Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology - MRCPsych A > Adverse effects > Flashcards

Adverse effects Flashcards

1
Q

What is the total rate of fatal agranular cytosis from Clozapine? (i.e. including countries without monitoring)

A

1 in 4,250

In monitoring groups is 1 in 8,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Can Clozapine be re-initiated if there has been a red alert on FBC count

A

Generally no should avoid - only given if specialist supervision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the CNS effects of SS caused by?

A

5HT2A agonism - therefore 5-HT2A antagonists are given i.e. cyproheptadine, chlorpramizine, methysergide, propanolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What was the CAITE trial?

A

Clinical antipsychotic treatment effectiveness - looked at patient or physician discontinuation within 18 months (included Olanzapine, Risperidone, Ziprasidone and Quetiapine)

75% discontinued
Median time to discontinuation was 4.6 months

64% stopped Olanzapine (lowest)
74% risperidone
79% ziprasidone
82% quetiapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the risk of Ebstein’s anomaly in those taking Lithium during preganancy?

A

2-3 x more than the general population

Risk is dose dependent and highest if taking Lithium in the first trimester (weeks 2-6).

Risk of congential malformations in general population is 1.15% and 2.41% in lithium exposed cohort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Outline the difference between type A and type B adverse drug reactions?

A

Type A:
- Dose-related
- Generally stop on cessation of the drug
- Pharmacologically related to the action of the drug and can be predicted i.e. ESPEs due to dopamine antagonism

Type B:
- Idiosyncratic
- Often unpredictable - may only be identified after a drug goes on a market
- Not dose related - although higher doses may increase risk
- Not reversible
- Patient factors may helpful to predict risk
- e.g Stevens Johnson post lamotrigine or agranular cytosis post clozapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the management of tardive dyskinesia?

A

Reduce dose - 50-55% are reversible

Stop anticholinergic
Px:
- Tetrabenazine
- Vitamin E
- BDZ

Exclude anti-NMDA encephalitis - particularly if an early development of TD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What medications may help akasthesia?

A

5-HT2A antagonist - Cyproheptadine or Mirtazapine

Low dose BDX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the most common EPSEs

A

Akasthesia 25-35% - hours to weeks
Parkinsonism - 20% - hours to days
Dystonia - 10% - minutes to hours
TD - 5% - years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the most common EPSEs

A

Akasthesia 25-35% - hours to weeks
Parkinsonism - 20% - hours to days
Dystonia - 10% - minutes to hours
TD - 5% - years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What antipsychotic is favourable in Parkinson’s disease?

A

Quetiapine - fast dissociation from D2 receptor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What antipsychotics are associated with most and least anticholinergic side effects?

A

Most:
- Clozapine
- Quetiapine
- Zuclopenthixol
- Flupenthixol

Least:
- Aripiprazole
- Ami/sulpride

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What medications are least affected by sexual dysfunction?

A

Clozapine
Quetiapine
Aripiprazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name some risk factors for agranular cytosis and neutropenia?

A

0.8% develop agranular cytosis (low neuts, eosinophils, basophils). RF include:
- Asian ethnicity
- Female
- Old age

2.7% develop neutropenia. RF include:
- Black ethnicity
- Female
- Young age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How often if FBC measured in Clozapine

A

Weekly for first 18 weeks
Every two weeks 18-52 weeks
Every 4 weeks after then

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How many given clozapine die of agranular cytosis (from sepsis)

A

1 in 10,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How many people on Clozapine develop myocarditis/myopathy?

A

Between 1 in 10,000 to 20 in 10,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What percentage of patients given Lithium develop CKD?

A

20%
- those that develop ESRD is 5.3/1000

18
Q

Name some SE of semisodium valproate?

A

Thrombocytopenia
Curly hair regrowth
Weight gain
Hyperammonia
Gastric irritation
Diarrhoea and nausea

If anaemia occurs - macrocytic

19
Q

Name some SE of carbamazepine

A

Hyponatraemia, oedema

Diplopia, ataxia, drowsiness, fatigue

Urticaria, dermatitis, skin rash

Leukopenia/blood disorders

20
Q

Name some SE from Lamotrigine

A

Rash, arthralgia, back pain

Diplopia, drowsiness, dizziness, aggression, insomnia, agitation, nystagmus, tremor

Dry mouth

21
Q

Which mood stabilisers can cause LFT derangement?

A

Carbamazepine and Sodium Valproate

Generally transient but rarely can present with acute hepatic failure

22
Q

What skin rashes are associated with mood stabilisers?

A

Drug rash with eosinophilia and systemic symptoms (DRESS)

Steven Johnson’s Syndrome (Lamotrigine per PsychMentor)

Toxic epidermal necrolysis

23
Q

What factors may precipitate Lithium toxicity

A

Dehydration - illness, diarrhoea, sweating

Low salt diets - 3/4 of Lithium is reabsorbed at proximal and distal tubules - if low salt more may get reabsorbed

Drug: loop diuretics, ACEi, NSAIDs - all reduce renal excretion

24
Q

Outline how the following receptors link to anti-D associated effects:

a) 5-HT1a
b) 5-HT2
c) 5-HT3
d) 5-HT4
e) 5-HT6
f) 5-HT7

A

a) 5-HT1a - anti-D effect
b) 5-HT2 - sexual dysfunction/vivid dreams
c) 5-HT3 - nausea + increased intestinal motility
d) 5-HT4 chronotropic effects arrhythmias and increased intestinal motility
e) 5-HT6 memory
f) 5-HT7 insomnia

25
Q

What is the effect of pre-synaptic alpha-2-adrenergic antagonism of Mirtazapine?

A

Increased serotonin release

Its antagonism of 5-HT2A, 5-HT2c and 5-HT3 make it less likely to cause serotonergic SE

26
Q

How do BDZ work?

A

Positive allosteric modulators to GABA on GABA-A channels - make GABA the agonist more likely to bind

Long term Benzodiazepine and Alcohol use leads to downregulation of GABA-A receptor

27
Q

Name some SE of methadone and buprenorphine

A

Pruritis, nausea, constipation, headache, resp depression

28
Q

What are the contraindications of disulfiram?

A

Cardiac disease, psychosis, personality disorder

29
Q

What is an iDAP

A

Interactive drug analysis profile - provides up to date information on the frequency and types of ADRs reported from drugs

30
Q

How can someone report an ADR

A

Yellow card scheme through MHRA

31
Q

OutlWhat is the maximum prescription length for controlled drugs?

A

NICE advise no more than 30 days

Can be up to 3 months if leaving the country

32
Q

Outline drug schedules?

A

I - no medical purpose only research needs exceptional approval from home office i.e. cannabis and LSD

II - handled and stored for safe prescription. Includes cocaine, heroin, pethidine and amphetamines

III - some BDZ (temazepam, midazolam), buprenorphine and barbiturates

IV - pat I includes Z drugs and most BDZ, part II includes gonadotrophins and anabolic steroids.

V - need invoices for 2 years but nothing else

I - III require prescriptions as per controlled drugs advice

Note schedules refers to the benefit / harm provided from a drug and does not relate to the legal ramifications of possessing a drug (class of drug)

33
Q

Name some drugs that undergo very little hepatic metabolism

A

Amisulpride, Sulpride

Gabapentin
Topiramate
Lithium

34
Q

Which medications experience significant first pass effect (not just hepatically metabolised)

A

Imipramine
Buprenorphine
Morphine
Diazepam
Fluphenazine

35
Q

Name the SSRI that has the highest concentration in the breast milk?

A

Fluoxetine

36
Q

Reboxetine is a noradrenaline reuptake inhibitor due to its peripheral adrenergic effects (constipation, dry mouth, urinary retention) what drugs and examples can be prescribed to manage the side effects?

A

Alpha-1-antagonists i.e. tamsulosin or doxazosin

37
Q

Paroxetine is contraindicated in which condition?

A

Closed angle glaucoma - due to its anticholinergic properties

38
Q

Which groups are most likely to experience hypothyroidism?

A

Young females

39
Q

Apart from topiramate which psychotropic drug may cause weight loss?

A

Buproprion

40
Q

What is the incidence of NMS?

A

0.7 - 2.0%

41
Q

Why may Linezolid not be prescribed with a certain anti-D?

A

Can cause serotonin syndrome with MAOI

42
Q

What is the management of cheese reaction?

A

BP control:
Alpha-adrenergic antagonist IV - phenolamine or chlorpromazine
Furosemide

HR control:
Beta-blocker to control

43
Q

Name some side effects associated with acetylcholinesteterase inhibitors

A

Nausea, vomiting, diarrhoea, muscle cramps, urinary incontinence

Pharmacology - MRCPsych A (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions