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PSYCHOPHARMACOLOGY MRCPSYCH PART A > Misc > Flashcards

Misc Flashcards

1
Q

Which antipsychotics are indicated in hepatic impairment

A

Paliperidone (if depot required)
Amisulpride
Sulpiride

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2
Q

Which antidepressants are indicated in hepatic impairment

A

Sertraline
Citalopram
Paroxetine
Vortioxetine

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3
Q

Which mood stabilisers are indicated in hepatic impairment

A

Lithium

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4
Q

Which sedatives are indicated in hepatic impairment

A

Lorazepam
Oxazepam
Temazepam
Zopiclone 3.75mg (with care)

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5
Q

Which antidepressants are best avoided in hepatic impairment

A

TCA and MAOI

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6
Q

What is Modafinil

A

psychostimulant which enhances wakefulness, attention, and vigilance

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7
Q

When is dystonia most likely?

A

early stages of treatment or after an increase in dose
It can also occur on drug withdrawal.

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8
Q

Gell and Coombs classification Type I is?

A

(IgE-mediated) reactions: These are immediate hypersensitivity reactions mediated by the IgE antibody. They can lead to symptoms such as hives, itching, swelling, and in severe cases, anaphylaxis. They generally occurs minutes to hours after exposure.

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9
Q

Gell and Coombs classification Type II is?

A

(Cytotoxic) reactions: These involve the activation of complement proteins and destruction of cells by antibodies. Examples include drug-induced haemolytic anaemia or thrombocytopenia. The timing of these reactions is variable.

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10
Q

Gell and Coombs classification Type III is?

A

(Immune Complex) reactions: Immune complexes, which are antigen-antibody aggregates, can form and deposit in tissues, leading to inflammation. This can manifest as conditions like serum sickness or drug-induced lupus. These usually occur 1 to 3 weeks after exposure.

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11
Q

Gell and Coombs classification Type IV is?

A

(Cell-mediated) reactions: These reactions are mediated by T cells and occur over a delayed period, often days to weeks after exposure to the drug. Contact dermatitis and some forms of drug-induced hepatitis are examples.

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12
Q

Lithium contraindications

A

Addison’s disease
Brugada syndrome
Cardiac disease associated with rhythm disorders
Clinically significant renal impairment
Untreated or untreatable hypothyroidism
Low sodium levels, including people that are dehydrated and those on low-sodium diets

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12
Q

Lithium : long term use associated with

A

Hypothyroidism and hyperthyroidism
Hypercalcemia/hyperparathyroidism
Irreversible nephrogenic diabetes insipidus
CKD

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13
Q

Drugs to avoid in people with pseudocholinesterase deficiency include

A

Donepezil
Galantamine
Procaine
Succinylcholine
Pilocarpine

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14
Q

Serotonin syndrome is characterized by the triad of

A

neuromuscular abnormalities (myoclonus, and clonus), altered mental state, and autonomic dysfunction.

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15
Q

Neuroleptic malignant syndrome (NMS) is a

A

acute disorder of thermoregulation and neuromotor control

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16
Q

Primary investigation in NMS?

A

CK - at least 4 times the upper limit of normal range
Gas - Resp failure and metabolic acidosis
Leukocytosis
Altered LFTs
U + E aki elctrolyte derangement are complications
Clotting - DIC/ liver failure
urinalysis - Haemolysed blood on urinalysis suggests myoglobinuria

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17
Q

Risk factors for NMS

A

Younger age
Being male
Psychosis and mental retardation
Psychomotor agitation
Dehydration
Previous NMS
Hyperthyroidism
Alcoholism
Parkinson’s disease

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18
Q

Which antihistamine can cause sedation and so may affect a person’s ability to drive?

A

Chlorpheniramine

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19
Q

The prevalence of metabolic syndrome in patients in the CATIE trial was approximately

A

40%

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20
Q

mood stabiliser that has been shown to increase the risk of nephrolithiasis (kidney stones)

A

Topiramate

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20
Q

Which SSRIs is most associated with discontinuation symptoms?

A

Paroxetine
shorter half-life and higher potency

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21
Q

t/f lithium is contraindicated in severe renal impairment

A

true

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22
Q

Methylphenidate acts primarily by blocking the

A

Sodium dependent dopamine-transporter

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23
Q

Selegiline is a

A

monoamine oxidase inhibitor (MAOI)

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24
Q

Mirtazapine is an atypical antidepressant that increases the

A

release of norepinephrine and serotonin by antagonising certain adrenergic and serotonergic receptors

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25
Q

Lithium induced diabetes insipidus is thought to result from

A

Impaired action of ADH on principal cells
inability to concentrate urine and subsequently polyuria and polydipsia

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26
Q

Atomoxetine is a highly selective

A

norepinephrine reuptake inhibitor (SNRI)
used in adhd

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27
Q

common side effect of guanfacine

A

somnolence

28
Q

difference between first generation tricyclics (tertiary amines), and second generation tricyclics (secondary amines)

A

secondary amines are said to have a lower side effect profile and to act primarily on noradrenaline.
The tertiary amines are thought to boost serotonin and noradrenaline.

29
Q

Valproate is available in the following three forms:-

A

Semi-sodium valproate (licensed for acute mania associated with bipolar disorder)
Valproic acid (licensed for acute mania associated with bipolar disorder)
Sodium valproate (licensed for epilepsy)

30
Q

The weight gain caused by antipsychotic drugs is thought to be mediated, in part, via what mechanism?

A

Histamine receptor antagonism

31
Q

Antidopaminergic effects

A

Galactorrhoea, gynecomastia, menstrual disturbance, lowered sperm count, reduced libido, Parkinsonism, dystonia, akathisia, tardive dyskinesia

32
Q

Anticholinergic central M1 SE

A

Memory impairment, confusion

33
Q

Anticholinergic peripheral M1 SE

A

Dry mouth, blurred vision, glaucoma, sinus tachycardia, urinary retention, constipation

34
Q

Histaminergic H1 SE

A

Weight gain, sedation

35
Q

Adrenergic alpha 1 antagonism SE

A

Orthostatic hypotension, sexual dysfunction, sedation

36
Q

5HT2a and 5-HT2c antagonism SE

A

Weight gain

37
Q

antidepressants is associated with a relatively lower incidence of sexual dysfunction?

A

Mirtazapine

38
Q

Zero order kinetics =

A

elimination at a constant rate
ZOCFLAP = zero order constant first linear and proportional

39
Q

First order kinetics =

A

elimination at a proportional rate
ZOCFLAP = zero order constant first linear and proportional

40
Q

he Maudsley Guidelines suggest using the following sedatives in the setting of hepatic impairment

A

Oxazepam, a benzodiazepine, is primarily metabolised and eliminated by the kidneys

Lorazepam
Oxazepam
Temazepam
Zopiclone

41
Q

t/f Mirtazapine carries a lower risk of sexual dysfunction compared to many other antidepressants.

A

true

42
Q

What is first pass metabolism

A

concentration of a drug is greatly reduced before it reaches the systemic circulation

43
Q

which psych meds undergo little or no first pass

A

lithium
pregabalin

44
Q

Examples of typical antipsychotics

A

Haloperidol, Chlopromazine, flupenthixol, zuclopenthixol, sulpiride

45
Q

examples of atypical antipsychotics

A

clozapine, risperidone, olanzapine, quetiapine, amilsulpride, aripiprazole

46
Q

How do EPSEs vary in relation to first vs second gen antipsychotics?

A

first-generation antipsychotic is defined by the ability to block dopamine (D2) receptors.
They also have in, varying degrees, M1, Alpha-1 and H1 receptor blockade
atypicality of the atypical antipsychotics has been attributed to the combination of the relatively lower D2 antagonism with the 5HT2A antagonism

47
Q

What is post injection syndrome and what are the symptoms

A

IM depot goes into blood vessel
Sedation
Confusion, disorientation
Agitation, anxiety, aggression
Extrapyramidal symptoms, dysarthria, ataxia
Dizziness, weakness
Hypertension
Convulsion

48
Q

A drug which is inactive until converted to its active metabolite is known as what?

A

prodrug

49
Q

we can calculate the total amount of drug in the body using the formula

A

Amount (mg) = Concentration (mg/L) x Volume (L)

50
Q

Approximately how many half-lives are required before a drug is 97% eliminated from the body?

A

5

51
Q

How do allostericmodulators work?

A

Allosteric modulators bind to a site distinct from the active site where the endogenous ligand binds. This binding can enhance (positive allosteric modulation) or reduce (negative allosteric modulation) the receptor’s response to the endogenous ligand.

52
Q

Whatis synergism

A

Synergism occurs when the combined effect of two drugs is greater than the sum of their individual effects. For example, the combination of aspirin and clopidogrel results in a greater antiplatelet effect than either drug alone, which is beneficial in preventing heart attacks.

53
Q

Benzodiazepines enhance the effect of

A

the inhibitory neurotransmitter gamma-aminobutyric acid (GABA)

54
Q

benzodiazipines increase the XXXXX of chloride channels

A

frequency

55
Q

barbiturates increase the XXXXXX of chloride channel opening

A

duration

56
Q

antidepressants most associated with priapism?

A

trazadone and chlorpromazine

57
Q

Buprenorphine is a partial agonist at the

A

mu opioid receptor

58
Q

Allosteric modulators can change the activity of receptors by

A

binding to a site distinct from the active site

59
Q

Mechanism of

A

Lofexidine Alpha 2 agonist

60
Q

Mechanism of

A

Buprenorphine Partial agonist at the mu-opioid receptor

61
Q

Mechanism of

A

Naloxone Pure opioid antagonist (will reverse mu, delta, and kappa)

62
Q

Mechanism of Naltrexone

A

Long acting (compared to naloxone) opioid antagonist, targeting endogenous opioid receptors
(mu, delta, and kappa receptors), but particularly the mu-opioid receptor

63
Q

Mechanism of Varenicline (Champix)

A

Nicotinic receptor partial agonist

64
Q

Mechanism of Disulfiram

A

Binds irreversibly to enzyme aldehyde dehydrogenase (ALDH) and causes acetaldehyde to accumulate following ingestion of alcohol. Elevated blood acetaldehyde causes facial flushing, severe headache, palpitations, tachycardia, hypertension, respiratory distress, nausea and vomiting. These symptoms commence within 15-30 min of ingesting alcohol and persist for several hours

65
Q

Mechanism of Acamprosate

A

Acamprosate NMDA glutamate receptor antagonist and positive allosteric modulator of GABAA receptors (effect on both receptors is indirect)

66
Q

Mechanism of Selegiline

A

selective, irreversible inhibition of monoamine oxidase type B (also inhibits MAO-A at higher doses

67
Q

Mechanism of Sildenafil

A

Inhibits cGMP-specific phosphodiesterase type 5 (PDE5)

68
Q

Mechanism of Prazosin

A

Alpha-1 adrenergic receptor antagonist

PSYCHOPHARMACOLOGY MRCPSYCH PART A (7 decks)

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