Drugs Flashcards
1
Q
amitriptyline is what type of anti-depressant?
A
tricyclic
2
Q
fluoxetine and citalopram are what types of anti-depressants?
A
SSRIs
3
Q
reboxetine is what type of anti-depressant?
A
noradrenaline re-uptake inhibitor
4
Q
venlafaxine is what type of anti-depressant?
A
serotonin noradrenaline re-uptake inhibitors
5
Q
mirtazapine is what type of anti-depressant?
A
noradrenaline and specific serotonin antidepressant
6
Q
how long should anti-depressants be trialled for before switching?
a) 1 week
b) 3 weeks
c) 6 weeks
d) 3 months
A
c) 6 weeks
7
Q
should patients be weaned off their current anti-depressants to avoid withdrawal before commencing new meds?
a) yes
b) no
A
a) yes
8
Q
how do tricyclic antidepressants work?
A
inhibit re-uptake of noradrenaline and serotonin from synaptic cleft
also block histamine, dopamine, a-adrenergic and muscarinic receptors
9
Q
why should tricyclic antidepressants be used with caution in those with suicide?
A
easier to OD than SSRIs
10
Q
are TCAs 1st or 2nd line for depression?
A
2nd
11
Q
what is the major contraindication for TCAs in men?
A
prostatic hypertrophy
12
Q
what is the major contraindication for TCAs in women?
A
pregnancy
13
Q
what are the anticholinergic side effects of TCAs?
A
hot as a hare blind as a bat dry as a bone red as a beet mad as a hatter
14
Q
what are the H1 and H1 side effects of TCAs?
A
sedation
hypotension
15
Q
what are the dopamine side effects of TCAs?
A
EPSEs
breast changes
sexual dysfunction
16
Q
what are the cardiac side effects of TCAs?
A
prolonged QT, arrhythmia
17
Q
why should TCAs not be used alongside class 1 and class 3 anti-arrhythmics?
A
prolong depolarisation and can increase risk of QT elongation
18
Q
how are TCAs metabolised?
A
p450 inhibitors
19
Q
how do SSRIs work?
A
inhibit neuronal re-uptake of serotonin from synaptic cleft
20
Q
why do SSRIs have fewer side effects and are less dangerous in overdose?
A
don’t inhibit noradrenaline uptake
21
Q
in what percentage of people are SSRIs effective?
a) 5-10%
b) 25-40%
c) 55-75%
d) 100%
A
c) 55-75%
22
Q
are SSRIs 1st or 2nd line treatment for depression?
A
1st
23
Q
what is the minimum time for a course of SSRIs?
a) 1 months
b) 3 months
c) 6 months
d) 1 year
A
c) 6 months
24
Q
why are SSRIs contraindicated in epilepsy?
A
lower seizure threshold
25
why are SSRIs contraindicated in peptic ulcer disease?
risk of upper GI bleed
26
why are SSRIs used with caution in young people?
increased risk of aggression, DSH and suicidal behaviours
27
why should SSRIs be used with caution in those with renal/hepatic impairment?
metabolised by the liver
citalopram is best for these patients
28
why should SSRIs only be used if the benefit really outweighs the risk in pregnant women?
excreted at high levels in breast milk
29
what electrolyte imbalance are elderly women at risk of with SSRIs?
hyponatraemia
30
what cardiac abnormality is a particular risk with citalopram (SSRI)?
QT prolongation
31
how are SSRIs excreted?
liver P450 inhibitor
32
how do mono-amine oxidase inhibitors work?
inactive an enzyme which oxidises dopamine, serotonin and tyramine
33
when are MAOIs used nowadays?
rarely used, resistant or atypical depression
34
what are the dietary restrictions of MAOIs?
tyramine containing foods e.g. cheese, game, liver, broad beans, marmite, red wine
35
what is the emergency tyramine reaction that can occur with MAOIs?
hypertensive crisis leading to SAH
36
why is reboxetine (NARI) used in those with bipolar and epilepsy?
less likely to trigger mania or seizures
37
name 2 side effects of reboxetine
dry mouth
constipation
insomnia
38
when is venlafaxine (SNARI) indicated?
treatment resistant depression
39
how can venlafaxine affect blood pressure?
hypertension
40
which two classes of antidepressant cannot be augmented together?
TCAs and SSRIs
41
true or false:
if patients are started early in their degree progression on anti-psychotic medication, their response is better
a) true
b) false
a) true
42
the tranquillising effects of anti-psychotics start to take effect in:
a) minutes
b) hours
c) days
d) weeks/months
b) hours
43
the side effects of anti-psychotics start to take effect in
a) minutes
b) hours
c) days
d) weeks/months
c) days
44
the anti-psychotic effects of anti-psychotics start to take effect in
a) minutes
b) hours
c) days
d) weeks/months
d) weeks/months
45
what is the minimum time period that anti-psychotics should be taken for?
6 months
46
what is the preferred total period of time that anti-psychotics should be taken for?
a) 6 months
b) 1 year
c) 18 months
d) 2 years
d) 2 years
47
haloperidol, chlorpromazine, fluphenazine, flupenthixol are all examples of what generation of antipsychotics?
first (typical)
48
how do anti-psychotics work?
dopamine receptor antagonists
49
why do atypical anti-psychotics take time to work?
a) body has to 'adjust'
b) poor adherance by patients
c) effective only when 60% of receptors blocked
c) effective only when 60% of receptors blocked
50
what 'line' treatment are typical (first-gen) anti-psychotics?
second
51
except for orally, how can anti-psychotics be administered?
depot injection
52
fill in the blanks
1st generation anti-psychotics have more ____________ side-effects, 2nd generation anti-psychotics have more _________ side-effects
metabolic/neurological
1st gen = neurological
| 2nd gen = metabolic
53
dystonia, akathisia, parkinsonism and tardive dyskinesia are all features of which group of side effects associated with 1st gen anti-psychotics?
extra pyramidal side effects (EPSEs)
54
which cardiac side effect is common with 1st gen anti-psychotics (ESPECIALLY HALOPERIDOL)
prolonged QT
55
what are anti-cholinergic side effects of 1st gen anti-psychotics?
```
blind as a bat
hot as a hare
mad as a hatter
red as a beet
dry as a bone
```
56
what are the anti-histaminergic side effects of 1st gen anti-psychotics?
weight gain
| sedation
57
what are the anti-adrenergic side effects of 1st gen anti-psychotics?
postural hypotension
| tachycardia
58
what are the serotoninergic side effects of 1st gen anti-psychotics?
hyperglycaemia, DMII, weight gain (appetite increase), anxiety, insomnia
59
what are the effects of hyperprolactinaemia in 1st gen anti-psychotics?
galactorrhoea, amenorrhoea
weight gain
osteoporosis
reduced libido
60
risperidone, olanzapine, aripiprazole, amisulpride, ziprasidone, palliperidone and clozapine are all examples of what generation of anti-psychotic?
second (atypical)
61
why do second gen anti-psychotics have less EPSEs than 1st-gen?
higher therapeutic index
62
clozapine works well with D2 AND D4 receptors. what situation is it used for?
treatment resistant psychosis (last resort)
63
what 'line' treatment are atypical (2nd-gen) anti-psychotics?
first
64
name 4 metabolic side effects of 2nd-gen anti-psychotics
```
hyperglycaemia
weight gain
dyslipidemia
insulin resistance
drowsiness
```
65
name a sexual side effect of 2nd-gen anti-psychotics
low libido
66
agranulocytosis, hyper-salivation and lower seizure threshold are side effects of which 2nd-gen anti-psychotic?
clozapine
67
in what psychiatric disorder are anti-convulsants often used?
bipolar
68
what alternative therapy is indicated in treatment resistant or pharmacology-contraindicated mania or depression?
ECT
69
how does lithium work?
mode unclear, affects the CNS
70
what drug is indicated to prevent relapse in bipolar?
a) lithium
b) midazolam
c) citalopram
d) oxytocin
a) lithium
71
at what blood concentration is lithium toxic?
a) 0.1mmol/L
b) 1.5mmol/L
c) 15mmol/L
d) 50mmol/L
b) 1.5mmol/L
72
why should lithium only be prescribed if intended use is consistent around 3 years?
poor compliance or quick finishing could lead to rebound mania
73
why does plasma lithium have to be measured after every dose for 5-7 days when the course is started?
to avoid toxicity which is v dangerous
74
which of these is NOT a short term side effect of lithium
a) fine tremor and muscle weakness
b) GI disturbances
c) hypotension
d) polyuria & polydipsia
e) metallic taste in mouth
c) hypotension
75
which of these is NOT a long term side effect of lithium?
a) weight gain
b) oedema
c) goitre (hypothyroidism & hyperparathyroidism)
d) muscle wasting
e) irreversible renal damage
f) T wave flattened on ECG
d) muscle wasting
76
why is lithium contra-indicated in pregnancy and advised against during breastfeeding?
a) einstein abnormality
b) albert abnormality
c) napoleon abnormality
d) epstein abnormality
d) epstein abnormaloty - downwards displacement of tricuspid valve to right ventricle - tricuspid regurg and stenosis
77
nystagmus, coarse tremor, dysarthria and ataxia are all symptoms of what adverse reaction to lithium therapy?
toxicity
78
how do you manage lithium toxicity?
a) lithiite antidote
b) saline or haemodialysis
c) anti-convulsants
d) morphine
b) saline or haemodialysis
79
how does lithium interact with diuretics (especially thiazides)?
sodium depletion which increases lithium leading to toxicity
80
why shouldn't lithium and carbamazepine be used together?
neurotoxicity - use valproate instead
81
which blood pressure medications should not be prescribed with lithium?
ace-inhibitors
82
how is lithium excreted?
unchanged by kidneys, half life related to kidney function
83
how do BZDPs work?
GABA receptor agonist - increase its effect
84
alprazolam and lorazepam have a ____ potency and a _____ half life
high
| short
85
clonazepam has a ____ potency and a ____ half life
high
| long
86
oxazepam and temazepam have a ___ potency and a _____ half life
low
| short
87
chlordiazepoxide has a ____ potency and a _____ half life
low
long
used to treat alcohol withdrawal
88
why are BZDPs only given as a short course when possible?
risk of dependence
89
which of these is NOT a symptom of BZDP withdrawal?
a) anxiety
b) irritability
c) incontinence
d) tremor
e) insomnia
f) altered perception
c) incontinence
90
what is the antidote for BZDP overdose?
flumezanil
91
which of these is NOT an example of a hypnotic to induce sleep?
a) donepezil
b) barbiturates
c) zolpidem
d) zopiclone
e) chlormethiazine/promethiazine
a) donepezil
92
donepezil, rivastigmine, galantamine and tacrine are examples of what type of drug used in dementia?
cholinesterase inhibitors
93
cholinesterase inhibitors improve cognitive and behavioural performance
a) temporarily
b) permanently
a) temporarily - maximum effect only lasts 9-12 months
94
what body system most commonly experiences side effects of cholinesterase inhibitors
GI
95
how many people respond well to cholinesterase inhibitors?
1/3 respond
1/3 won't
1/3 unknown
96
how does mementine (NMDA receptor antagonist) work in dementia?
protects neurones against neurotoxicity
97
which anti-psychotic is liscenced for use in dementia?
risperidone
98
which form of dementia should anti-psychotics never be prescribed in?
lewy body
99
why should levodopa and carbidopa be prescribed together in parkinson's disease?
levodopa = DOPA decarboxylase which activates all dopamine receptors including peripheral ones (N&V), carbidopa reduces peripheral side effects - DOPA decarboxylase inhibitor which cannot cross blood brain barrier
100
what drug can be given in parkinson's if the patient is unable to tolerate oral medication?
rivistigmine patch
