drugs

Question 1

C/I for BZD

Answer 1

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

Question 2

BZD- paradoxical effect

Answer 2

increase in hostility, agression

Question 3

Dexafetamine and lisdexfetamine s/e

Answer 3

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

Question 4

antipsychotics c/i

Answer 4

CNS depression, coma, hypothyroidism, phaeochromocytoma

Question 5

antipsychotics cautions

Answer 5

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

Question 6

chlorpromazine i/n food& lifestyle

Answer 6

smoking, dose adjustiment

Question 7

why will chlorpromazine ( antipsychotics) exacerbate PD

Answer 7

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

Question 8

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

Answer 8

antipsychotics ( 1st Gen), hepatotoxic

Question 9

why all antipsychotics users should avoid direct sunlight

Answer 9

photosensitisation occur with high dose

Question 10

monitoring for antipsychotics

Answer 10

prolactinaemia - prolactin conc 6M, Y

Question 11

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

Answer 11

schizophrenia, antipsychotics

QT prolongation

Question 12

monitoring of pimozide?

Answer 12

ECG annually

Question 13

drug i/n with pimozide

Answer 13

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

Question 14

what antipsychotics is used for resistant schizophrenia

Answer 14

clozapine

Question 15

what GI cautions with clozapine

Answer 15

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

Question 16

s/e of clozapine

Answer 16

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

Question 17

lithium toxicity signs

Answer 17

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

Question 18

how should lithium be monitored ? and what are the ranges

Answer 18

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

Question 19

lithium S/E and I/N

Answer 19

• 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 )

Question 20

OTC i/n for lithium

Answer 20

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

Question 21

what is agomelatine indicated for

Answer 21

major depression

Question 22

which two SSRI have highest risk in QT prolongation

Answer 22

citalopram and escitalopram

Question 23

which SSRI is safe for children

Answer 23

fluoxetine

Question 24

which SSRI is high risk of withdrawal reaction

Answer 24

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

Question 25

is SSRI safe in MI and unstable angina

Answer 25

yes

Question 26

SSRI s/e

Answer 26

``` 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

Question 27

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

Answer 27

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

Question 28

side effect for dopamine agonist

Answer 28

impulse control disorder - sleep - sudden onset of sleeping - eat - gamble

Question 29

which anti-emetic is recommended for PD

Answer 29

domperidone (dopamine antagonist )

Question 30

which enzyme metabolites domperidone ? and what is its max duration

Answer 30

CYP3A4 | 1 week

Question 31

what serious s/e does domperidone have?

Answer 31

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

Question 32

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

Answer 32

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

Question 33

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

Answer 33

facial and skeletal muscle spasms and oculogyric crises injection of anti-parkisonism drugs- procyclidine

Question 34

s/e of opioids

Answer 34

respiratory depression - artificial ventilation hypogonadism, adrenal insufficiency hyperalgesia - reduce dose/ naloxone (risk of paralytic ileus )

Question 35

what is ergotamine indicated for ? and when to stop treatment

Answer 35

cluster headache | numbness and tingling of extremeties - stop and contact doct

Question 36

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

Answer 36

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

Question 37

carbamazepine - blood, skin and hepatic disorders

Answer 37

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

Question 38

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

Answer 38

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

Question 39

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

Answer 39

hyponatraemia and can induce diuretics like water toxification

Question 40

what are CBZ i/n that need to be considered

Answer 40

hyponatraemia, reduced seizure threshold, hepatotoxic

Question 41

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

Answer 41

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

Question 42

what group is susceptible to specific skin reactions for fosphenytoin?

Answer 42

Han chinese or thai origin HLA B 1502 allele | steven johnson syndrome

Question 43

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

Answer 43

SJS and toxic epidermal necrolysis

Question 44

is lamotrigine susceptible to blood disorder

Answer 44

yes

Question 45

what condition may lamotrigine exacerbate?

Answer 45

myclonic seizure and PD

Question 46

what should sodium valporate be cautions with

Answer 46

SLE ,systemic lupus erythematosus

Question 47

why should sodium valporate be given vitamin D

Answer 47

reduce risk of bone density

Question 48

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

Answer 48

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

Question 49

which enzyme is sodium valporate susceptible to ?

Answer 49

CYP 450

Question 50

what are the s/e of sodium valporate

Answer 50

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

Question 51

what are the brand specific antiepileptics

Answer 51

phenytoin, carbamazepine, phenobarbital, primidone