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MRCPSYCH Paper B _ Mainly general Adult (mentor&more) > Meds_Guidlines_6 > Flashcards

Meds_Guidlines_6 Flashcards

1
Q

What is the effectiveness of topiramate compared to naltrexone for alcohol use disorder treatment?

A

Topiramate appears as effective as naltrexone, with possibly greater reduction in alcohol craving.

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2
Q

What is the maximum daily dose of topiramate?

A

200mg daily.

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3
Q

How long does dose titration for topiramate take to minimize side effects?

A

Six weeks.

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4
Q

Did genetic variations in glutamate and mu-opioid receptor genes influence the effectiveness of topiramate or naltrexone?

A

No, neither topiramate nor naltrexone’s effectiveness was influenced by these genetic variations.

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5
Q

What three medications has the FDA approved for the treatment of AUD?

A

Disulfiram, acamprosate, naltrexone

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6
Q

True or False: All FDA-approved medications for AUD are widely effective and commonly used.

A

False

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7
Q

In what year was disulfiram first approved?

A

1951

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8
Q

What severe effects are associated with disulfiram when taken with alcohol?

A

Severe, potentially life-threatening effects

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9
Q

Which medications have better safety profiles compared to disulfiram?

A

Acamprosate and naltrexone

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10
Q

Fill in the blank: Acamprosate and naltrexone have _______ efficacy.

A

modest

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11
Q

Why is disulfiram currently used very little?

A

Because of severe, potentially life-threatening effects when taken with alcohol

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12
Q

What is the main reason for the limited use of disulfiram in treating AUD?

A

Severe side effects with alcohol

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13
Q

Which medication among the approved options has been used the longest?

A

Disulfiram

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14
Q

What do acamprosate and naltrexone have in common regarding their use?

A

Better safety profiles and tolerability

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15
Q

What is Cariprazine?

A

A drug with FDA approvals for both mania and bipolar depression.

It is not currently approved for maintenance treatment.

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16
Q

For which conditions does Cariprazine have FDA approvals?

A

Mania and bipolar depression.

It is notable for its dual approval status.

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17
Q

Is Cariprazine approved for maintenance treatment?

A

No, it is not approved for maintenance treatment at this time.

This is an important distinction in its usage.

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18
Q

What is the correct answer regarding the medication to be avoided in patients with very low blood pressure?

A

Lofexidine

Lofexidine is an alpha-2 adrenergic agonist that can cause hypotension.

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19
Q

What effect does Lofexidine have on norepinephrine?

A

It decreases the release of norepinephrine

This decrease can further lower blood pressure.

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20
Q

Why is Lofexidine unsuitable for patients experiencing hypotension?

A

It can exacerbate low blood pressure

This can lead to dizziness, fainting, or even shock.

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21
Q

Is Naltrexone associated with lowering blood pressure?

A

No

Naltrexone is primarily used to prevent relapse.

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22
Q

Fill in the blank: Lofexidine should be avoided in patients with very low _______.

A

blood pressure

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23
Q

True or False: Lofexidine is safe for patients with hypotension.

A

False

Lofexidine can worsen hypotension.

24
Q

What are the potential clinical effects of using Lofexidine in patients with low blood pressure?

A

Dizziness, fainting, or shock

These effects result from exacerbated hypotension.

25
What is the recommended approach for increasing the dose of buprenorphine in patients using illicit opioids?
There should be a low threshold for increasing the dose of buprenorphine.
26
When both methadone and buprenorphine are equally suitable, which should be prescribed as the first choice?
Methadone should be prescribed as the first choice.
27
Why is methadone preferred over buprenorphine in some cases?
Methadone is much cheaper and easier to titrate and supervise.
28
How often is buprenorphine normally prescribed?
Buprenorphine is normally prescribed daily.
29
What is a potential benefit of buprenorphine compared to methadone?
Buprenorphine may provide a 'clear head' response.
30
What type of response is sometimes associated with methadone or heroin use?
A 'clouding' response.
31
True or False: Buprenorphine is typically prescribed less frequently than methadone.
False
32
1st line management in panic
SSRI
33
mild panic attack Rx
Individual self help
34
What if sertaline 50 mg daily failed to treat panic attacks?
Increase its dose
35
Licenced Rx for panic aatack
Sertraline Paroxetine Citalopram
36
What if two types of ssri did not work for panic attack?
2nd line : TCAs like imipramine
37
What are anticholinergic drugs and dopamine agonists used for?
They are used in the treatment of Parkinson's disease
38
Which treatment for Parkinson's disease has a higher risk of inducing psychosis?
Anticholinergic drugs and dopamine agonists
39
What is often considered the first-line therapy for motor symptoms in Parkinson's disease?
Levodopa
40
Why is levodopa preferred over other treatments for Parkinson's disease?
Due to its effectiveness and lower side effect profile
41
True or False: All dopaminergic medications can potentially induce psychosis.
True
42
Fill in the blank: Levodopa is often considered as _______ therapy for motor symptoms in Parkinson's disease.
[first-line]
43
What can dopaminergic medications do to pre-existing psychosis?
Worsen it
44
Recommended drugs in Child OCD in UK
sertraline + Fluvoxamine
45
Course of action: pregnant lady with mild depression on sertraline and in remission for 5 months...🤔
suggest Stop sertraline and monitor to balance risk of sertraline and relapse
46
Course of action: pregnant lady with moderate to severe depression on sertraline 100 mg is now pregnant
Continue the sertraline
47
Drug that if taken during pregnancy may lead to neural tube defect
Sodium Valproate
48
Maudsley recommendation for antiDepressant use in depression during pregnancy with no hx
Sertraline
49
Leads to hypospedias when used in pregnancy
Valproid acid
50
Leads to cleft lipwhen used during pregnancy
Diazepam
51
Off licence drug for insomnia in pregnancy when other non pharma approach did not work (NICE)
promethaine
52
ssri which leads to neonatal withdrawal syndrome
paroxetine
53
TCA TO be avoided in breast feeding
Doxepin
54
Avoid this antipychotic in breastfeeding
Clozapine
55
Alternative prophylactic antipsychotic to lithium when have to be stoped in bipar post partum lady or when breastfeeding starts
Olan and quetiapine (Maudsley 13th)
56
Safest TCI in pregnancy
Amitriptyline

MRCPSYCH Paper B _ Mainly general Adult (mentor&more) (90 decks)

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