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Block 33 Pharmacology Flashcards

1
Q

Benzodiazepines drug examples?

A
  • diazepam
  • lorazepam
  • temazepam
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2
Q

SSRI drug examples?

A
  • Citalopram
  • Fluoxetine
  • Paroxetine
  • Sertraline
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3
Q

what are the indications for benzos?

A

Anxiety disorders, acute behavioural control and rapid tranquillisation

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4
Q

indications for SSRIs?

A

Depression, anxiety disorders

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5
Q

safety info w benzos?

A
  • co-presribing w opiods can cause increased risk of sedation, coma, resp depression and death
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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
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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
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8
Q

side effects of benzos?

A
  • ataxia and confusion - elderly
  • resp depression - high dose and IV use
  • sleep disorders
  • withdrawal syndrome
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9
Q

overdose of benzodiazepines?

A
  • drowsiness, ataxia, dysarthria, nystagmus, and occasionally respiratory depression, and coma
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10
Q

benzos mechanism?

A
  • CNS depressants
  • enhances effect at GABA-A receptor -> sedative, hypnotic, and anxiolytic, muscle relaxant, anticonvulsant effect
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11
Q

SSRI drug action?

A
  • seletively inhibit the re-uptake of serotonin
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12
Q

CI for SSRIs?

A
  • poolry controlled SSRI
  • manic phase
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13
Q

SSRI - elderly?

A

care with hyponatreaemia

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14
Q

side effects of SSRIs?

A
  • GI side effect more common
  • inc risk of GI bleeding
  • inc anxiety and agitation after starting
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15
Q

which SSRIs have a higher risk of drug interactions?

A

fluoxetine and paroxetine

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16
Q

Which SSRIs can’t be used in long QT syndrome?

A
  • citralopram and escitalopram
  • cause QT prolongation
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17
Q

when should a PPI be prescribed w an SSRI?

A

if ppt also taking NSAIDs

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18
Q

interactions of SSRIS?

A
  • MAOIs - serotonin syndrome
  • aspirin
  • NSAIDs-> prescribe PPI
  • warfarin
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19
Q

SSRI overdose?

A
  • nausea
  • vomiting
  • nystagmus
  • sinus tachyardia
  • tremor
  • agitation
  • convulsions
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20
Q

serotonin syndrome?

A

marked neuropsychiatric effects, neuromuscular hyperactivity, and autonomic instability, hyperthermia, rhabdomyolysis, renal failure, and coagulopathies may develop.

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21
Q

examples of SNRIs?

A
  • Duloxetine
  • Venlafaxine
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22
Q

SNRIs mechanism?

A
  • inhibits reuptake of serotonin and noradrenaline
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23
Q

duloxetine is also used for?

A

urinary incontinence

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24
Q

SNRI safety info?

A
  • SNRIs in the last month b4 delievry can inc risk of postpartum haemorrhage
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25
Q

side effects of SNRIs?

A
  • Falls
  • GI disorders
  • sexual dysfunction
  • palpitations
  • urinary disorders
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26
Q

which SNRI is associated w higher risk of withdrawal?

A

Venlafaxine

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27
Q

Reboxetine mechanism?

A

Selective noradrenaline reuptake inhibitor

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28
Q

Indication of Reboxetine?

A

depression

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29
Q

Cautions of Reboxetine?

A
  • bipolar
  • epilepsy
  • CVD
  • urinary retention
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30
Q

Side effects of Reboxetine?

A
  • accomodation disorder
  • anx
  • insomnia
  • tachycardia
  • vasodilation
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31
Q

Interactions of Reboxetine?

A
  • isocardboxazid
  • phenelzine - hypertensive crisis
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32
Q

Mirtazapine =

A
  • pre-synaptic alpha-2 adrenoreceptor receptor blocker
  • blocks serotonin receptors
  • atypical tetracyclic AD
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33
Q

mitrazepine ix?

A

major depression

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34
Q

cautions of Mirtazapine?

A
  • cardiac disorders
  • DM
  • mania
  • seizures
  • urinary retention
  • hypotension
  • psychosis
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35
Q

side effects of Mirtazapine?

A
  • anx
  • inc appetite
  • constipation
  • confusion
  • oedema
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36
Q

examples of TCAs?

A
  • Amitriptyline
  • Imipramine
  • Lofepramine
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37
Q

indications for tricyclics?

A

Depression, adjunct for chronic or neuropathic pain

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38
Q

CI of TCAs?

A
  • heart block
  • arrhythmias
  • manic phase
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39
Q

TCAs- elderly?

A
  • susceptible to side effects
  • low initial doses
  • monitoring for psychiatric and cardiac side effects
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40
Q

interactions of amitryptiline?

A
  • adrenaline
  • bupropion
  • cloazpine - hyponatraemia and hypotension
  • fluoxetine
  • lithium
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41
Q

side effects of amitryptiline?

A
  • anticholinergic syndrome
  • droswiness
  • QT prolongation
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42
Q

amitryptiline overdose?

A
  • high rate of fatality
  • dry mouth
  • coma
  • hypotension
  • hypothermia
  • resp failure
  • arrhythmias
  • dilated pupils
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43
Q

lofepramine side effects?

A
  • agranulocytosis
  • bone marrow disorders
  • cardiac conduction disorders
  • gynacomastia
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44
Q

Imipramine cautions?

A
  • hyperthyroidism - high risk of arrhytmias
  • inc intraocular pressure
  • sig suicide risk
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45
Q

side effects of Imipramine?

A
  • decreased appetite
  • arrthymias
  • hypotension
  • hallucinations, tremors
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46
Q

TCAs mechanism?

A
  • block serotonin, NA, and dopamine reiptake
  • also block muscaronic receptors
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47
Q

anticholinergic effects of TCAs?

A

dry mouth, blurry vision, constipation, and urinary retention

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48
Q

MAOis indications?

A

Major depression and phobic patients with hypochondriacal features, social anxiety disorder

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49
Q

examples of MAOAi?

A
  • phenelzine
  • moclobemide
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50
Q

phenelzine =

A

non selective MAOI

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51
Q

Moclobemide=

A

reversible inhibitor of MAOA-A

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52
Q

monoamine oxidase?

A
  • inhibiting this prevents breakdown of serotonin, melatonin, epinephrine, norepinephrine
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53
Q

CI for all MAOI?

A
  • Cerebrovascular disease
  • severe CVD
  • phaechromocytoma
  • manic phase
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54
Q

side effects of MAOI?

A
  • Anx
  • hallucinations
  • insomnia
  • postural hypotension - more common in elderly
  • suicidal behavs
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55
Q

when should MAOA be discontinued?

A

Risk of postural hypotension and hypertensive responses. Discontinue if palpitations or frequent headaches occur.

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56
Q

monitoring for MAOI?

A
  • MONITOR BP -risk of postural hypotension and hypertensive responses
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57
Q

withdrawal from MAOI?

A
  • Agitation
  • irritability
  • slow speech
  • vivid dreams
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58
Q

other symtoms that can occur when discontinuing MAOi?

A

hallucinations, paranoid delusions

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59
Q

Drugs used for managing opioid withdrawal ?

A

Methadone & Buprenorphine

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60
Q

methadone Ix?

A
  • opiod dependence
  • svr pain
61
Q

CI of all opiods (includes methadone)

A
  • ARD
  • head injury, raised ICP
  • risk of paralytic ileus
62
Q

CI for methadone?

A

phaechromocytoma

63
Q

methadone mechanism?

A
  • 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
Q

buprenorphine mechanism?

A
  • 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
Q

drugs causing prolonged QT?

A
  • amiodarone, solatolol
  • TCA, SSRIs - espec citalopram
  • methadone
  • haloperidol
  • ondansteron
66
Q

side effects of all opiods?

A
  • arrhythmias
  • euphoric mood
  • hallucination
  • miosis
  • palpitations
  • resp depression
  • vomiting and nausea - more common on initiation
67
Q

methadone side effects?

A
  • asthma exacerbation
  • hyperprolactinaemia
  • hypothermia
  • QT prolongation
68
Q

methadone toxicity?

A
  • long acting opiod - hazardous even in low doses for kids
69
Q

buprenorphine side effects?

A
  • anxiety
  • depression
  • diarrhoea
  • tremor
70
Q

effects of ? are only partially reversed by naloxone?

A

buprenorphine

71
Q

Drugs used for smoking cessation?

A
  • Nicotine replacement therapy
  • Bupropion
  • Varenicline
72
Q

NRT mechanism?

A
  • Reduced cravings due to nicotine addiction
  • patches, gum, sprays, tablets, lozenges
73
Q

cautions of nicotine?

A
  • DM - monitoring of BG needed when initating Tx
  • haemodynamically unstable ppts
74
Q

side effects of nicotine?

A
  • dizziness
  • headaches
  • hyperhidrosis
  • nausea, vomiting
  • palpitations
75
Q

nicotine withdrawal symptoms?

A
  • malaise
  • headache
  • dizziness
  • sleep disturbance
  • coughing
  • restlessness
  • dec HR
  • apthous ulcers
76
Q

Bupropion mechanism?

A
  • dopamine and NA reuptake inhibition ->insomnia
  • works on pathways involved in addiction and withdrawal
77
Q

buprion safety info?

A
  • SS when taken with SSRI and SNRIs
78
Q

CI of bupropion?

A
  • acute alcohol withdrawal
  • acute benzo withdrawal
  • bipolar
  • EDs
  • seizures
79
Q

side effects of buprion?

A
  • abd pain
  • anx
  • conc impaired
  • tremor
  • insomnia - don’t take near bedtime
80
Q

Varenicline mechanism?

A

selective nicotinic receptor partial agonist

81
Q

side effects of varenicline?

A
  • nausea - most common
  • headache
  • insomnoa
  • abn dreams
82
Q

cautions of vareniciline?

A
  • lowered seizure threshold
  • history of psychiatric illness
83
Q

Ix of lithium?

A

Treatment and prophylaxis of mania, hypomania and depression in bipolar disorder

84
Q

lithium mechanism?

A
  • reduced glutamate and dopamine
  • inc GABA - release and upregulates receptors
85
Q

CI of lithium?

A
  • low sodium diets
  • cardiac disease
  • addisions
  • dehydration
86
Q

LT lithium use?

A
  • associated w thyroid disorders and mild cognitive and memory impairment
  • monitoring of thyroid function every 6 months
87
Q

lithium interactions?

A
  • amitryptiline
  • acetazolamide
  • bupropion
88
Q

lithium side effects?

A
  • angioedema
  • AV block
  • delirium
  • idiopathic intercranial hypertension
  • QT prolongation
89
Q

lithium toxicity?

A
  • coarse tremor (a fine tremor is seen in therapeutic levels)
  • hyperreflexia
  • acute confusion
  • polyuria
  • seizure
  • coma
90
Q

what can lithium toxicity be precipitated by?

A
  • dehydration
  • renal failure
  • drugs: diuretics (especially thiazides), ACE
    inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole.
91
Q

lithium is?

A

teratogenic

92
Q

lithium safety?

A
  • very narrow therapeutic index
  • requires monitoring of serum concs
93
Q

Mood stablising anticonvulsant drugs?

A
  • Sodium valproate
  • Carbamazepine
  • Lamotrigine
94
Q

when are mood stabilising anticonvulsants used?

A

Treatment and prophylaxis of mania, hypomania and depression in bipolar disorder

95
Q

sodium valproate is CI in?

A
  • women and girls of childbearing age unless conds of pregnancy prevention programme are met
  • severe hepatic dysfunction
  • urea cycle disorders - hyperammonaemia risk
96
Q

valproate -> ? toxicity?

97
Q

Hair

side effects of valproate?

A
  • alopecia - regrowth may be curly
  • abn behaviour
  • hepatic disorders
  • hallucination
  • stupor
98
Q

when should valproate be withdrawn?

A

persistent vomiting and abdominal pain, anorexia, jaundice, oedema, malaise, drowsiness, or loss of seizure control.

99
Q

valproate mechanism?

A
  • voltage gated sodium channel blockage
  • inc GABA levels -> anti-manic properties
100
Q

carbamazepine mechanism?

A
  • sodium channel inhibitor
  • serotonin releasing agent
101
Q

CI of carbamazepine?

A
  • acute porphyrias
  • AV conduction abn
  • history of BM suppression
102
Q

side effects of carbamazepine?

A
  • induces P450 enzyme
  • drowsiness
  • visual disturbances - espec diplopia
  • leucopenia and agranulocytosis
  • hyponatraemia secondary to syndrome of inappropriate ADH secretion
103
Q

lamotrigine mx?

A

binds and inhibits sodium VGC, inhibits glutamate and aspartate release

104
Q

cautions of lamotrigine?

A
  • PD
  • seizures
  • brugada syndrome
105
Q

side effects of lamotrigine?

A
  • aggressgion
  • dizziness
  • drowsiness
  • dry mouth
  • rash
106
Q

skin changes w lamotrigine?

A
  • SJS
  • toxic epidermal necrolysis
107
Q

Atypical antipsychotic drugs?

A
  • Risperidone
  • Olanzapine
  • Clozapine
  • Aripiprazole
    - Quetiapine
108
Q

AP indications?

A

Psychosis, schizophrenia, rapid tranquillisation, mania

109
Q

typical AP/ first gen?

A
  • Haloperidol (a butyrophenone)
  • Chlorpromazine (a phenothiazine)
  • Flupentixol (a thioxanthine)
  • Sulpiride (a substituted benzamide)
110
Q

Atypical AP mechanism?

A
  • antagonism of D2 receptors in the mesolimbic pathway (overactivity leads to positive symptoms)
  • antagonism of serotonin, alpha-1 adrenoreceptor, histamine 1
111
Q

when should risperidone be avoided?

A
  • acute porphyrias
  • cataract surgery
  • LBD
  • prolactin dependent tumours
  • dehydration
112
Q

interactions of risperidone?

A
  • levodopa
  • lithium
  • methylphenidate
113
Q

risperidone side effects?

A
  • decreased weight
  • vision disorders
  • sexual dysfunction
  • oedema
114
Q

olanzapine mechanism?

A

Olanzapine is a dopamine D1, D2, D4, 5-HT2, histamine- 1-, and muscarinic-receptor antagonist.

115
Q

CI of olanzapine?

A
  • unstable angina
  • bradycardia
  • severe hypotension
  • SSS
  • acute MI
116
Q

Interactions of olanzapine?

A
  • smoking - dose adjustment
  • clozapine: constipation -> intestinal obstruction
  • levodopa
  • valproate
117
Q

olanzapine side effects?

A
  • anticholinergic syndrome
  • eosinophilia
  • fever
  • glycosuria
  • sexual dysfunction
118
Q

stopping AP?

A
  • 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
Q

monitoring for olanzapine?

A
  • 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
Q

clozapine mechanism?

A

dopamine D1, dopamine D2, 5-HT2A, alpha1-adrenoceptor, and muscarinic-receptor antagonist.

121
Q

clozapine indications?

A
  • Tx resistant schiz
  • psychosis in PD
122
Q

Clozapine - safety info?

A
  • risk of intestinal obstruction, faecal impaction and paralytic ileus
123
Q

Two,relate them to side effects

CI of clozapine?

A
  • history of neutropenia or agranulocytosis
  • bone marrow disorders
  • severe CNS depression
  • paralytic ileus
124
Q

monitoring for Clozapine?

A
  • FBC - neutropenia and agranulocytosis
  • fatal myocarditis (most commonly in the first 2 months) and cardiomyopathy
125
Q

constipation & clozapine?

A
  • 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
Q

clozapine interactions?

A
  • dose adjustment for if smoking started/ stopped
  • buprenorphine
  • carbamazepine
  • halopreidol
127
Q

clozapine side effects?

A
  • leucocytosis
  • speech impairment
  • temp reg disorders, sweating abn
  • syncope
128
Q

photosensitisation?

A
  • can occur with higher doses of AP
  • should avoid direct sunlight
129
Q

aripriprazole mechanism?

A
  • partial D2 agonist
  • weak serotonin 1 agonist
  • 5-HT2 antagonsim
130
Q

side effects of aripiprazole?

A
  • DM
  • MSK stiffness
  • vision disorders
131
Q

quetiapine mechanism?

A
  • dopamine D1 and D2 antagonist
  • serotonin, alpha-1 adrenoreceptor and histamine 1 receptor antagonist
132
Q

Quetiapine interactions?

A
  • lithium
  • clozapine
  • clarithromycin
133
Q

quetiapine side effects?

A
  • dyspepsia
  • palpitations
  • peripheral oedema
  • withdrawal
  • suicidal behaviour
  • syncope
134
Q

haloperidol mechanosm?

A
  • D2 receptor antagonism
135
Q

CI for haloperidol?

A
  • congenital QT syndrome
  • LBD
  • QT-c prolongation
136
Q

haloperidol interactions

A
  • amiodarone
  • apiprazole
  • chlorpromazine
  • citraopram
  • clozapine
  • erythromycin
137
Q

side effects of haloperidol?

A
  • depression
  • neuromuscular dysfunction
  • psychotic disorder
  • vision disorders
138
Q

chlorpromazine mechanism?

A
  • D2 receptor antagonism
  • Blocks α-1 & 5-HT2 > D2 >D1.
139
Q

CI of chloropromazine?

A
  • CNS depression
  • bone marrow depression
  • hypotension
  • Parkinsonism
  • hepatic dysfunction
  • glaucoma
  • QT prolongation (e.g. drug-induced)
140
Q

antimuscarinic side effects of chlorpromazine?

A
  • sedation
  • blurred vision
  • tachycardia,
  • dry mouth & dental cavaties,
  • constipation,
  • difficulty urinating
  • toxic doses
  • confusional state
141
Q

chlorpromazine general side effects?

A
  • impaired glucose intolerance
  • muscle tone inc
  • SLE
  • temp reg issues
142
Q

Flupentixol mechanism?

A
  • primarily D2 receptors
  • 5-HT2 receptors
143
Q

CI for flupentixol?

A
  • circ collapse
  • CNS depression
  • comatose states
  • excitable states, overactive ppts
144
Q

flupentixol interactions?

A
  • clozapine
  • levodopa
145
Q

flupentixol side effects?

A
  • drowsiness
  • dry mouth
  • weight gain
  • EPS - muscle stiffness, tremors, involuntary movements
146
Q

Sulpiride mechanism?

A
  • D2 antagonism
147
Q

CI for Sulpiride?

A
  • CNS depression
  • comatose states
  • phaechromocytoma
148
Q

sulpiride side effectS?

A
  • Breast abn
  • abn orgasm
  • oculogyric crisis
149
Q

sulpiride interactions?

A
  • levodopa
  • lithium

Year 3 (45 decks)

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