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CH.4 NS > drugs > Flashcards

drugs Flashcards

1
Q

C/I for BZD

A

pulmonary insufficiency, marked neuromusclar respiratory weakness, sleep apnoea synd, unstable myasthenia gravis

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2
Q

BZD- paradoxical effect

A

increase in hostility, agression

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3
Q

Dexafetamine and lisdexfetamine s/e

A

tics and tourette syndrome - stop if tics happen
monitor children’s growth, weight and height
growth restriction in prolonged treatment

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4
Q

antipsychotics c/i

A

CNS depression, coma, hypothyroidism, phaeochromocytoma

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5
Q

antipsychotics cautions

A

DM, blood dyscrasia, depression, seizures, CVD, DM ( raise BG), jaundice, MG, PD ( may be exacerbated), photosensitisation, prostatic hypertrophy, severe resp, angle closure glaucoma

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6
Q

chlorpromazine i/n food& lifestyle

A

smoking, dose adjustiment

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7
Q

why will chlorpromazine ( antipsychotics) exacerbate PD

A

acute dystonic reaction, facial and skeletal muscle spasm and oculogyrics crises

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8
Q

phenothiazines are indicated for? and is it toxic to liver or kidney

A

antipsychotics ( 1st Gen), hepatotoxic

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9
Q

why all antipsychotics users should avoid direct sunlight

A

photosensitisation occur with high dose

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10
Q

monitoring for antipsychotics

A

prolactinaemia - prolactin conc 6M, Y

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11
Q

what is the biggest C/I of pimozide ? what is the indication

A

schizophrenia, antipsychotics

QT prolongation

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12
Q

monitoring of pimozide?

A

ECG annually

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13
Q

drug i/n with pimozide

A

other antipsychotics, TCA, antimalarial, some antihistamines ( electrolyte disturbances )
risk of QT prolongation drugs

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14
Q

what antipsychotics is used for resistant schizophrenia

A

clozapine

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15
Q

what GI cautions with clozapine

A

risk intestinal obstuction due to antimuscarinic effect in GI
cautions when use with other constipating medication (antimuscarinic )
or those with a history of colonic disease or lower abdominal surgery

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16
Q

s/e of clozapine

A

leucocytopenia, blood dsycrasia
children’s endocrine, growth restriction
myocarditis and cardiomyopathy
hypersalivation ( treat with hyoscine)

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17
Q

lithium toxicity signs

A 
REVeNGe 
renal dist 
Extrapyramidal 
Visual dist 
cNs disturba 
GI dist 
(hyponatraemia)

> 2mmol/ L severe OD- seizures, cardiac arrhythmia, BP changes, circulatory failure, coma and sudden death

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18
Q

how should lithium be monitored ? and what are the ranges

A

0.4-1mmol/l ( post dose 12 hrs)
0.8-1mmol/l for acute mania or who have previously relapsed or sub-syndromal symptx
weekly at initiation and after each dose change until conc is stable, then 3 montly,
additional measurement if ill or significant change in sodium and fluid intake

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19
Q

lithium S/E and I/N

A
  • renal ( polyuria, polydispisia)
  • thyoid - hypothyroidism - ( weigh loss, fatigue)
  • Neurotoxicity
  • serotonin syndrome
  • QT prolongation
  • seizures threshold
  • benign intracranial HTN ( headache, visual disturbances)
  • hyponatramia (predispose to Li toxicity)
  • extrapyramidal
  • mild cognitive and memory impairment
  • teratogenic
    (brand specific )
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20
Q

OTC i/n for lithium

A

ibuprofen, soluble analgesics ( high salt content), Na+ containing antacids

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21
Q

what is agomelatine indicated for

A

major depression

22
Q

which two SSRI have highest risk in QT prolongation

A

citalopram and escitalopram

23
Q

which SSRI is safe for children

A

fluoxetine

24
Q

which SSRI is high risk of withdrawal reaction

A

paroxetine - dose reduced gradually over abt 4 weeks or longer ( 6M if patient on long term maintenance)

25
Q

is SSRI safe in MI and unstable angina

A

yes

26
Q

SSRI s/e

A 
GASH 
GI disturbance ( dose related )
Appetite loss/gain, weigh loss/gain
Serotonin synd 
Hypersensitivity ( stop if rash)

(hyponatraemia, hypokalaemia)

  • seizure threshold
  • muscle disorder/ dyskinesia
  • increase bleeding risk

O/D

  • N+V
  • nystagmus
  • convulsion
  • agitation
  • drowsiness
  • tremour
  • sinus bradycardia
27
Q

ergot derived dopamine antagonist
list some example
and important s/e

A

bromocriptine, cabergoline, pergolide
- fibrotic reactions
associated with pulmonary, retroperitoneal and pericardial reactions
- exclude cardiac valvulopathy with ECHO before starting treatment
measure erythrocyte sedimentation rate, serum CR, chest XR
- monitor for dyspnoea, persistent cough, chest pain, cardiac failure, abd pain or tenderness

28
Q

side effect for dopamine agonist

A

impulse control disorder

  • sleep - sudden onset of sleeping
  • eat
  • gamble
29
Q

which anti-emetic is recommended for PD

A

domperidone (dopamine antagonist )

30
Q

which enzyme metabolites domperidone ? and what is its max duration

A

CYP3A4

1 week

31
Q

what serious s/e does domperidone have?

A

cardiac s/e - QT prolongation
lowest dose, shortest duration
>12 y/o 10 mg TDS
<12 and < 35kg = 250mcg/kg up to TDS

32
Q

what serious s/e does metoclopramide have? what is it indicated for?

A

EPS ( worsen PD), tardive dyskinesia
only chemo induced, post operative induced, acute migraine related
- only up to 5 days
- usual dose - 10mg, repeated up to TDS, max 500mcg/kg
- IV slow bolus over 3 mins

  • can also cause hyperprolactinaemia, gynaecomastia, galactorrhoea, menstrual changes
33
Q

metoclopramide may induce acute dystonia. what is that and what is used to resolve?

A

facial and skeletal muscle spasms and oculogyric crises

injection of anti-parkisonism drugs- procyclidine

34
Q

s/e of opioids

A

respiratory depression - artificial ventilation
hypogonadism, adrenal insufficiency
hyperalgesia - reduce dose/ naloxone

(risk of paralytic ileus )

35
Q

what is ergotamine indicated for ? and when to stop treatment

A

cluster headache

numbness and tingling of extremeties - stop and contact doct

36
Q

is carbamazepine brand specific ? and what are the signs of toxicity

A 
yes 
iHANDBAG
- incordination 
- Hyponatraemia 
- Ataxia 
-Nystagmus 
- Drowsiness 
- Blood dyscrasia 
- Arrhythmia 
- GI dist ( NVD)
37
Q

carbamazepine - blood, skin and hepatic disorders

A

should be withdrawn immed in case of aggravated liver dysfunction
leucopoenia - severe with clinical sympts need to be withdraw

38
Q

carbamazepine - rash, what reaction is this? what group is susceptible?

A

hypersensitivity, han chinese and thai HLAB 1502 allele - increase risk of SJS

39
Q

CBZ- which electrolyte does it affect and what serious effect can it lead

A

hyponatraemia and can induce diuretics like water toxification

40
Q

what are CBZ i/n that need to be considered

A

hyponatraemia, reduced seizure threshold, hepatotoxic

41
Q

what route is fosphenytoin administered via? and what reaction should it be cautions of? and what monitoring is therefore needed ?

A

IM/ IV
severe cardiac reactions - asystole, VF, cardiac arrest, hypotension, bradycardia, heart block
- BP, HR, respiratory function for the duration of infusionj
reduce dose in renal or hepatic or elderly

42
Q

what group is susceptible to specific skin reactions for fosphenytoin?

A

Han chinese or thai origin HLA B 1502 allele

steven johnson syndrome

43
Q

when lamotrigine and valporate concomitant use, what s/e increase risk?

A

SJS and toxic epidermal necrolysis

44
Q

is lamotrigine susceptible to blood disorder

A

yes

45
Q

what condition may lamotrigine exacerbate?

A

myclonic seizure and PD

46
Q

what should sodium valporate be cautions with

A

SLE ,systemic lupus erythematosus

47
Q

why should sodium valporate be given vitamin D

A

reduce risk of bone density

48
Q

which antiepileptic is the most teratogenic ? and what is the preventative measure?

A 
sodium valporate 
7 days Rx validity contraceptive for 30 days supply 
exclude pregnancy before trmxt 
risk acknowledgement form 
annual specialist review
49
Q

which enzyme is sodium valporate susceptible to ?

A

CYP 450

50
Q

what are the s/e of sodium valporate

A

liver dysfunction - increase fatality with other antiepiletics
blood dyscrasia
pancreatitis ( abdominal pain, nausea, vomiting)

51
Q

what are the brand specific antiepileptics

A

phenytoin, carbamazepine, phenobarbital, primidone

CH.4 NS (1 decks)

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