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ART_MRCPSYCH_B_MENTOR > 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
Q

What is the recommended approach for increasing the dose of buprenorphine in patients using illicit opioids?

A

There should be a low threshold for increasing the dose of buprenorphine.

26
Q

When both methadone and buprenorphine are equally suitable, which should be prescribed as the first choice?

A

Methadone should be prescribed as the first choice.

27
Q

Why is methadone preferred over buprenorphine in some cases?

A

Methadone is much cheaper and easier to titrate and supervise.

28
Q

How often is buprenorphine normally prescribed?

A

Buprenorphine is normally prescribed daily.

29
Q

What is a potential benefit of buprenorphine compared to methadone?

A

Buprenorphine may provide a ‘clear head’ response.

30
Q

What type of response is sometimes associated with methadone or heroin use?

A

A ‘clouding’ response.

31
Q

True or False: Buprenorphine is typically prescribed less frequently than methadone.

A

False

32
Q

1st line management in panic

A

SSRI

33
Q

mild panic attack Rx

A

Individual self help

34
Q

What if sertaline 50 mg daily failed to treat panic attacks?

A

Increase its dose

35
Q

Licenced Rx for panic aatack

A

Sertraline
Paroxetine
Citalopram

36
Q

What if two types of ssri did not work for panic attack?

A

2nd line : TCAs like imipramine

37
Q

What are anticholinergic drugs and dopamine agonists used for?

A

They are used in the treatment of Parkinson’s disease

38
Q

Which treatment for Parkinson’s disease has a higher risk of inducing psychosis?

A

Anticholinergic drugs and dopamine agonists

39
Q

What is often considered the first-line therapy for motor symptoms in Parkinson’s disease?

A

Levodopa

40
Q

Why is levodopa preferred over other treatments for Parkinson’s disease?

A

Due to its effectiveness and lower side effect profile

41
Q

True or False: All dopaminergic medications can potentially induce psychosis.

A

True

42
Q

Fill in the blank: Levodopa is often considered as _______ therapy for motor symptoms in Parkinson’s disease.

A

[first-line]

43
Q

What can dopaminergic medications do to pre-existing psychosis?

A

Worsen it

44
Q

Recommended drugs in Child OCD in UK

A

sertraline + Fluvoxamine

45
Q

Course of action:

pregnant lady with mild depression on sertraline and in remission for 5 months…🤔

A

suggest Stop sertraline and monitor to balance risk of sertraline and relapse

46
Q

Course of action:

pregnant lady with moderate to severe depression on sertraline 100 mg is now pregnant

A

Continue the sertraline

47
Q

Drug that if taken during pregnancy may lead to neural tube defect

A

Sodium Valproate

48
Q

Maudsley recommendation for antiDepressant use in depression during pregnancy with no hx

A

Sertraline

49
Q

Leads to hypospedias when used in pregnancy

A

Valproid acid

50
Q

Leads to cleft lipwhen used during pregnancy

A

Diazepam

51
Q

Off licence drug for insomnia in pregnancy when other non pharma approach did not work (NICE)

A

promethaine

52
Q

ssri which leads to neonatal withdrawal syndrome

A

paroxetine

53
Q

TCA TO be avoided in breast feeding

A

Doxepin

54
Q

Avoid this antipychotic in breastfeeding

A

Clozapine

55
Q

Alternative prophylactic antipsychotic to lithium when have to be stoped in bipar post partum lady or when breastfeeding starts

A

Olan and quetiapine (Maudsley 13th)

56
Q

Safest TCI in pregnancy

A

Amitriptyline

ART_MRCPSYCH_B_MENTOR (38 decks)

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