Meds_Guidlines_6 Flashcards
What is the effectiveness of topiramate compared to naltrexone for alcohol use disorder treatment?
Topiramate appears as effective as naltrexone, with possibly greater reduction in alcohol craving.
What is the maximum daily dose of topiramate?
200mg daily.
How long does dose titration for topiramate take to minimize side effects?
Six weeks.
Did genetic variations in glutamate and mu-opioid receptor genes influence the effectiveness of topiramate or naltrexone?
No, neither topiramate nor naltrexone’s effectiveness was influenced by these genetic variations.
What three medications has the FDA approved for the treatment of AUD?
Disulfiram, acamprosate, naltrexone
True or False: All FDA-approved medications for AUD are widely effective and commonly used.
False
In what year was disulfiram first approved?
1951
What severe effects are associated with disulfiram when taken with alcohol?
Severe, potentially life-threatening effects
Which medications have better safety profiles compared to disulfiram?
Acamprosate and naltrexone
Fill in the blank: Acamprosate and naltrexone have _______ efficacy.
modest
Why is disulfiram currently used very little?
Because of severe, potentially life-threatening effects when taken with alcohol
What is the main reason for the limited use of disulfiram in treating AUD?
Severe side effects with alcohol
Which medication among the approved options has been used the longest?
Disulfiram
What do acamprosate and naltrexone have in common regarding their use?
Better safety profiles and tolerability
What is Cariprazine?
A drug with FDA approvals for both mania and bipolar depression.
It is not currently approved for maintenance treatment.
For which conditions does Cariprazine have FDA approvals?
Mania and bipolar depression.
It is notable for its dual approval status.
Is Cariprazine approved for maintenance treatment?
No, it is not approved for maintenance treatment at this time.
This is an important distinction in its usage.
What is the correct answer regarding the medication to be avoided in patients with very low blood pressure?
Lofexidine
Lofexidine is an alpha-2 adrenergic agonist that can cause hypotension.
What effect does Lofexidine have on norepinephrine?
It decreases the release of norepinephrine
This decrease can further lower blood pressure.
Why is Lofexidine unsuitable for patients experiencing hypotension?
It can exacerbate low blood pressure
This can lead to dizziness, fainting, or even shock.
Is Naltrexone associated with lowering blood pressure?
No
Naltrexone is primarily used to prevent relapse.
Fill in the blank: Lofexidine should be avoided in patients with very low _______.
blood pressure
True or False: Lofexidine is safe for patients with hypotension.
False
Lofexidine can worsen hypotension.
What are the potential clinical effects of using Lofexidine in patients with low blood pressure?
Dizziness, fainting, or shock
These effects result from exacerbated hypotension.
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.
When both methadone and buprenorphine are equally suitable, which should be prescribed as the first choice?
Methadone should be prescribed as the first choice.
Why is methadone preferred over buprenorphine in some cases?
Methadone is much cheaper and easier to titrate and supervise.
How often is buprenorphine normally prescribed?
Buprenorphine is normally prescribed daily.
What is a potential benefit of buprenorphine compared to methadone?
Buprenorphine may provide a ‘clear head’ response.
What type of response is sometimes associated with methadone or heroin use?
A ‘clouding’ response.
True or False: Buprenorphine is typically prescribed less frequently than methadone.
False
1st line management in panic
SSRI
mild panic attack Rx
Individual self help
What if sertaline 50 mg daily failed to treat panic attacks?
Increase its dose
Licenced Rx for panic aatack
Sertraline
Paroxetine
Citalopram
What if two types of ssri did not work for panic attack?
2nd line : TCAs like imipramine
What are anticholinergic drugs and dopamine agonists used for?
They are used in the treatment of Parkinson’s disease
Which treatment for Parkinson’s disease has a higher risk of inducing psychosis?
Anticholinergic drugs and dopamine agonists
What is often considered the first-line therapy for motor symptoms in Parkinson’s disease?
Levodopa
Why is levodopa preferred over other treatments for Parkinson’s disease?
Due to its effectiveness and lower side effect profile
True or False: All dopaminergic medications can potentially induce psychosis.
True
Fill in the blank: Levodopa is often considered as _______ therapy for motor symptoms in Parkinson’s disease.
[first-line]
What can dopaminergic medications do to pre-existing psychosis?
Worsen it
Recommended drugs in Child OCD in UK
sertraline + Fluvoxamine
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
Course of action:
pregnant lady with moderate to severe depression on sertraline 100 mg is now pregnant
Continue the sertraline
Drug that if taken during pregnancy may lead to neural tube defect
Sodium Valproate
Maudsley recommendation for antiDepressant use in depression during pregnancy with no hx
Sertraline
Leads to hypospedias when used in pregnancy
Valproid acid
Leads to cleft lipwhen used during pregnancy
Diazepam
Off licence drug for insomnia in pregnancy when other non pharma approach did not work (NICE)
promethaine
ssri which leads to neonatal withdrawal syndrome
paroxetine
TCA TO be avoided in breast feeding
Doxepin
Avoid this antipychotic in breastfeeding
Clozapine
Alternative prophylactic antipsychotic to lithium when have to be stoped in bipar post partum lady or when breastfeeding starts
Olan and quetiapine (Maudsley 13th)
Safest TCI in pregnancy
Amitriptyline
