Meds-Guidlines - 9

Question 1

what is Tamoxifen?

Answer 1

It is a SERM
Selective Oestrogen Receptor modulator

Question 2

what is tamoxifen used for?

Answer 2

breast cancer

Question 3

what cyp450 enzyme metabolizes tamoxifen?

Answer 3

CYP2D6

Question 4

what antidepressants are known to inhibit CYP2D6?

Answer 4

—Strong inhibitors
Fluoxetine
Paroxetine
Bupropion
Dulexetin
—-Moderate inhibitors
Sertraline
Citalopram
doxepin

Question 5

which antidepressant is known to be a weak inhibitor of CYP2D6, hence safer with tomoxifen

Answer 5

Venlafaxine

Question 6

where Topiramte is used?

Answer 6

Epilepsy
Bipolar
Migraine

Question 7

How does Topiramate work?

Answer 7

It inhibits voltage-gated sodium channels ===>suppresses action potential
It also increase GABA level

Question 8

what is unusual about topiramate use?

Answer 8

it causes weight loss

Question 9

psychiatric side effects of topiramate

Answer 9

mood disturbance & depression

Question 10

medical side effects of topiramate?

Answer 10

kidney stones

Question 11

are kidney stone dose-dependent side effects of topiramate

Answer 11

yes

Question 12

how does topiramate causes kidney stones?

Answer 12

the increasing acidity of urine ==>formation of crystal

Question 13

1st line treatment for depression in diabetes

Answer 13

SSRIs (fluoxetin)

Question 14

Antidepressants to avoid in diabetes?

Answer 14

MAOIs and TCIs

Question 15

how is response defined in trials of antidepressant?

Answer 15

50% reduction in symptoms

Question 16

Number needed to treat for antidepressant vs placebo in moderate depression

Answer 16

5

Question 17

Number needed to treat for antidepressant vs no Rx in moderate depression

Answer 17

3

Question 18

The number needed to treat for antidepressant vs placebo in mild depression

Answer 18

10-25

Question 19

which cyp450 enzyme fluovaxamine affects?

Answer 19

CPY1A2

Question 20

which drugs is increase in blood when fluovaxamine is given simultaneiously?

Answer 20

Theophylline

Question 21

Which cyp450 enzyme Fluoxetine affects?

Answer 21

CYP2D6 (Affecting clozapine)

Question 22

which cyp enzypes metabolize clozapine?

Answer 22

cyp1A2 *
cyp2D6
cyp3A4 *

• main

Question 23

what is minimum period that is required for maximum antidepressants to work?

Answer 23

2 weeks

Question 24

Consensus on switching or increasing the dose of antidepressants if no response is achieved?

Answer 24

after 4 weeks

Question 25

What is the period needed for statistical significance between the placebo and antidepressant effect?

Answer 25

2-4 weeks

Question 26

when should you increase the dose and when to switch to another class?

Answer 26

when little improvement----> increase dose when no improvement -----> change class after 4 weeks

Question 27

Valproate main indications in psychiatry?

Answer 27

Mania

Question 28

off license use of valproate in psychiatric

Answer 28

bipolar prophylaxis bipolar derpession

Question 29

side effects of valproates

Answer 29

Hepatic failure Pancreatitis Suicidal behaviours & ideations Thrombocytopenia

Question 30

Carbamazepine Main indications in psychiatry

Answer 30

Prophylaxis of bipolar disorder

Question 31

side effects of carbamazepine

Answer 31

Marrow suppression Increased risk of SIADH Skin reactions TEN and SJS Suicidality

Question 32

Lamotrigine Mian Indications in psychiatry

Answer 32

Prophylaxis of bipolar disorder Bipolar depression

Question 33

Lamotrigine side effects

Answer 33

Skin reaction (TEN and SJS) Suicidality Blood dyscrasias

Question 34

anti epileptic drugs (AEDs) that are not licenced for any psychiatric disorder?

Answer 34

Gabapentin Oxcarbazepine Topiramate Levetriracetam Vigabatrin

Question 35

what are behavioural side effects of AEDs?

Answer 35

irritability anger hostility

Question 36

AEDs with risk for aggression?

Answer 36

levetiracetam Topiramate Perampanel

Question 37

AEDs with no specific risk for aggression?

Answer 37

LA CAOX Carbamazepine Oxcarbazepine Lamotrigine?

Question 38

what is the mnemonic for AEDs with no aggression risk?

Answer 38

LA CAOX

Question 39

antipsychotics best for diabetes & schizophrenia

Answer 39

AZA Aripiprazole Ziprasidone Amisulpride

Question 40

Best antipsychotics for dylipidemia?

Answer 40

AZ Aripiprazole Ziprosidone

Question 41

is noradrenergic and specific serotonergic antidepressant (NaSSA) that is particularly suitable for older adults presenting with low mood, poor appetite, insomnia, and post-operative frailty

Answer 41

Mirtazapine

Question 42

Paradoxical injunction is

Answer 42

a method used to prevent particular unwanted behaviours. It involves inviting the person concerned to perform the behaviour concerned. For example someone who frequently self harms would be urged to do so. It can be a very effective approach but it has its risks and should be used only in the appropriate, carefully chosen circumstances.

Question 43

Develop discrepancy (PRINCIPLE OF MOTIVATIONAL THERAPY)

Answer 43

helping patients recognise the gap between their current behaviours and their broader life goals or values, which can increase their motivation to change. By highlighting this discrepancy, clinicians encourage patients to consider how their actions align or misalign with their aspirations, thereby fostering internal motivation. For example, a patient who smokes but wants to improve their overall health might be encouraged to explore how their smoking habit conflicts with their health goals.

Question 44

Diagnoses of bulimia and binge eating disorder -----.

Answer 44

cannot co-exist

Question 45

which one has a lower risk of over dose buprenorphine or methadone?

Answer 45

buprenorphine

Question 46

which one require more monitoring buprenorphine or methadone?

Answer 46

buprenorphine (withdrawal)