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MRCPSYCH_Paper B_MENTOR & More_Dr. ART > Meds-Guidlines - 8 > Flashcards

Meds-Guidlines - 8 Flashcards

1
Q

Agent that lowers level of ALT (Liver function)

A

Vigabatrin

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2
Q

Agents that lowers level of ALP

A

Buprenorphine

Zolpidem (rarely)

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3
Q

Agents that lower level of AST?

A

Trifluperazine

Vigabatrin

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4
Q

agent that lowers THS?

A

Moclobemide

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5
Q

Agent that lowers thyroxine

A

Lithium

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6
Q

antipsychotics that increase level of liver enzyme?

A

Haloperidol
Olan
Quetiapine
SSRIs
Clozapine

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7
Q

Agents that increase TSH?

A

Lithium
Aripiprazole
Carbamazepine
Que
Sertraline

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8
Q

what are patients on antiepliptic at high risk for?

A

Depression
Anxeity
Psychosis
Suicide

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9
Q

link between antiepileptics and psychiatric disease is ……..!

A

bidirectional

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10
Q

Antidepressant with low risk for epilepsy?

A

SSRIs
Mirtazapine
Duloxetine

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11
Q

Antidepressant with high risk of epilepsy?

A

Bupropion
Maprotiline
TCAs

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12
Q

antidepressant with moderate risk for epilepsy?

A

lithium
Trazadone
Venlafaxine

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13
Q

antipsychotic with low risk for seizure?

A

amisul/sulpride
aripiprazole
ziprasidone
High potency FGA (haloperidol)

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14
Q

antipsychotic with high risk for seizure?

A

clozapine
depots
low potency (chlorpromazine)
zotepine
loxapine

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15
Q

antipsychotic with moderate risk for seizure

A

quetiapine
olanzapine

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16
Q

stimulants with high rsk for seizure?

A

amfetamines

atomoxetine

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17
Q

stimulants with low risk for seizure?

A

methylpphenidate

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18
Q
A
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19
Q

How QTc is measured

A

The start of Q wave to T wave corrected for hear rate

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20
Q

How QTc is calculated?

A

By Bazett’s formula

QT interval divided by the square root of the RR INTERVAL

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21
Q

what QTc is very risky?

A

> 550

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22
Q

What can QTc >550 lead to

A

Torsades de pointes

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23
Q

Rate of sudden death in Torsade de pointes?

A

1 out of 10

24
Q

Normal QTc in man

A

<440

25
Q

Normal QTc in Woman

A

> 470

26
Q

Cardiac risk for QTc prolongation

A

Long QT syndrome
Bradychardia
Ischemic Heart Disease
Myocarditis
MI
LVH

27
Q

Metabolic risk of QTc Prolong.

A

Hypo ka, ca, mg

28
Q

Other risk for QTc prolongation

A

Extreme exertion
Stress
Anorexia
Extreme of age
Female

29
Q

Main drug class that cause QT c prolongation

A

Antipsychotic

30
Q

A patient put on antipsychotics , QTc <440

A

No action unless T wave morphology changes

31
Q

QTc in Male (>440) and female (>470) on anti psychotics

A

Consider switch & reduce dose
Repeat ECG
Call cardiologist

32
Q

QTc >500

A

Stop the causitive agent
switch to less problematic agent
call cardiologist

33
Q

Anti psychotic with high risk of QT c prolongation

A

Pimozide

34
Q

Anti psychotic with no effect on QT c prolongation

A

Lurasidone

35
Q

Anti psychotic with moderate risk of QT c prolongation

A

Haloperidol
Quetiapine
Chlorpromazine
Ziprasidone
Amisulpride

36
Q

Which SSRI can prolong. QTc

A

Citalopram and escitalopram

37
Q

Which antidepressants may prolong QTc

A

Tricyclics
Trazadone

38
Q

Antibiotics that can cause QTc prolongation

A

Erythromycin
ampicilin

39
Q

Antimalarias that can cause QTc Prolongation

A

Quinine
Chloroquinine

40
Q

Other misc. drugs that cause QTc prolongation

A

Tamoxifen
Methadone
Amantadine

41
Q

Antiarrythmatics that cause qtc prolongation

A

Amiodarone
sotalol

42
Q

Rate of akathisia antipsychotic use

A

haloperidol 57%,
risperidone 20%,
aripiprazole 18%,
ziprasidone 17%,
olanzapine 4% and
quetiapine 3.5%.

(mausley)

43
Q

Rx suggested to be better for patients who develop/at risk of developing akathisia

A

Lumateperone and pimavanserin

44
Q

what is lumaterperone signficance?

A

less risk for akathisia

45
Q

what is pimavanserin signficance?

A

might ameliorate haloperidol-induced akathisia

46
Q

Lumateperone indications

A

Schizophrenia
&
Biplar

both FDA approved

47
Q

mechanism of action of lumateperone

A

potent antagonist at serotonin 5-HT2A receptors
partial agonist at dopamine presynaptic D2 receptors
antagonist at dopamine postsynaptic D2 receptors

48
Q

antagonist at serotonin 5-HT2A receptors

A

improve sleep, treat depression, and have antipsychotic properties

49
Q

How lumateperone compares to other antipsychotics

A

Lumateperone’s occupancy of dopamine D2 receptors at its effective doses
Lower risk of movement disorders and hyperprolactinemia

50
Q

what is so especial about pimavanserin?

A

first antipsychotic drug that shows selectivity for serotonin 5-HT2 receptors (5-HT2Rs)
&
lacks affinity for dopamine D2 receptors (D2Rs)

51
Q

Pimavanserin Comparison to other antipsychotics: Quetiapine

A

more effective
better tolerance

52
Q

which antipsychotic should be avoided in cognitive impairmed (like Parkison’s dementia)

A

Quetiapine

53
Q

Pimavanserin Comparison to other antipsychotics: Onalzapine

A

More effective
Better choice

54
Q

Pimavanserin Comparison to other antipsychotics: Clozapine

A

similar efficacy in psychosis
less somnolence

55
Q
A

MRCPSYCH_Paper B_MENTOR & More_Dr. ART (62 decks)

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