Meds-Guidlines - 9 Flashcards
what is Tamoxifen?
It is a SERM
Selective Oestrogen Receptor modulator
what is tamoxifen used for?
breast cancer
what cyp450 enzyme metabolizes tamoxifen?
CYP2D6
what antidepressants are known to inhibit CYP2D6?
—Strong inhibitors
Fluoxetine
Paroxetine
Bupropion
Dulexetin
—-Moderate inhibitors
Sertraline
Citalopram
doxepin
which antidepressant is known to be a weak inhibitor of CYP2D6, hence safer with tomoxifen
Venlafaxine
where Topiramte is used?
Epilepsy
Bipolar
Migraine
How does Topiramate work?
It inhibits voltage-gated sodium channels ===>suppresses action potential
It also increase GABA level
what is unusual about topiramate use?
it causes weight loss
psychiatric side effects of topiramate
mood disturbance & depression
medical side effects of topiramate?
kidney stones
are kidney stone dose-dependent side effects of topiramate
yes
how does topiramate causes kidney stones?
the increasing acidity of urine ==>formation of crystal
1st line treatment for depression in diabetes
SSRIs (fluoxetin)
Antidepressants to avoid in diabetes?
MAOIs and TCIs
how is response defined in trials of antidepressant?
50% reduction in symptoms
Number needed to treat for antidepressant vs placebo in moderate depression
5
Number needed to treat for antidepressant vs no Rx in moderate depression
3
The number needed to treat for antidepressant vs placebo in mild depression
10-25
which cyp450 enzyme fluovaxamine affects?
CPY1A2
which drugs is increase in blood when fluovaxamine is given simultaneiously?
Theophylline
Which cyp450 enzyme Fluoxetine affects?
CYP2D6 (Affecting clozapine)
which cyp enzypes metabolize clozapine?
cyp1A2 *
cyp2D6
cyp3A4 *
- main
what is minimum period that is required for maximum antidepressants to work?
2 weeks
Consensus on switching or increasing the dose of antidepressants if no response is achieved?
after 4 weeks
What is the period needed for statistical significance between the placebo and antidepressant effect?
2-4 weeks
when should you increase the dose and when to switch to another class?
when little improvement—-> increase dose
when no improvement —–> change class
after 4 weeks
Valproate main indications in psychiatry?
Mania
off license use of valproate in psychiatric
bipolar prophylaxis
bipolar derpession
side effects of valproates
Hepatic failure
Pancreatitis
Suicidal behaviours & ideations
Thrombocytopenia
Carbamazepine Main indications in psychiatry
Prophylaxis of bipolar disorder
side effects of carbamazepine
Marrow suppression
Increased risk of SIADH
Skin reactions TEN and SJS
Suicidality
Lamotrigine Mian Indications in psychiatry
Prophylaxis of bipolar disorder
Bipolar depression
Lamotrigine side effects
Skin reaction (TEN and SJS)
Suicidality
Blood dyscrasias
anti epileptic drugs (AEDs) that are not licenced for any psychiatric disorder?
Gabapentin
Oxcarbazepine
Topiramate
Levetriracetam
Vigabatrin
what are behavioural side effects of AEDs?
irritability
anger
hostility
AEDs with risk for aggression?
levetiracetam
Topiramate
Perampanel
AEDs with no specific risk for aggression?
LA CAOX
Carbamazepine
Oxcarbazepine
Lamotrigine?
what is the mnemonic for AEDs with no aggression risk?
LA CAOX
antipsychotics best for diabetes & schizophrenia
AZA
Aripiprazole
Ziprasidone
Amisulpride
Best antipsychotics for dylipidemia?
AZ
Aripiprazole
Ziprosidone
