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GPhC Exam '22 > CH4: CNS DRUGS > Flashcards

CH4: CNS DRUGS Flashcards

1
Q

What are the long acting benzodiazepines?

A

CCAD

Chlordiazepoxide
Clobazam
Alprazolam
Diazepam

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2
Q

What are the short acting benzodiazepines?

A

LO

  • Lorazepam
  • Oxazepam
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3
Q

Side effects of benzodiazepines?

A
  1. Paradoxical effects (opposite effect = due toxicity) e.g. anxious, aggressive, hostility, excited
  2. Sedative effects
    - Increased by use with alcohol, CNS depressants (opioids, other sedatives) and CYP inhibitors.
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4
Q

Name the benzodiazepines that have a driving limit

A

COLD FT

Clonazepam
Oxazepam
Lorazepam
Diazepam

Flunitrazepam
Temazapam

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5
Q

Antidote for benzodiazepine overdose

A

Flumazenil

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6
Q

Benzos in pregnancy?

A
  • Use may cause neonatal withdrawal symptoms
  • AVOID unless there is a clear indication such as seizure control
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7
Q

What are the dependency symptoms for benzos? & how long this can occur in long term and short term use

A

anxiety, weight loss, loss of appetite, sweating, tremor and tinnitus

May occur up to 3 weeks for long term use of benzos, up to 1 day for short term use.

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8
Q

How to slowly withdraw benzos?

A
  1. Convert all benzos to ONCE a nightly dose of diazepam
  2. Reduce dose to 1-2mg (1/10th of the larger dose) every 2-4 weeks
    > can reduce further if pt has overcome withdrawal symptoms
  3. Reduce further (0.5mg to near end)
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9
Q

What class of drugs should be avoided when using benzos?

A
  • Beta blockers
  • Antipsychotics
  • Antidepressants (SSRIs, TCA, MAOIs)
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10
Q

Sertraline

A
  • 1st line treatment for treating depression
  • Safer for patients with cardiac events
  • better tolerated and safe in overdose
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11
Q

Fluoxetine

A

licensed for ages 5-18 for treating depression

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12
Q

SSRIs side effects

A

• GI disturbances: diarrhoea, vomiting
• Weight gain/ fluctuations
• Sexual dysfunction
• Risk of bleeding: increased by NSAIDs, anticoagulants… => offer GI protection
• Insomnia- take in morning to avoid this
• QT prolongation (Especially with escitalopram/ citalopram)
• Hyponatraemia
• Suicide ideation
• Serotonin syndrome
• Hypersensitivity – stop if rash occurs

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13
Q

What TCAs are not recommended for treatment of depression

A
  1. Amitriptyline
  2. Dosulepin

They are both dangerous in overdose.

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14
Q

State the sedating TCAs

A

CATD

Clomipramine
Amitriptyline
Dosulepin
Trazadone

better for agitated and anxious patients – helps with sleep

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15
Q

State the less sedating TCAs

A

NIL

Nortriptyline
Imipramine (most antimuscarinic)
Lofepramine (hepatotoxic)

Better for withdrawn and apathetic patients

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16
Q

Side effects for TCAs

A

CASHH

Cardiac event (QTc prolongation)
Antimuscarinic
Seizures
Hypotension
Hallucination

17
Q

Interactions of SSRIs

A

• CYP enzyme inhibitors: avoid grapefruit- increases concentration
• CYP enzyme inducers reduces effectiveness
• Drugs that cause QT prolongation: amiodarone, sotalol, quinolones, antipsychotics, macrolides, TCA’s…
• Drugs that increase bleed risk
• Hyponatraemia: carbamazepine and diuretics
• Serotonin syndrome

18
Q

Interactions of TCAs

A

• CYP enzyme inhibitors – avoid grapefruit – increases plasma concentrations
• CYP enzyme inducers – reduces effectiveness
• Drugs that cause QT prolongation – amiodarone, sotalol, quinolones
• Anti-muscarinic drugs
• Anti-hypertensive drugs
• Serotonin syndrome

19
Q

Name the MAOIs drugs that cause hepatotoxicity

A

phenelzine and isocarboxazid

20
Q

Side effects of MAOIs

A

Hypertensive crisis
- STOP if the throbbing headache
- avoid: OTC pseudoephedrine and sympathomimetics and dopaminergic drugs
- avoid: tyramine rich foods, stale foods

21
Q

The combination therapy of tranylcypromine + clomipramine may cause?

A
  • fatal
  • cause hypertensive crisis
22
Q

Washout period for starting MAOIs after SSRIs have been stopped?

A

1 week after SSRIs or related antidepressant has been stopped
5 weeks- Fluoxetine
2 weeks - Sertraline

23
Q

Washout period for starting MAOIs after TCAs have been stopped?

A

1-2 weeks after TCAs or related antidepressants have been stopped
3 weeks - Clomipramine or Imipramine

24
Q

Washout period for starting MAOIs after previous use of MAOIs has been stopped?

A

2 weeks
unless it is Moclobemide = short-acting, no wash out periods required

25
Q

Name MAOIs drugs

A

phenelzine
isocarboxazid
tranylcyprmine
moclobemide

26
Q

Name the antidepressants that have the highest risk of withdrawal symptoms

A

paroxetine
venlafaxine

27
Q

withdrawal period for antidepressants on maintenance

A

over 6 months

27
Q

withdrawal period for antidepressants on maintenance

A

over 6 months

GPhC Exam '22 (16 decks)

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