Misc Flashcards
Which antipsychotics are indicated in hepatic impairment
Paliperidone (if depot required)
Amisulpride
Sulpiride
Which antidepressants are indicated in hepatic impairment
Sertraline
Citalopram
Paroxetine
Vortioxetine
Which mood stabilisers are indicated in hepatic impairment
Lithium
Which sedatives are indicated in hepatic impairment
Lorazepam
Oxazepam
Temazepam
Zopiclone 3.75mg (with care)
Which antidepressants are best avoided in hepatic impairment
TCA and MAOI
What is Modafinil
psychostimulant which enhances wakefulness, attention, and vigilance
When is dystonia most likely?
early stages of treatment or after an increase in dose
It can also occur on drug withdrawal.
Gell and Coombs classification Type I is?
(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.
Gell and Coombs classification Type II is?
(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.
Gell and Coombs classification Type III is?
(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.
Gell and Coombs classification Type IV is?
(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.
Lithium contraindications
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
Lithium : long term use associated with
Hypothyroidism and hyperthyroidism
Hypercalcemia/hyperparathyroidism
Irreversible nephrogenic diabetes insipidus
CKD
Drugs to avoid in people with pseudocholinesterase deficiency include
Donepezil
Galantamine
Procaine
Succinylcholine
Pilocarpine
Serotonin syndrome is characterized by the triad of
neuromuscular abnormalities (myoclonus, and clonus), altered mental state, and autonomic dysfunction.
Neuroleptic malignant syndrome (NMS) is a
acute disorder of thermoregulation and neuromotor control
Primary investigation in NMS?
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
Risk factors for NMS
Younger age
Being male
Psychosis and mental retardation
Psychomotor agitation
Dehydration
Previous NMS
Hyperthyroidism
Alcoholism
Parkinson’s disease
Which antihistamine can cause sedation and so may affect a person’s ability to drive?
Chlorpheniramine
The prevalence of metabolic syndrome in patients in the CATIE trial was approximately
40%
mood stabiliser that has been shown to increase the risk of nephrolithiasis (kidney stones)
Topiramate
Which SSRIs is most associated with discontinuation symptoms?
Paroxetine
shorter half-life and higher potency
t/f lithium is contraindicated in severe renal impairment
true
Methylphenidate acts primarily by blocking the
Sodium dependent dopamine-transporter
Selegiline is a
monoamine oxidase inhibitor (MAOI)
Mirtazapine is an atypical antidepressant that increases the
release of norepinephrine and serotonin by antagonising certain adrenergic and serotonergic receptors
Lithium induced diabetes insipidus is thought to result from
Impaired action of ADH on principal cells
inability to concentrate urine and subsequently polyuria and polydipsia
Atomoxetine is a highly selective
norepinephrine reuptake inhibitor (SNRI)
used in adhd
common side effect of guanfacine
somnolence
difference between first generation tricyclics (tertiary amines), and second generation tricyclics (secondary amines)
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.
Valproate is available in the following three forms:-
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)
The weight gain caused by antipsychotic drugs is thought to be mediated, in part, via what mechanism?
Histamine receptor antagonism
Antidopaminergic effects
Galactorrhoea, gynecomastia, menstrual disturbance, lowered sperm count, reduced libido, Parkinsonism, dystonia, akathisia, tardive dyskinesia
Anticholinergic central M1 SE
Memory impairment, confusion
Anticholinergic peripheral M1 SE
Dry mouth, blurred vision, glaucoma, sinus tachycardia, urinary retention, constipation
Histaminergic H1 SE
Weight gain, sedation
Adrenergic alpha 1 antagonism SE
Orthostatic hypotension, sexual dysfunction, sedation
5HT2a and 5-HT2c antagonism SE
Weight gain
antidepressants is associated with a relatively lower incidence of sexual dysfunction?
Mirtazapine
Zero order kinetics =
elimination at a constant rate
ZOCFLAP = zero order constant first linear and proportional
First order kinetics =
elimination at a proportional rate
ZOCFLAP = zero order constant first linear and proportional
he Maudsley Guidelines suggest using the following sedatives in the setting of hepatic impairment
Oxazepam, a benzodiazepine, is primarily metabolised and eliminated by the kidneys
Lorazepam
Oxazepam
Temazepam
Zopiclone
t/f Mirtazapine carries a lower risk of sexual dysfunction compared to many other antidepressants.
true
What is first pass metabolism
concentration of a drug is greatly reduced before it reaches the systemic circulation
which psych meds undergo little or no first pass
lithium
pregabalin
Examples of typical antipsychotics
Haloperidol, Chlopromazine, flupenthixol, zuclopenthixol, sulpiride
examples of atypical antipsychotics
clozapine, risperidone, olanzapine, quetiapine, amilsulpride, aripiprazole
How do EPSEs vary in relation to first vs second gen antipsychotics?
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
What is post injection syndrome and what are the symptoms
IM depot goes into blood vessel
Sedation
Confusion, disorientation
Agitation, anxiety, aggression
Extrapyramidal symptoms, dysarthria, ataxia
Dizziness, weakness
Hypertension
Convulsion
A drug which is inactive until converted to its active metabolite is known as what?
prodrug
we can calculate the total amount of drug in the body using the formula
Amount (mg) = Concentration (mg/L) x Volume (L)
Approximately how many half-lives are required before a drug is 97% eliminated from the body?
5
How do allostericmodulators work?
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.
Whatis synergism
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.
Benzodiazepines enhance the effect of
the inhibitory neurotransmitter gamma-aminobutyric acid (GABA)
benzodiazipines increase the XXXXX of chloride channels
frequency
barbiturates increase the XXXXXX of chloride channel opening
duration
antidepressants most associated with priapism?
trazadone and chlorpromazine
Buprenorphine is a partial agonist at the
mu opioid receptor
Allosteric modulators can change the activity of receptors by
binding to a site distinct from the active site
Mechanism of
Lofexidine Alpha 2 agonist
Mechanism of
Buprenorphine Partial agonist at the mu-opioid receptor
Mechanism of
Naloxone Pure opioid antagonist (will reverse mu, delta, and kappa)
Mechanism of Naltrexone
Long acting (compared to naloxone) opioid antagonist, targeting endogenous opioid receptors
(mu, delta, and kappa receptors), but particularly the mu-opioid receptor
Mechanism of Varenicline (Champix)
Nicotinic receptor partial agonist
Mechanism of Disulfiram
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
Mechanism of Acamprosate
Acamprosate NMDA glutamate receptor antagonist and positive allosteric modulator of GABAA receptors (effect on both receptors is indirect)
Mechanism of Selegiline
selective, irreversible inhibition of monoamine oxidase type B (also inhibits MAO-A at higher doses
Mechanism of Sildenafil
Inhibits cGMP-specific phosphodiesterase type 5 (PDE5)
Mechanism of Prazosin
Alpha-1 adrenergic receptor antagonist
