Block 33 Pharmacology Flashcards
(149 cards)
1
Q
Benzodiazepines drug examples?
A
- diazepam
- lorazepam
- temazepam
2
Q
SSRI drug examples?
A
- Citalopram
- Fluoxetine
- Paroxetine
- Sertraline
3
Q
what are the indications for benzos?
A
Anxiety disorders, acute behavioural control and rapid tranquillisation
4
Q
indications for SSRIs?
A
Depression, anxiety disorders
5
Q
safety info w benzos?
A
- co-presribing w opiods can cause increased risk of sedation, coma, resp depression and death
6
Q
CI for all benzodiazepines?
A
- acute pulm insufficiency
- marked NM weakness
- can’t be used alone for: chronic psychosis, depression
- sleep apnea syndrome
7
Q
paraxodical effects of benzos?
A
- paradoxical increase in hostility and agggression
- ranges from talkativeness and excitement to aggressive and antisocial acts
- increased anxiety and perceptual disorders
8
Q
side effects of benzos?
A
- ataxia and confusion - elderly
- resp depression - high dose and IV use
- sleep disorders
- withdrawal syndrome
9
Q
overdose of benzodiazepines?
A
- drowsiness, ataxia, dysarthria, nystagmus, and occasionally respiratory depression, and coma
10
Q
benzos mechanism?
A
- CNS depressants
- enhances effect at GABA-A receptor -> sedative, hypnotic, and anxiolytic, muscle relaxant, anticonvulsant effect
11
Q
SSRI drug action?
A
- seletively inhibit the re-uptake of serotonin
12
Q
CI for SSRIs?
A
- poolry controlled SSRI
- manic phase
13
Q
SSRI - elderly?
A
care with hyponatreaemia
14
Q
side effects of SSRIs?
A
- GI side effect more common
- inc risk of GI bleeding
- inc anxiety and agitation after starting
15
Q
which SSRIs have a higher risk of drug interactions?
A
fluoxetine and paroxetine
16
Q
Which SSRIs can’t be used in long QT syndrome?
A
- citralopram and escitalopram
- cause QT prolongation
17
Q
when should a PPI be prescribed w an SSRI?
A
if ppt also taking NSAIDs
18
Q
interactions of SSRIS?
A
- MAOIs - serotonin syndrome
- aspirin
- NSAIDs-> prescribe PPI
- warfarin
19
Q
SSRI overdose?
A
- nausea
- vomiting
- nystagmus
- sinus tachyardia
- tremor
- agitation
- convulsions
20
Q
serotonin syndrome?
A
marked neuropsychiatric effects, neuromuscular hyperactivity, and autonomic instability, hyperthermia, rhabdomyolysis, renal failure, and coagulopathies may develop.
21
Q
examples of SNRIs?
A
- Duloxetine
- Venlafaxine
22
Q
SNRIs mechanism?
A
- inhibits reuptake of serotonin and noradrenaline
23
Q
duloxetine is also used for?
A
urinary incontinence
24
Q
SNRI safety info?
A
- SNRIs in the last month b4 delievry can inc risk of postpartum haemorrhage
25
side effects of SNRIs?
- Falls
- GI disorders
- sexual dysfunction
- palpitations
- urinary disorders
26
which SNRI is associated w higher risk of withdrawal?
Venlafaxine
27
Reboxetine mechanism?
Selective noradrenaline reuptake inhibitor
28
Indication of Reboxetine?
depression
29
Cautions of Reboxetine?
- bipolar
- epilepsy
- CVD
- urinary retention
30
Side effects of Reboxetine?
- accomodation disorder
- anx
- insomnia
- tachycardia
- vasodilation
31
Interactions of Reboxetine?
- isocardboxazid
- phenelzine - hypertensive crisis
32
Mirtazapine =
- pre-synaptic alpha-2 adrenoreceptor receptor blocker
- blocks serotonin receptors
- atypical tetracyclic AD
33
mitrazepine ix?
major depression
34
cautions of Mirtazapine?
- cardiac disorders
- DM
- mania
- seizures
- urinary retention
- hypotension
- psychosis
35
side effects of Mirtazapine?
- anx
- inc appetite
- constipation
- confusion
- oedema
36
examples of TCAs?
- Amitriptyline
- Imipramine
- Lofepramine
37
indications for tricyclics?
Depression, adjunct for chronic or neuropathic pain
38
CI of TCAs?
- heart block
- arrhythmias
- manic phase
39
TCAs- elderly?
- susceptible to side effects
- low initial doses
- monitoring for psychiatric and cardiac side effects
40
interactions of amitryptiline?
- adrenaline
- bupropion
- cloazpine - hyponatraemia and hypotension
- fluoxetine
- lithium
41
side effects of amitryptiline?
- anticholinergic syndrome
- droswiness
- QT prolongation
42
amitryptiline overdose?
- high rate of fatality
- dry mouth
- coma
- hypotension
- hypothermia
- resp failure
- arrhythmias
- dilated pupils
43
lofepramine side effects?
- agranulocytosis
- bone marrow disorders
- cardiac conduction disorders
- gynacomastia
44
Imipramine cautions?
- hyperthyroidism - high risk of arrhytmias
- inc intraocular pressure
- sig suicide risk
45
side effects of Imipramine?
- decreased appetite
- arrthymias
- hypotension
- hallucinations, tremors
46
TCAs mechanism?
- block serotonin, NA, and dopamine reiptake
- also block muscaronic receptors
47
anticholinergic effects of TCAs?
dry mouth, blurry vision, constipation, and urinary retention
48
MAOis indications?
Major depression and phobic patients with hypochondriacal features, social anxiety disorder
49
examples of MAOAi?
- phenelzine
- moclobemide
50
phenelzine =
non selective MAOI
51
Moclobemide=
reversible inhibitor of MAOA-A
52
monoamine oxidase?
- inhibiting this prevents breakdown of serotonin, melatonin, epinephrine, norepinephrine
53
CI for all MAOI?
- Cerebrovascular disease
- severe CVD
- phaechromocytoma
- manic phase
54
side effects of MAOI?
- Anx
- hallucinations
- insomnia
- postural hypotension - more common in elderly
- suicidal behavs
55
when should MAOA be discontinued?
Risk of postural hypotension and hypertensive responses. Discontinue if palpitations or frequent headaches occur.
56
monitoring for MAOI?
- MONITOR BP -risk of postural hypotension and hypertensive responses
57
withdrawal from MAOI?
- Agitation
- irritability
- slow speech
- vivid dreams
58
other symtoms that can occur when discontinuing MAOi?
hallucinations, paranoid delusions
59
Drugs used for managing opioid withdrawal ?
Methadone & Buprenorphine
60
methadone Ix?
- opiod dependence
- svr pain
61
CI of all opiods (includes methadone)
- ARD
- head injury, raised ICP
- risk of paralytic ileus
62
CI for methadone?
phaechromocytoma
63
methadone mechanism?
- methadone is a full agonist of the mu-opioid receptor - binds to these receptors in the brain and fully activates them.
- This action can relieve withdrawal symptoms and cravings. Has a long half-life
64
buprenorphine mechanism?
- partial agonist of the mu-opioid receptor and an antagonist of the kappa-opioid. It binds to the mu-opioid receptors in the brain but only partially activates them.
- This partial activation is enough to alleviate cravings and withdrawal symptoms in individuals with opioid dependence
- displaces other opiods from kappa receptors
65
drugs causing prolonged QT?
- amiodarone, solatolol
- TCA, SSRIs - espec citalopram
- methadone
- haloperidol
- ondansteron
66
side effects of all opiods?
- arrhythmias
- euphoric mood
- hallucination
- miosis
- palpitations
- resp depression
- vomiting and nausea - more common on initiation
67
methadone side effects?
- asthma exacerbation
- hyperprolactinaemia
- hypothermia
- QT prolongation
68
methadone toxicity?
- long acting opiod - hazardous even in low doses for kids
69
buprenorphine side effects?
- anxiety
- depression
- diarrhoea
- tremor
70
effects of ? are only partially reversed by naloxone?
buprenorphine
71
Drugs used for smoking cessation?
- Nicotine replacement therapy
- Bupropion
- Varenicline
72
NRT mechanism?
- Reduced cravings due to nicotine addiction
- patches, gum, sprays, tablets, lozenges
73
cautions of nicotine?
- DM - monitoring of BG needed when initating Tx
- haemodynamically unstable ppts
74
side effects of nicotine?
- dizziness
- headaches
- hyperhidrosis
- nausea, vomiting
- palpitations
75
nicotine withdrawal symptoms?
- malaise
- headache
- dizziness
- sleep disturbance
- coughing
- restlessness
- dec HR
- apthous ulcers
76
Bupropion mechanism?
- dopamine and NA reuptake inhibition ->insomnia
- works on pathways involved in addiction and withdrawal
77
buprion safety info?
- SS when taken with SSRI and SNRIs
78
CI of bupropion?
- acute alcohol withdrawal
- acute benzo withdrawal
- bipolar
- EDs
- seizures
79
side effects of buprion?
- abd pain
- anx
- conc impaired
- tremor
- insomnia - don't take near bedtime
80
Varenicline mechanism?
selective nicotinic receptor partial agonist
81
side effects of varenicline?
- nausea - most common
- headache
- insomnoa
- abn dreams
82
cautions of vareniciline?
- lowered seizure threshold
- history of psychiatric illness
83
Ix of lithium?
Treatment and prophylaxis of mania, hypomania and depression in bipolar disorder
84
lithium mechanism?
- reduced glutamate and dopamine
- inc GABA - release and upregulates receptors
85
CI of lithium?
- low sodium diets
- cardiac disease
- addisions
- dehydration
86
LT lithium use?
- associated w thyroid disorders and mild cognitive and memory impairment
- monitoring of thyroid function every 6 months
87
lithium interactions?
- amitryptiline
- acetazolamide
- bupropion
88
lithium side effects?
- angioedema
- AV block
- delirium
- idiopathic intercranial hypertension
- QT prolongation
89
lithium toxicity?
- coarse tremor (a fine tremor is seen in therapeutic levels)
- hyperreflexia
- acute confusion
- polyuria
- seizure
- coma
90
what can lithium toxicity be precipitated by?
- dehydration
- renal failure
- drugs: diuretics (especially thiazides), ACE
inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole.
91
lithium is?
teratogenic
92
lithium safety?
- very narrow therapeutic index
- requires monitoring of serum concs
93
Mood stablising anticonvulsant drugs?
- Sodium valproate
- Carbamazepine
- Lamotrigine
94
when are mood stabilising anticonvulsants used?
Treatment and prophylaxis of mania, hypomania and depression in bipolar disorder
95
sodium valproate is CI in?
- women and girls of childbearing age unless conds of pregnancy prevention programme are met
- severe hepatic dysfunction
- urea cycle disorders - hyperammonaemia risk
96
valproate -> ? toxicity?
liver
97
# Hair
side effects of valproate?
- alopecia - regrowth may be curly
- abn behaviour
- hepatic disorders
- hallucination
- stupor
98
when should valproate be withdrawn?
persistent vomiting and abdominal pain, anorexia, jaundice, oedema, malaise, drowsiness, or loss of seizure control.
99
valproate mechanism?
- voltage gated sodium channel blockage
- inc GABA levels -> anti-manic properties
100
carbamazepine mechanism?
- sodium channel inhibitor
- serotonin releasing agent
101
CI of carbamazepine?
- acute porphyrias
- AV conduction abn
- history of BM suppression
102
side effects of carbamazepine?
- induces P450 enzyme
- drowsiness
- visual disturbances - espec diplopia
- leucopenia and agranulocytosis
- hyponatraemia secondary to syndrome of inappropriate ADH secretion
103
lamotrigine mx?
binds and inhibits sodium VGC, inhibits glutamate and aspartate release
104
cautions of lamotrigine?
- PD
- seizures
- brugada syndrome
105
side effects of lamotrigine?
- aggressgion
- dizziness
- drowsiness
- dry mouth
- rash
106
skin changes w lamotrigine?
- SJS
- toxic epidermal necrolysis
107
Atypical antipsychotic drugs?
- Risperidone
- Olanzapine
- Clozapine
- Aripiprazole
**- Quetiapine**
108
AP indications?
Psychosis, schizophrenia, rapid tranquillisation, mania
109
typical AP/ first gen?
- Haloperidol (a butyrophenone)
- Chlorpromazine (a phenothiazine)
- Flupentixol (a thioxanthine)
- Sulpiride (a substituted benzamide)
110
Atypical AP mechanism?
- antagonism of D2 receptors in the mesolimbic pathway (overactivity leads to positive symptoms)
- antagonism of serotonin, alpha-1 adrenoreceptor, histamine 1
111
when should risperidone be avoided?
- acute porphyrias
- cataract surgery
- LBD
- prolactin dependent tumours
- dehydration
112
interactions of risperidone?
- levodopa
- lithium
- methylphenidate
113
risperidone side effects?
- decreased weight
- vision disorders
- sexual dysfunction
- oedema
114
olanzapine mechanism?
Olanzapine is a dopamine D1, D2, D4, 5-HT2, histamine- 1-, and muscarinic-receptor antagonist.
115
CI of olanzapine?
- unstable angina
- bradycardia
- severe hypotension
- SSS
- acute MI
116
Interactions of olanzapine?
- smoking - dose adjustment
- clozapine: constipation -> intestinal obstruction
- levodopa
- valproate
117
olanzapine side effects?
- anticholinergic syndrome
- eosinophilia
- fever
- glycosuria
- sexual dysfunction
118
stopping AP?
- high risk of relapse if medication stopped after 1-2 yrs
- withdrawal should be gradual and monitored for 2 years for signs of relapse
119
monitoring for olanzapine?
- blood lipids and weight at baseline,at 3 months, and then yearly
- fasting blood glucose at baseline, at 4–6 months, and then yearly
120
clozapine mechanism?
dopamine D1, dopamine D2, 5-HT2A, alpha1-adrenoceptor, and muscarinic-receptor antagonist.
121
clozapine indications?
- Tx resistant schiz
- psychosis in PD
122
Clozapine - safety info?
- risk of intestinal obstruction, faecal impaction and paralytic ileus
123
# Two,relate them to side effects
CI of clozapine?
- history of neutropenia or agranulocytosis
- bone marrow disorders
- severe CNS depression
- paralytic ileus
124
monitoring for Clozapine?
- FBC - neutropenia and agranulocytosis
- fatal myocarditis (most commonly in the first 2 months) and cardiomyopathy
125
constipation & clozapine?
- Impairment of intestinal peristalsis, including constipation, intestinal obstruction, faecal impaction, and paralytic ileus, (including fatal cases) reported
- should be used in caution in ppts taking drugs that can constipate e.g. AM, or w a history of colonic disease or lower abd surgery
126
clozapine interactions?
- dose adjustment for if smoking started/ stopped
- buprenorphine
- carbamazepine
- halopreidol
127
clozapine side effects?
- leucocytosis
- speech impairment
- temp reg disorders, sweating abn
- syncope
128
photosensitisation?
- can occur with higher doses of AP
- should avoid direct sunlight
129
aripriprazole mechanism?
- partial D2 agonist
- weak serotonin 1 agonist
- 5-HT2 antagonsim
130
side effects of aripiprazole?
- DM
- MSK stiffness
- vision disorders
131
quetiapine mechanism?
- dopamine D1 and D2 antagonist
- serotonin, alpha-1 adrenoreceptor and histamine 1 receptor antagonist
132
Quetiapine interactions?
- lithium
- clozapine
- clarithromycin
133
quetiapine side effects?
- dyspepsia
- palpitations
- peripheral oedema
- withdrawal
- suicidal behaviour
- syncope
134
haloperidol mechanosm?
- D2 receptor antagonism
135
CI for haloperidol?
- congenital QT syndrome
- LBD
- QT-c prolongation
136
haloperidol interactions
- amiodarone
- apiprazole
- chlorpromazine
- citraopram
- clozapine
- erythromycin
137
side effects of haloperidol?
- depression
- neuromuscular dysfunction
- psychotic disorder
- vision disorders
138
chlorpromazine mechanism?
- D2 receptor antagonism
- Blocks α-1 & 5-HT2 > D2 >D1.
139
CI of chloropromazine?
- CNS depression
- bone marrow depression
- hypotension
- Parkinsonism
- hepatic dysfunction
- glaucoma
- QT prolongation (e.g. drug-induced)
140
antimuscarinic side effects of chlorpromazine?
- sedation
- blurred vision
- tachycardia,
- dry mouth & dental cavaties,
- constipation,
- difficulty urinating
- toxic doses
- confusional state
141
chlorpromazine general side effects?
- impaired glucose intolerance
- muscle tone inc
- SLE
- temp reg issues
142
Flupentixol mechanism?
- primarily D2 receptors
- 5-HT2 receptors
143
CI for flupentixol?
- circ collapse
- CNS depression
- comatose states
- excitable states, overactive ppts
144
flupentixol interactions?
- clozapine
- levodopa
145
flupentixol side effects?
- drowsiness
- dry mouth
- weight gain
- EPS - muscle stiffness, tremors, involuntary movements
146
Sulpiride mechanism?
- D2 antagonism
147
CI for Sulpiride?
- CNS depression
- comatose states
- phaechromocytoma
148
sulpiride side effectS?
- Breast abn
- abn orgasm
- oculogyric crisis
149
sulpiride interactions?
- levodopa
- lithium
