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ART_MRCPSYCH_B_MENTOR > Meds_guidlines_4 > Flashcards

Meds_guidlines_4 Flashcards

1
Q

In a schizo patient who’s suspected to to be compliant with oral antipsychotics…what is next

A

I.M antipsychotic

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2
Q

Investigation in suspect clozapin induced myocardial infarction

A

Troponin

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3
Q

name one One medication that used in patients on clozapine to reduce siezure chances?

A

Valproate

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4
Q

Normal serum level for quetiapine

A

50-500 μg/L

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5
Q

Normal serum level for clozapine

A

350-600 μg/L

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6
Q

Normal serum level for Lithium

A

0.6-1.1 mg /L

> .9 mg/L is safe

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7
Q

Normal serum level for valproate

A

50-100 mg/L

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8
Q

Which one is more strongly assoiated with suicidality decline?

1_Arip
2_QUE
3_Olan
4_Risp
5_Clozapime

A

Clozapine

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9
Q

Percetage of treatment resistent patients (30%) that is thought to respond to clozapine

A

60%

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10
Q

Which patient require lower clozapine dose?

A

Females
patients on flouxetine

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11
Q

A treatment that in combination with another antipsychotic is suggested when clozapine failed to work?

A

Allopuridone (modulate glutamatergics)

example: olan and allopuridon

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12
Q

What medication is thought to increase white cells in neutropenia?

A

Lithium

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13
Q

If serum clozapine is as high as 1.1 mg/L, and patient is still stable… what would you be concerned about and what would you do?

A

siezure
1-Stop clozapine for 1 day —-immideate reduces the siezure risk
2- Restart at half of previous dose —still effective at this dose most likely
3- Add sodium valproate to prevent siezure

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14
Q

What would you do if amber appeared on clozapine patient monitoring system (CPMS)?

A

Continue same dose and re send for test in 2 days, the continue 2wice weekly until returns to normal range

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15
Q

Fatality due to clozapine induced agranulocytosis?

A

1 in 10k

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16
Q

Estimated rate of agranulocutosis in clozapine therapy

A

1%

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17
Q

drug that if given to a patient with clozapine induced neutropenia may benefit by increase the white cells

A

Mr. Lithium

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18
Q

Is hypersalivation caused by clozapine life threatening?

A

Yes

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19
Q

Not allowed to be given inpatients on clozapine

A

Carbamazepine

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20
Q

Drug used to treat hypersalivation

A

hyocine hydrobromide

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21
Q

Receptors involved with clozapine induced hypersalivation

A

Muscarinic and adrenergic

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22
Q

Best evidence based suggestion for a prophylactic agent to prevent postoperative delirium

A

Haloperidol

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23
Q

Pharamacologialtreatment for delirium

A

Haloperidol (1st line in reducing aggitation and aggression) [NICE]

24
Q

most likely to cause delirium in elderly?

A

pethidine

25
Q

which TCAs carry least risk for delirium in ssri resistent depressed elderly with cognitive impairment due to their anticholinergic effects?

A

Nortriptyline
Desipramine

26
Q

An antihistamine available over the counter that can cause delirium in elderly

A

Diphenhydramine

27
Q

Drug licenced to be used in behavioural problem associated with dementia (Alzheimer’s)

A

Risperidone

28
Q

Rx of choice for a 65 y o with moderate cognitive impairment with cerebral and white matter atrophy on CT!

A

donepezil (AchE-I)

29
Q

Drugs most effective to treate lewy body psychosis (hallucinations)

A

Clozapine
Quetiapine (alternative)

30
Q

Least suitable treatment for behavioural problems in dementia

A

Lorazepam

31
Q

Max dose licensed for risperidone in dementia related behavioural problems

A

1 mg BD (BNF)

32
Q

2nd line of treatment for dementia with lewy body

A

memantine

33
Q

1st line treatment for dementia with lewy body

A

AChE-I

34
Q

What is next for an alzheimer patient whose donepezil was increased and developed urinary incontinence?

A

Reduce the dose and continue

35
Q

When Memantine is indicated for alzheimer’s

A

Severe cases amd moderates who don’t tolerate ache-I.

36
Q

A medication recommended by NICE for SSRI ressistant PTSD

A

venlafaxine

37
Q

activated charcoal is unlike to be helpful with overdose of

A

Lithium
Iron
Alcohol

38
Q

What is a evidence based augmentation suggestion for depression in a patient who has not responded properly to a SSRI trials

A

Add Lithium but monitor for toxicity esp. in elderly

39
Q

NICE recommend what for 1st line of treatment in severe depression

A

SSRI Alone

40
Q

How long antidepressants should be continued at least after remission?

A

6 monthsp

41
Q

Which SSRI is associated with higher risk of withdrawal syndrome

A

Paroxetine

42
Q

Maudsley supports what combinations in treatment resistant depression?

A

Venlafaxine and Mirtazapine

43
Q

When should you reveiw a non suicidal patient (above 25) who you put on antidepressants, according to NICE?

A

in 2 weeks

44
Q

When should you reveiw a patient (below 25) who you put on antidepressants, according to NICE?

A

1 week

45
Q

Least like TCI to be assoiated with overdose?

A

Lofepramine

46
Q

1st line antidepressant in patient with co-morbid physical health issues, accordint to NICE

A

CITALOPRAM (CYP3A4 AND CYP2C19)

47
Q

best antidepressant for patients on NSAIDS

A

Mirtazapine—-less increase in serotonin level in blood—»> less chance of GI bleeding associated with combination of SSRI AND NSAIDS

48
Q

How fluvoxamine can increase clozapine

A

By inhibiting CYP1A2 which is crucial in metabolism of clozapine

49
Q

How can fuvoxamine induced increase in clozapine level can manifest in patients?

A

Sedation
confusion
flu like symptom (fever + sore throat)
excessive salivation
tachycardia

50
Q

Antidepressant that is safe to be used with warfarin

A

Reboxetine

51
Q

In refractory depression what medication is recommended by NICE?

A

Vortioxetine

52
Q

Whatbis so special about vortioxetine?

A

It is called serotonin modulator and stimulator due to its effect not only as reuptake inhibitor but also modulating 5-HT receptors (agonist at 5-HT1A, Antagonist at 5-HT3,5-HT7, 5-HT1D).

as a result it has anxiolytic and cognitive improving effects.

53
Q

What associations were found in Clozapine users regarding cytochrome P450 activity?

A

Reduced cytochrome P450, 2C19, and 1A2 activity is associated with a higher risk of pneumonia

This suggests a potential link between metabolic activity and pneumonia risk in patients taking Clozapine.

54
Q

Why is it important to monitor Clozapine levels in patients with fever or pulmonary symptoms?

A

Inflammatory cytokines block 1A2 and increase clozapine levels

Elevated clozapine levels can lead to adverse effects and complications.

55
Q

What intervention may be critical for acutely ill patients admitted to a medical hospital taking Clozapine?

A

Reducing the clozapine level

This helps avoid very high clozapine levels and reduces pneumonia lethality.

56
Q

True or False: Increased activity of cytochrome P450, 2C19, and 1A2 is linked to a lower risk of pneumonia in Clozapine users.

A

False

Reduced activity is associated with a higher risk of pneumonia.

57
Q

Fill in the blank: Inflammatory cytokines block _______ and increase clozapine levels.

A

1A2

This mechanism contributes to the management of clozapine in patients with pulmonary symptoms.

ART_MRCPSYCH_B_MENTOR (38 decks)

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