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Pharmacy Pre-reg exam 2020-2021 > Mental Health > Flashcards

Mental Health Flashcards

1
Q

Apart from low WBC and neutrophils, what else can give RED result in Clozapine blood monitoring?

A

Low platelets

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2
Q

When is Clozapine lvl taken post dose?

A

12 hours post dose (trough lvls)

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3
Q

What class of drug is procyclidine and what is it used for?

A

Antimuscarinic; EPSs

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4
Q

Which receptors do benzodiazepines act on?

A

GABAa receptors agonists (allosteric modulation)

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5
Q

Diazepam - Lorazepam - Clonazepam dose conversions

A

5mg Diazepam - 0.5mg Lorazepam - 0.25mg Clonazepam

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6
Q

Clozapine monitoring intervals

A

Weekly for 18 weeks; Every 2 weeks from week 19 to week 52; Monthly afterwards

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7
Q

What is necrotic skin reaction called?

A

Stevens-Johnson syndrome

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8
Q

What should never be done with Lamotrigine regimen?

A

Speed up titration

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9
Q

Why does aripiprazole have the least side-effects?

A

It`s a partial D2 agonist

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10
Q

What checks need to be done before starting Lithium?

A

BMI, ECG, thyroid, parathyroid, kidneys

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11
Q

Target Lithium lvls

A

0.4 - 1

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12
Q

When to take Lithium lvls?

A

12 hours post dose, 1 week after initiation

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13
Q

Can Lithium be sedating?

A

Yes

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14
Q

Lithium side-effects

A

Stomach upsets (at the start of the treatment), shaky hands, metallic taste, weight gain, swelling of ankles

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15
Q

Signs of Lithium toxicity

A

Severe tremor, confusion, dizziness, blurred vision, stomach aches with nausea or diarrhoea, slurred speech, muscle weakness, muscle twitches

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16
Q

Which 2 antipsychotics have the safest profile in terms of QT prolongation and cardiac risks?

A

Aripiprazole and Flupenthixol

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17
Q

Name antipsychotics with mood-stabilizing properties? (5)

A

Risperidone, paliperidone, olanzapine, quetiapine, aripiprazole

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18
Q

Which antipsychotic is used to treat psychotic depression?

A

Quetiapine

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19
Q

Why does quetiapine, olanzapine and clozapine cause postural hypotension?

A

They act on a-adrenoceptors

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20
Q

Why does Clozapine cause constipation?

A

Acts on M1 receptors

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21
Q

What is special about Quetiapine`s action on receptors?

A

Dissociates fast from the receptor complex, so no EPS even though has affinity for D2 receptors

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22
Q

Name antipsychotics for acute psychosis (3)

A

Risperidone, Olanzapine, Haloperidol

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23
Q

What class is Mirtazapine

A

Tetracyclic antidepressant

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24
Q

Symptoms of hyperprolactinaemia

A

Gynecomastia, Galactorrhoea, Erectile dysfuntion, irregular periods

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25
Q

Medication to treat hyperprolactinaemia (2)

A

Bromocriptine and cabergoline

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26
Q

Alzheimers Dementia treatments

A

Mild-moderate: galanthamine, rivastigmine, donepezil

Severe: Memantine

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27
Q

Lewy body dementia treatment

A

Mild-moderate: rivastigmine or donepezil

Memantine only if the others failed

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28
Q

Side-effects of Galanthamine

A

GI - take with food

Rash - discontinue as potentially SJS

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29
Q

What is the know paradoxical effect of benzodiazepines

A

Hostility and aggression

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30
Q

When is buspirone used

A

Short-term management of anxiety

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31
Q

How are benzodiazepines metabolized?

A

By liver

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32
Q

Which benzodiazepines are preferred in liver impairment?

A

Short-acting

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33
Q

ADHD 1st line management

A

Lisdexamphetamine or Methylphenidate - try either one for 6 weeks, switch to the other if ineffective

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34
Q

What is atomoxetine used for

A

last line in ADHD

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35
Q

What side-effects do ADHD medication have in common

A

Mental health side-effects

36
Q

Contraindications of Methyphenidate

A

CVD, HF, psychosis

37
Q

In which disease is Lithium contraindicated

A

Addison’s

38
Q

What adjustments does Lithium require in pregnancy and why

A

Dose to be increased in 2nd and 3rd trimester due to increased volume of distribution

39
Q

Which antidepressant is the safest in MI and unstable angina

A

Sertraline

40
Q

What electrolyte does all antidepressants derange

A

Sodium - hyponatraemia

41
Q

Serotonin syndrome symptoms

A

Muscle rigidity, tremor, myoclonus
Hyperthermia, BP changes, tachycardia
Confusion, agitation, mania

42
Q

Examples of sedative tricyclics (4)

A

Amitriptyline, Clomipramine, Dosulepin, Trazodone

43
Q

Examples of less sedative tricyclics (2)

A

Nortriptyline, Imipramine

44
Q

Examples of MAOis

A

Phenelzne, Moclobemide, Isocarboxazid

45
Q

What is a serious side-effect of Atomoxetine

A

Liver toxicity

46
Q

Symptoms of SSRI withdrawal

A

Electric shock feeling, GI disturbances, headache, flu-like symptoms

47
Q

Which antidepressant is associated with most withdrawal

A

Venlafaxine

48
Q

When is Venlafaxine contraindicated

A

Arrhythmias, uncontrolled HTN

49
Q

Cautions for Mirtazapine

A

CVD, diabetes, epilepsy

Can also cause blood disorders

50
Q

How to distinguish NMS from Serotonin Syndrome?

A

In NMS - CK will be elevated

51
Q

Which class of anti-psychotics is more effective for negative symptoms?

A

SGAs

52
Q

What can Chlorpromazine cause

A

SLE - protect skin from light

53
Q

Which anti-psychotic is licensed for PD?

A

Clozapine

54
Q

What side effect does Clozapine have on heart?

A

Can cause myocerditis/cardiomyopathy - discontinue

55
Q

What special parameter to monitor for Quetiapine and why

A

Weight gain - increases appetite

56
Q

Parkinsons Disease management

A

If patient`s quality of life is affected: Co-caredopa/Co-beneldopa

If quality of life isn`t affected:
Levodopa 1st line
Or D-receptor agonists (non-ergot derived)
MAOI-Bs

57
Q

Dopamine receptor agonists examples (3)

A

Rotigotine, ropinirole, pramipexole

58
Q

MAOI-B examples (2)

A

Rasagiline, Selegiline

59
Q

Which major side-effects are all PD meds associated with (3)?

A

Impulse control disorders, Psychiatric symptoms, Sudden onset of sleep

60
Q

Which drug is associated with most end of dose deterioration?

A

Levodopa

61
Q

What can happen if PD drugs stopped abruptly?

A

NMS

Akinesia

62
Q

Ergot-derived D-receptor agonists examples (3)

A

Bromocriptine, cabergoline, pergolide

63
Q

Antiemetic of choice in Parkinsons?

A

Domperidone

64
Q

When is Metoclopramide contraindicated?

A

GI disorders, PD

65
Q

Where does Domperidone act?

A

Chemoreceptor trigger factor

66
Q

When is Domperidone contraindicated?

A

Cardiac disease

67
Q

Anti-emetic of choice in pregnancy & 2nd line options

A

Promethazine - 1st line

Metoclopramide & Prochlorperazine - 2nd line

68
Q

Options for motion sickness

A

Hyoscine - 1st line

Promethazine, Cyclizine, Cinnarizine

69
Q

What SE is Ondansetron associated with?

A

QT prolongation

70
Q

Buprenorphine action on opioid receptors

A

Both agonist and antagonist

71
Q

What happens if you give buprenorphine to somebody who is already on opioids

A

It can trigger withdrawal

72
Q

What happens with opioids in renal impairment

A

Accumulation - avoid or adjust the dose

73
Q

Side-effect of SC opioid injection

A

Severe itching

74
Q

What can IV fentanyl cause

A

Muscle rigidity

75
Q

Which antiemetics to give in nausea in migraine?

A

Domperidone, metoclopramide

76
Q

When are triptans contraindicated?

A

Unstable HTN, previous cardiac event

77
Q

Medications of choice in neuropathic pain (3)

A

Amitriptyline, Pregabalin, Gabapentin

78
Q

Drug of choice in post-herpetic neuralgia

A

Topical Capsaicin

79
Q

Drug of choice in trigeminal neuralgia

A

Carbamazepine

80
Q

Symptoms of benzos withdrawal

A

Toxic psychosis, convulsions, delirium tremens

81
Q

In which benzos withdrawal is more common

A

Short-acting benzos

82
Q

Examples of long-acting benzos (2)

and short-acting benzos (2)

A

Diazepam, Chlordiazepoxide

Lorazepam, Oxazepam

83
Q

What can Methadone exacerbate?

A

Asthma

84
Q

When is Disulfuram contraindicated

A

CVD

85
Q

When to immediately discontinue Disulfiram

A

If liver toxicity develops

Pharmacy Pre-reg exam 2020-2021 (20 decks)

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