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MRCPSYCH_Paper B_MENTOR & More_Dr. ART > Clozapine - 3 > Flashcards

Clozapine - 3 Flashcards

1
Q

what class is clozapine classfied in ?

A

tricyclic benzodiazepine drivatives

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2
Q

mechanism of clozpaine

A

—-antagonists at D1, D2, D3 and D4
—-antagonists at alpha adrenoceptors 1 and 2
—-antagonists at 5-HT2A
—-antagonists at muscarinic-receptor (M1, M2, M3, M5)

—agonist at M4

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3
Q

unique thing about clozpane mechanism compared to other antipsychotics?

A

high affinity at D4
weak at D2
More active at limbic
less active at striatal

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4
Q

why clozapine is thougt to be more EPSE safe?

A

weak at D2

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5
Q

clozapine main metabolizer cyp?

A

cyp1a2

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6
Q

what does smoking do to clozapine

A

reduce in blood (induce cyp1a2)

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7
Q

what does coffeee do to clozapine?

A

increase in blood ( inhibit cyp1a2)

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8
Q

is it absolute necessary to avoid coffee in clozapine therapy?

A

no, just don’t fluctuate the amount consumed

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9
Q

drugs that increase clozapine level?

A

SEC

SSRIs
Erythromycin
Caffeine

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10
Q

drugs that decrease clozapine level?

A

PCT

Phenytoin
Carbamazepine
Tobacco

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11
Q

main active clozapine metabolite

A
  • nor clozapine (n-desmethyl clozapine)
  • Clozapine N-Oxide
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12
Q

side effects of clozapine (loosing)

A

Nausea
Vomitting
Salivation

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13
Q

side effects of clozapine (gaining)

A

constipation
weight gain
dyspepsia

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14
Q

side effects of clozapine (sleepy)

A

Dizziness
Sedation
Insomnia

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15
Q

rate of hypertention in clozapine therapy

A

1/100

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16
Q

prevalence of hypersalivation in clozapine therapy?

A

31%

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17
Q

risks of hypersalivations?

A

asphyxiation
pneumonia
embarrasing in society

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18
Q

when is hypersalivation worse?

A

at evening

19
Q

when is usually hypersalivation seen in clozapine therapy/

A

early in therapy

20
Q

RCT based medication used in hypersalivation?

A

-amisulpride
-propantheline

21
Q

medication used in hypersalivation commonly but no data?

A

hyoscine hydrobromide

22
Q

what does sympathetic stimulation do to saliva

A

increase protein contain

23
Q

what does parasympathetic stimulation do to saliva

A

increase the flow

24
Q

hypothesis for hypersalivation due to clozpaine

A
  • reduced swallowing
  • a 2 adrenoceptor antagonist increases saliva
    -M4 agonist
25
Q

Adverse events associated with clozapine?

A

pancreatitis
agranulocytosis
myocarditis
seizure
severe orthost. hypotension
mortality in the elderly and dementia cases
colitis
thrombocytopenia
insulin resistant
thromboembolism

26
Q

prevalence of diabetes in clozapine

A

33%

27
Q

which conditions BNF requries caution about in clozapine therapy?

A

Above 60
Prostatic hypertrophy
Susceptible to angle closure glaucoma

28
Q

is there any therapeutic window established for clozapine

A

no

29
Q

What is generally accepted as the level required to trigger a therapeutic response in clozapine therapy?

A

0.35 mg/l

30
Q

what level indicate caution in clozapine therapy?

A

above 0.5 mg/l

31
Q

prevalence of clozapine induced myocarditis?

A

1/500

32
Q

when do myocarditis happen in the course of clozapine therapy

A

80% in first 4 week
90% in first 8 weeks

33
Q

what pathology suggests in post mortum analysis of clozapine-induced myocarditis?

A

Type 1 Ig E- mediated acute hypersensitivity reaction

34
Q

findings of pathological analysis of clozapine induced myocarditis(CIM)?

A

infiltration of eosinophils and myocytes

35
Q

will recurrent myocarditis happen in a subsequent restart of clozapine?

A

yes

36
Q

features of myocarditis(CIM)?

A

Fever flu like
chest pain
dyspnoea
palpitation
tackycardia
ECG changes (prolongation)
Elevated oesinophils and cardiac enzymes

37
Q

gold standard to Rx clozapine induced myocariditis (CIM)?

A

biopsy

38
Q

biomarkers of CIM

A

Creatine Kinase
Lactate dehydrogenase
Aspartate aminotransferase
Myoglobin
Troponin

39
Q

what troponin type is specifict to CIM?

A

Troponin I & T

40
Q

mortality rate in CIM?

A

50%

41
Q

contraindication for clozapine?

A

paralytic ileus
Epilepsy (uncontrolled)
Unable to undergo regular blood tests
hx of agranulocytosis
concomitant use of depot
impaired bone marrow
renal, cardiac or liver diseases

42
Q

what are two completely atypical antipsychotics?

A

clozapine
and
possibly quetiapine

43
Q
A

MRCPSYCH_Paper B_MENTOR & More_Dr. ART (69 decks)

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