causes sympathomimetic actions 20min-1h after food.

220
Q

Signs of cheese reaction

A 
Nausea
Apprehension
Chills
Sweating
Restlessness
Hypotension - with occipital headache, palpitations and vomiting
Dilated pupils
Fever
221
Q

Severe effect of cheese reaction?

A

Cerebral haemorrhage

222
Q

Which MAOIs are safest for severity of hypertensive crisis?

A

Reversible MAOIs

223
Q

Which foods must be avoided re tyramine-rich?

A 
Stilton
Blue cheese
Old cheddar
Mozarella
Fish
Sausage
Cured meats
Mature poultry
Wild game
Liqueurs
Concentrated yeast extract
224
Q

How to treat MAOI-induced hypertensive crisis?

A

Alpha-adrenergic antagonists

225
Q

Give eg. of alpha-adrenergic antagonists for hypertensive crisis treatment?

A

Phentolamine

Chlorpromazine

226
Q

What can help reduce polyuria in Lithium use?

A

Once daily rather than twice daily dosing

227
Q

What causes polyuria with Lithium?

A

Functional antagonism of ADH

228
Q

What can help control polyuria due to Lithium?

A

K+ sparing diuretics

229
Q

What can lead to renal failure from Lithium?

A

Cumulative lithium use

230
Q

What renal damage is common with chronic lithium use?

A

> 10 years:

Interstitial fibrosis

231
Q

How does Topiramate work?

A

Weak inhibitor of carbonic anhydrase

Can cause renal stones

232
Q

What is Oxcarbazepine?

A

10-keto derivate of CBZ - less enzyme induction

233
Q

SEs of Oxcarbazepine?

A

More likely to cause hyponatraemia than CBZ

234
Q

ECG effects of Lithium?

A

Similar to low K+:
Flat T waves
Inverted T waves

235
Q

Which cardiac problem is Lithium CI in and why?

A

Sick sinus syndrome;

Lithium can depress sinus node activity

236
Q

Which thyroid problem can Lithium most commonly cause?

A

Benign hypothyroid state

237
Q

Who is thyroid deficiency SE of when Lithium is used?

A

Those with high risk for pre-existing antithyroid antibodies (middle-aged women)
First two years of treatment
Rapid cycling patients

238
Q

Which TFT dysfunction is seen in 1/3 of chronic Lithium patients, even in absence of symptoms?

A

High TSH

239
Q

Explain use of thyroxine in subclinical hypothyroid and mood disorder?

A

In resistant depression and non-responsive rapid cyclers with bipolar, thyroxine treating hypothyroidism can be beneficial for the mood disorder

240
Q

Which antimanic drug can increase risk of polycystic ovaries?

A

Valporate 10%

241
Q

Why does valproate cause polycystic ovaries?

A

Valproate increases ovarian androgen production.
Can lead to weight gain and insulin resistance; risk factors.
In liver, it can increase unbound testosterone.

242
Q

When is oligomenorrhea likely to occur with valproate?

A

Within first year of treatment

243
Q

Which antimanic drugs result in leucocytosis?

A

Lithium

Carbamazepine - first 3 months of treatment

244
Q

Which antimanic drugs can lead to thrombocytopenia?

A

Valproate

Carbamazepine

245
Q

Which tremor is a sign of toxicity in Lithium use?

A

Coarse tremor

246
Q

Which tremor is a SE of lithium use?

A

fine tremor

247
Q

SEs of Lamotrigine?

A 
Dizziness
Ataxia
Headache
Sedation
Tremor
248
Q

SEs of Topiramate

A

Renal stones
Anomia - word finding difficulties
Poor concentration

249
Q

SEs of Vigabatrin

A

Visual field defects

250
Q

What is Vigabatrin used for?

A

Anti-epileptic

251
Q

Effect of Valproate on liver?

A

Induces hepatic enzymes

Elevation in liver transaminases - asymmptomatic

252
Q

Which antimanic drugs can cause liver failure?

A

Valproate
Lamotrigine
Topirimate
Carbamazepine

253
Q

What risk factors lead to liver failure if on antimanic drugs?

A

Young age

Combination therapy

254
Q

What results in liver failure from antimanic drugs?

A
  1. Metabolic toxicity - due to 4-en valproate, a metabolite of valproate.
  2. Hypersensitivity - dose-independent effect is resulting in fulminant failure.
255
Q

When is severe hepatic disease seen in (with valproate)?

A

Those with learning disability when undiagnosed urea cycle disorders present (often less than 2 years of age)

256
Q

Which antimanic drug can cause acute pancreatitis?

A

Valproate

257
Q

Can dose-reduction of valproate reduce risk of pancreatitis?

A

No - this is a hypersensitivity reaction, not dose-dependent

258
Q

When can hyperammonaemia occur with antimanic drugs?

A

Carbamazepine

259
Q

How does Hyperammonaemia present?

A

Coarse tremor

260
Q

Treatment for hyperammonaemia?

A

L-carnitine

261
Q

Most common teratogenic effect of Lithium?

A

Ebsteins anomaly of tricuspid valves

262
Q

Risk of Ebsteins in lithium-exposed foetuses?

A

1 in 1,000 (20x risk of general population)

263
Q

Is Lithium more or less teratogenic than valproate and carbamazepine?

A

Less

264
Q

Which antimanic drug is excreted into breast milk?

A

Lithium

265
Q

Signs of lithium toxicity in infants?

A

Lethargy
Cyanosis
Sluggish neonatal reflexes

266
Q

Teratogenic effect of valproate?

A

Neural tube defects

267
Q

Risk of neural tube defects in mothers using valproate?

A

1-4%

268
Q

What can help reduce teratogenic risk of Valproate?

A

Folate-vitamin B complex supplementation

269
Q

Most common teratogenic effect of Valproate?

A

Learning disability

Low IQ

270
Q

Effect of Lithium on the skin

A

Acne
Psoriases
Alopecia - 5-10%

271
Q

Effect of Valproate on Endocrinology system?

A

Obesity
Hyperandrogenism
PCOD - hirutism

272
Q

Which drugs are most likely to cause anticonvulsant hypersensitivity syndrome?

A 
Aromatic compounds:
Lamotrigine
Carbamazepine
Phenytoin
Phenobarbitone
273
Q

Common SE of aromatic compunds?

A

Rash

274
Q

Risk factors leading to skin reactions/rash with aromatic compounds?

A

Rapid initial dose escalation
Concurrent VPA
Age <16 years

275
Q

What happens if a rash occurs with aromatic compounds?

A

Stop drug - cannot tell if benign from serious

276
Q

Which antimanic drug can lead to Steven Johnson syndrome?

A

Lamotrigine - especially if combined with Valproate

277
Q

Why do valproate + lamotrigine together increase risk of Steven Johnson Syndrome?

A

Valproate has enzyme inhibiting effects which increase lamotrigine levels

278
Q

Initial signs of Steven Johnson syndrome?

A

Rash
Pharyngitis
Fever
Systemic involvement if drug not stopped

279
Q

Dose-related effects of Carbamazepine

A 
Visual disturbances
GI disturbance
Cognitive impairment
Vertigo
Dizziness
280
Q

Dose-related effects of Valproate

A

Hyperammonaemia
Teratogenicity
Sedation
Thrombocytopenia

281
Q

Idiosyncratic reactions of Carbamazepine

A

Haematological reactions: agranulocytosis/aplastic anaemia, Steven Johnson, fulminant liver damage, pancreatitis
SIADH - elderly

282
Q

Idiosyncratic reactions of Valproate

A

Hepatotoxicity
Pancreatitis
Rash
Acute dermatitis (rare)

283
Q

Which antimanics cause weight gain?

A

Valproate - 70%

Carbamazine - 40%

284
Q

What causes weight gain with valproate?

A

Impaired beta-oxidation of fatty acids

285
Q

Which antimanic drug can be used to counteract weight gain caused by psychotropic drugs?

A

Topiramate

286
Q

Common SE of cholinesterase inhibitors

A

Nausea/vomiting
Diarrhoea
Insomnia
Muscle cramps

287
Q

What type of drug is Tacrine?

A

Cholinesterase inhibitor

288
Q

Why is Tacrine no longer used?

A

Fatal hepatotoxicity

289
Q

Important SEs of cholinesterase inhibitors due to increased cholinergic stimulation?

A 
UGIB (esp if peptic ulcer/NSAIDS)
Bradycardia 
Exacerbate COPD
Urinary retention
Increase seizure risk
290
Q

In which patients is there a higher risk of bradycardia if on cholinesterase inhibitor?

A

Supraventricular conduction delay

291
Q

Which types of drugs can cholinesterase inhibitors prolong the risk of?

A

Succinylcholine-type muscle relaxants

292
Q

Where is Memantine excreted?

A

Mainly urine

293
Q

Is Rivastigmine metabolised by liver?

A

Rarely

294
Q

Does Memantine affect liver enzymes?

A

No

295
Q

SEs of stimulants used in ADHD

A 
Anxiety
Irritability
Insomnia
Tachycardia
Cardiac arrhythmias
Dysphoria
Decreased appetite - tolerance develops
296
Q

Less common SE of stimulants used in ADHD?

A

Self-limited exacerbation of movement disorders (tics, dyskinesias)
Linked to growth suppression

297
Q

What is Pemoline?

A

Stimulant used in ADHD

298
Q

Why is Pemoline no longer used?

A

Associated with Hepatic failure

299
Q

Which drug used in ADHD can cause dependence (rare)?

A

Methylphenidate

300
Q

SEs of Atomoxetine?

A

Appetite loss
Sexual dysfunction
Dizziness
Severe liver injury

301
Q

Signs of Benzo OD?

A 
Slurred speech
Incoordination
Unsteady gait
Nystagmus
Impairment in attention + memory
Stupor/coma
Inappropriate sexual/aggressive behaviour
Mood lability
302
Q

Which benzos cause anterograde amnesia?

A

High-potency

303
Q

Why is Triazolam banned in UK since 1991?

A

Disinhibition and aggression

304
Q

When can paradoxical disinhibition present with benzo use?

A

If patients have pre-existing brain damage

305
Q

Which type of patients can have respiratory impairment from benzo use?

A

COPD

Sleep apnoea

306
Q

Which patients should Benzos be avoided in due to risk of respiratory impairment?

A

Myasthenia Gravis
Head injury
Porphyria

307
Q

SE of Alprazolam?

A

Weight gain via appetite stimulation

308
Q

Teratogenic effects of Benzos?

A

Cleft palate and lips

309
Q

When is benzo withdrawl syndrome seen in neonates?

A

If used in third trimester

310
Q

SEs of Z-hypnotics?

A

Diarrhoea

Abdominal pain

311
Q

Unique SE of eszopiclone?

A

Unnpleasant taste

312
Q

What does benzo withdrawl syndrome depend on?

A

Half-life
Rate of tapering
Dose
Duration

313
Q

Signs of benzo withdrawl

A 
Anxiety
Diaphoresis
Kinaesthetic hallucinations
Restlessness/irritability
Tremor
Insomnia
Autonomic hyperactivity
Weakness
314
Q

Severe SEs of benzo withdrawl?

A

Paranoia
Delirium
Grand mal seizures

315
Q

When does benzo withdrawl syndrome occur with long-acting benzos?

A

1-2 weeks after long-acting benzos stopped

316
Q

Which benzos are associated with immediate and severe withdrawl syndrome?

A

Alprazolam

Lorazepam

317
Q

At what point are prescribed benzos unlikely to cause withdrawl?

A

<4 weeks use

318
Q

Withdrawl rate in benzo use for 6-8 years?

A

75%

319
Q

Withdrawl rate in benzo use for 2 years?

A

25-45%

320
Q

Withdrawl rate for benzo use in 4 months?

A

5-10 mnoths

321
Q

How to taper benzos?

A

Rate of 25% per week
Use of longer acting agents when tapering
Avoid long-term use of short-acting benzos
Use carbamazepine to assist discontinuation

322
Q

Psych SEs of beta-blockers

A

Sedation
Nightmares
Dysphoria
Depression

323
Q

In which type of beta-blockers are psych SEs seen in?

A

Lipophilic compounds

e.g. metoprolol, propranolol

324
Q

Psych SEs of ACE inhibitors

A 
Increased arousal
Anxiety
Fatigue
Insomnia
Increased psychomotor activity
325
Q

Psych SEs of Clonidine

A 
Sedation
Anxiety
Agitation
Depression
Insomnia
326
Q

Psych SEs of nitrates?

A 
Delirium
Psychosis
Anxiety
Restlessness/agitation
Hypomanaia
327
Q

Psych SEs of digoxin?

A

Depression

Delirium

328
Q

Psych SEs of statins?

A

Depression

329
Q

Psych SEs of corticosteroids?

A

Mania>depression
Agitation
Lethargy

330
Q

What makes corticosteroid-induced psych SEs more likely?

A

Dose-dependent
If >80mg/day
Symptoms start within 2 weeks
More common in females + those with past psych history

331
Q

Psych SEs of anabolic androgenic steroids?

A 
Acute parnoia
Delirium
Mania
Homicidal rage
Aggression
Extreme mood swings
Increase in libido
Agitation
Anger
332
Q

What makes psych SEs more likely with anabolic androgenic steroid use?

A

Dose-dependent

333
Q

Psych SEs of GNRH agonists (e.g. leuprolide)?

A

Depression

334
Q

Psych SEs of interferon-alpha?

A

Depression - seen in first 12 weeks

335
Q

Psych SEs of penicillin?

A

Sedation
Anxiety
Hallucinations

336
Q

Psych SEs of cephalosporins?

A

Delirium

337
Q

Psych SEs of ciprofloxacin and ofloxacin?

A 
Restlessness
Lethargy
Tremors
Insomnia
Mania
Depression
Psychosis
Delirium
Seizures
Catatonia
338
Q

Psych SEs of Isoniazid?

A

Delirium
Mania
Depression
Psychosis

339
Q

Psych SEs of Tetracyclines?

A

Depression
Insomnia
Irritability - at high doses

340
Q

Psych SEs of antihistamines and decongestants?

A

Atropine-like psychosis

341
Q

Psych SEs of PPIs & H2 antagonists?

A

Confusion
Agitation
Depression
Hallucinations

342
Q

Who are Psych SEs of PPIs and H2 antagonists more common in?

A

Elderly patients with impaired hepatic-renal function

343
Q

Psych SEs of Ondansetron?

A

Anxiety

344
Q

Psych SEs of Isotretinoin?

A

Severe depression and suicidal behaviour

345
Q

Psych SEs of aminophylline and salbutamol?

A

Agitation
Insomnia
Euphoria
Delirium

346
Q

Name some depressogenic drugs

A 
Beta blocks
Ca channel blocks
Interferons (alpha>beta)
Steroids
Cyproterone, progesterone
Varenicline
Isotretinoin
Ezetimibe
347
Q

How does Rimonabant work?

A

CB1 receptor antagonist

348
Q

What is Rimonabant used for?

A

Anti-obesity; blockig central cannabinoid activity may reduce food intake

349
Q

Concerns regarding Rimonabant use?

A

Severe psychiatric SEs; 2.5x more depression, 3x more anxiety

350
Q

What do animal studies show about blockade of CB1 receptor?

A

Impairs anti-depressant reducing and anxiety-reducing actions of endocannabinoids

351
Q

Name some Class A drugs

A 
Ecstacy
LSD
Heroin
Cocaine
Crack
Magic mushrooms
Merthylamphetamine
Other amphteamines if prepared for injection
352
Q

Penalty for possession of class A drug?

A

Upto 7 years in prison, unlimited fine or both

353
Q

Penalty for dealing Class A drug?

A

Upto lif in prison, unlimited fine or both

354
Q

Name some Class B drugs

A

Amphetamines
Methylphenidate
Pholcodine

355
Q

Penalty for possession of Class B drugs

A

Upto 5 years in prison or unlimited fine or both

356
Q

Penalty for dealing of Class B drugs

A

Upto 14 years in prison or unlimited fine or both

357
Q

Name some Class C drugs

A 
Cannabis
Tranquilisers
Some pankillers
GHB
Ketamine
358
Q

Penalty for possession of class c drug

A

Upto 2 years in prison, unlimited fine or both

359
Q

Penalty for dealing Class C drug

A

Upto 14 years in prison, unlimited fine or both

360
Q

Class A, B, C drugs are under which Act?

A

2001 Misuse of Drugs Act UK

361
Q

Schedule 1, 2,3, 4 and 5 drugs are under which Act?

A

2001 Misuse of Drugs Regulations

362
Q

Examples of Schedule 1 drugs

A

Coca lef
Cannabis
LSD
Mescaline

363
Q

Regulations of Schedule 1 drugs?

A

No medicinal use.
Supply limited to research or other special purposes judged to be in public interest; requires home office license to possess

364
Q

Give some e.g. of Schedule 2 drugs

A 
Diamorphine
Morphine
Dipipanone
Remifentanil
Pethidine
Secobarbital
Glutethimide
Amphetamine
Cocaine
365
Q

Regulations of Schedule 2 drug use?

A

Subject to special prescription requirements and safe custody requirements - except for secobarbital.
Stock drugs must be recorded in a register.
Regulations and drug stock must only be destroyed in presence of an appropriately authorized person.

366
Q

Name some examples of Schedule 3 drugs

A 
Barbituates - except secobarbital
Buprenorphine
Diethylpropion
Mazindol
Meprobamate
Pentazocine
Phenter,ine
Temazepam
367
Q

Regulations of Schedule 3 drugs

A

Subject to special prescription requirements - except for temazepam, but not to safe custody requirements (except for buprenorphine, diethylpropion, flunitrazepam and temazepam) or to keep register.
Requirements for retention of invoices for 2 years.

368
Q

Give examples of some Schedule 4, Part 1 drugs

A

Benzos - except temazepam

Zolpidem

369
Q

Regulations for schedule 4 drugs?

A

Not subject to special prescription requirements or safe custody requirements.
No need to keep register
requirement for retention of invoices for 2 years

370
Q

Give examples of Schedule 4, Part 2 drugs

A 
Androgenic and anabolic steroids
Clenbuterol
HCG
Non-human chorionic gonadotrophin
Somatotropin
Somatrem
Somatropin
371
Q

Name some examples of Schedule 5 drugs

A

Weak preparations of drugs usually in other schedules - e.g. morphine, codeine

372
Q

Regulations of Schedule 5 drugs?

A

Exempt from all controlled drug regulations except the need to keep invoices for at least 2 years

373
Q

Which drugs cannot be prescribed on repeat prescriptions?

A

Schedule 2 and 3 drugs

374
Q

How should patients collect controlled drugs?

A

In person, show ID on first occasion and sign back of prescription form

375
Q

Which drugs must be prescribed in daily instalments?

A

Substitute opioids

376
Q

What must prescription of instalments specify?

A

Number of instalments
Interval between instalments
Instructions for supplies at weekends/BH
Total quantity to provide treatment for a period (not exceeding 14 days)
Quantity to be supplied in each instalment along with duration of instalment to be set out on prescription

377
Q

Purpose of reporting adverse drug reactions?

A

Reduce hazards of medical prescribing

Trigger regulatory action to ensure patient safety

378
Q

Should adverse reaction be reported if reaction is well known?

A

Yes

379
Q

Should adverse reaction be reported if you are unsure whether the drug caused this reaction?

A

Yes

380
Q

Should adverse reaction be reported if it was a result of an overdose?

A

Yes

381
Q

Should an adverse reaction be reported if other drugs were given at the same time?

A

Yes

382
Q

Who can use the yellow card scheme to report adverse reactions?

A

Prescribers
Patients
Carers
Pharmacists

383
Q

What does the black triangle symbol mean?

A

Preparation is newly licensed and requires additional monitoring by the European Medicines agency

384
Q

What is the requirement for adverse reaction reporting if there is a black triangle symbol?

A

MHRA requires all suspected reactions, including those that are not serious, be reported.

385
Q

For drugs w/o the black triangle symbol, when are you expected to use the yellow card reporting system?

A

To report SE that are serious, medically significant or result in harm.
Also those reactions that occur due to a medication error

386
Q

For SEs, what does very common mean?

A

Greater than 1 in 10

387
Q

For SEs, what does common mean?

A

1 in 100 to 1 in 10

388
Q

For SEs, what does uncommon or less commonly mean?

A

1 in 1000 to 1 in 100

389
Q

For SEs, what does rare mean?

A

1 in 10,000 to 1 in 1000

390
Q

For SEs, what does very rare mean?

A

Less than 1 in 10,000

391
Q

What is the WHO Collaborating Centre for International Drug Monitoring?

A

International system for monitoring ADRs developed by WHO in 1971
Located in Uppsala Monitoring Centre, Sweden

392
Q

Which drugs cause EPSEs?

A

All neuroleptics - less for anticholinergic neuroleptics e.g. CPZ
Higher dose atypicals

393
Q

Which drugs cause delirium?

A

Anticholinergic TCAs

Anticholinergic antipsychotics

394
Q

Which drugs cause seizures?

A

Bupropion

Clozapine

395
Q

Which drugs cause tics?

A

Stimulants

396
Q

Which drugs cause hepatic damage?

A

Nefazodone
VPA
Tacrine

397
Q

Which drugs cause hepatic enzyme induction?

A

CBZ
Phenytoin
Barbituates

398
Q

Which drugs cause acute pancreatitis?

A

VPA

399
Q

Which drugs cause paralytic ileus?

A

Clozapine

400
Q

Which drugs can cause UGIB?

A

SSRIs

Acetylcholinesterase inhibitors

401
Q

Which drugs can cause weight gain?

A 
All antipsychotics - less of Aripiprazole, ZPD
TCAs
Lithium
VPA
CBZ
402
Q

Which drugs cause weight loss?

A

Topiramate

Bupropion

403
Q

Which drugs cause renal damage?

A

Lithium

404
Q

Which drugs cause renal stones?

A

Topiramate

405
Q

Which drugs cause Priapism?

A

Trazadone

Risperidone

406
Q

Which drugs cause polycystic ovaries?

A

Valproate

407
Q

Which drugs cause erectile dysfunction?

A

All TCAs

Antipsychotics

408
Q

Which drugs caused anorgasm or delayed ejaculation?

A

SSRIs

409
Q

Which drug can lead to a rash?

A

CBZ

Lamotrigine

410
Q

Which drug can cause thrombocytopenia?

A

Valproate

411
Q

Which drug can cause sweating?

A

Particularly Venlafaxine
TCAs
SSRIs

412
Q

Which drug can cause psoriasis and acne?

A

Lithium

413
Q

Which drugs cause worsening of glaucoma?

A

Paroxcetine
Quetiapine
TCAs

414
Q

Which drug can cause retinitis pigmentosa?

A

Thioridazine

415
Q

Which drug can cause hypersalivation?

A

Clozapine

416
Q

Most common SE of clozapine?

A

Hypersalivation

417
Q

Which drug can cause corneal deposits?

A

CPZ

418
Q

Which drug can cause visual field defects?

A

Vigabatrin

419
Q

Which drugs can cause bruxism?

A

Stimulants

420
Q

Which drugs can cause hypothyroidism?

A

Lithium

421
Q

Which drugs can cause PE or myocarditis?

A

Clozapine

422
Q

Which drugs can cause prolonged QT?

A

All antipsychotics - especially thioridazine, pimozide, droperidol

423
Q

Which drugs can cause arrhythmias?

A

High dsoe TCAs

424
Q

Which drug s can cause hypertension?

A

VFX

TCAs

425
Q

Which drugs can cause fine tremors?

A

Therapeutic dose of Lithium, TCAs

426
Q

Which drugs can cause coarse tremors?

A

Lithium toxicity

Antipsychotic Parkinsonism

427
Q

Which drugs can cause osteoporosis?

A

Hyperprolactinaemic antipsychotics

428
Q

Which drugs can cause WCC suppression?

A 
Clozapine
Olanzapine
Mirtazapine
Carbamazapine
Mianserin
429
Q

Which drugs can cause haemolytic anaemia?

A

Nomifensine

430
Q

Which drugs can cause Guillian Barre?

A

Zimeldine

431
Q

Which drug can cause pedal oedema?

A

MAOIs

432
Q

Which drugs can cause cramps?

A

Acetylcholinesterase inhibitors

433
Q

Which drugs can cause othostatic hypotension?

A

All TCAs

All antipsychotics

MRCPsych Part A - Al-Rashid Hospital (22 decks)

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