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Year 3 Drug > MH > Flashcards

MH Flashcards

1
Q

examples for tricyclic antidepressant?

A

amitriptyline, lofepramine

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2
Q

indication for tricyclic antidepressant

A

second line treatment for moderate-severe depression where 1st line SSRI are ineffective

treatment option for neuropathic pain (not license though)

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3
Q

MOA for tricyclic antidepressant

A

inhibit the reuptake of serotonin (5-HT) and noradrenaline from the synaptic cleft - inc availability of neurotransmission and hence mood and physical symptoms

black muscarinic, histamine (H1), alpha-adrenergic (Alpha 1&2), dopamine receptors limiting the clinical use of this drug and many adverse effect

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4
Q

contra-indication ofr tricyclic antidepressants

A

elderly pts, cardiovascular disease, eliepsy, constipation, prostatic hypertrophy, raised IOP

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5
Q

side-effect of tricyclic anti-depressants

A

antimuscarinic - dry mouth, constipation, urinary retention and blurred vision

H1 & Alpha 1 receptors - sedation and hypotension, cardiac arrhythmia, ECG changes (incl. prolongation of QT and QRS durations)

brain - convulsions, hallucinations, and mania (period of excitement)

dopamine - breast changes, sexual dysfunction and extrapyramidal symptoms (eg tremor and dyskinesia, rare)

if in overdose - dangerous, severe hypotension, arrhythmia, convulsion, coma and resp failure - fatal

sudden withdrawal - GI upset, neurological and influenza-like symptoms and sleep disturbance

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6
Q

interaction of tricyclic antidepressants

A

should not be given with monoamine oxidase inhibitors as both inc serotonin and noradrenaline levels at the synapse - can cause hypertension and hyperthermia or serotonin syndrome

antimuscarinic, sedative or hypotensive drugs

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7
Q

where is tricyclic antidepressant eliminated

A

liver

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8
Q

pt info for tricyclic antidepressants

A

more side effects than SSRIs, continue treatment for >6 moth (can only be taken off slowly as withdrawal effect of sudden withdrawal)

constant review over 1-2 weeks

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9
Q

what does SSRI stand for

A

Selective Serotonin Reuptake Inhibitors

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10
Q

What are some examples for SSRI

A

Citalopram, Fluoxetine, sertraline, escitalopram

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11
Q

indication for SSRI

A

-1st line for moderate-severe depression and in mild depression if pyschological treatment fails

painc disorder

Obsessive compulsive disorder

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12
Q

MOA for SSRI

A

inhibit neuronal reuptake of serotonin (5-HT) from synaptic cleft

SSRi do not inhibit noradrenaline uptake and so less blockade than tricyclic

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13
Q

contra-indication for SSRI

A

eliepsy, peptic ulcer depression, young ppl (might lead to inc risk of self-harm), hepatic impairment pts

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14
Q

where is SSRI metabolised

A

liver

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15
Q

side effect of SSRI

A

GI upset, appetite and weight disturbance
hyponatraemia (low Na2+ level) - might cause confusion and reduced consciousness
suicidal thoughts and behaviour might inc in pts on SSRI
lower seizures threshold
prolong QT interval and arrhythmia (citalopram)
inc risk of bleeding
serotonin syndrome (in high dose) - triad of hypersensitivity, altered mental state and neuromuscular excitation

sudden withdrawal - GI upset, neurological and influenza-like symptoms and sleep disturbance

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16
Q

interaction of SSRi

A

monoamine oxidase inhibitors - inc synaptic serotonin level
aspirin or NSAIDs or anti-coagulants - inc risk of bleeding
drugs which prolong QT interval

17
Q

pt info for SSRI

A

continue treatment for >6moths and review 1-2 weeks

18
Q

what is the classname for diazepam

A

Benzodiazepines

19
Q

what are some examples of benzodiazepine

A

diazepam, temazepam, -pam

20
Q

indication for benzodiazepine

A

1st line for seizure and statuys epilepticus, alcohol withdrawal reactions

common choice for sedation for interventional procedures if general analgesia is unnecessary or undersirable

short-term use for severe, disabling or distressing and insomnia

21
Q

MOA for benzodiazepine

A

target s the GABA a receptor (dorsal-aminobutyric acid type A) which is a chlordie channel that opens when binding by GABA and has the effect of inhibitory nuerotransmitter in the brain.

open of this channel allows chloride to flow into cell and make cell more resistance to depoloriation and hence firing.

Benzo failitate and enhance binding of GABA to the GABA a receptor and so depressaning on synaptic transmission

This reduce anxiety, sleepiness, sedation and anticonvulsant effect and so making pt more happy
ethanol alos binds to GABA a receptor and so cuases tolerant of ethanol in alcohol excessive use and so Benzo can be used instead of alcohol for withdrawal effect

22
Q

contra-indication of benzo

A

elderly - more susceptible
benzo should be avoided in pt with significant resp impairment or neuromusclar disease (eg myasthenia gravis)
should be avoided in liver failure as benzo can cuase liver encephalopathy (lorzepram - depends less on liver for elmination)

23
Q

where is benzo eliminated

A

liver

24
Q

side effect of benzo

A

dose-dependant drowsiness, sedation and coma
can lead to airway relax loss and airway obstruction and death
dependance can be built up and cause withdrawal reaction

25
Q

interaction of benzo

A

inc effect with drug of sedative effect which requires P450 elimination eg alochol, opioids, amiodarone, diltiazem etc

26
Q

what is the class name for donepezil

A

ACh-ase inhibitors

27
Q

MOA of donepezil

A

more Ach at synspes

28
Q

main indiction for donepezil

A

Alzheimer’s

29
Q

contra-indication for donepezil

A

heart disease, COPD, asthma, arrhythmia, peptic ulcer

30
Q

side effect for donepezil

A

N+V, diarrhoea, sleep issues, cramps, anorexia,

31
Q

where is donepezil eliminated

A

liver

32
Q

interaction of donepezil

A

NSAIDs

Year 3 Drug (12 decks)

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