Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology - MRCPsych A > MRCPsych > Flashcards

MRCPsych Flashcards

1
Q

Name some markers for Clozapine associated myocarditis?

A

Troponin T and I are the most specific

Other markers to check include LDH, AST, CK and Myoglobin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which dementia drugs are broken down by hepatic enzymes?

A

Donepezil (minor) and Galantamine - both mainly by CYP2D6 and CYP3A4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Name some symptoms of discontinuation syndrome?

A

Anxiety
Vivid dreams
Crying spells
Dizziness
Flu-like symptoms
Electric shock sensations
Irritability
Crying sensations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which anti-depressants are most likely to cause discontinuation symptoms?

A

Paroxetine
Venlafaxine
Amitriptyline
Imipramine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Name some factors that would lead to a higher rate of discontinuation symptoms?

A

Taking for 8 weeks or longer
Higher doses
Receiving other central acting drugs - antihistamines, antipsychotics, anti-hypertensives
Young people
Anxiety symptoms on anti-D initiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What medications should be avoided when prescribing MAOIs

A

SSRI
SNRI
TCAs particularly Imipramine and Clomipramine due to risk of serotonin syndrome
Triptan migraine products
St John’s Wart
Cold products - dextromethorphan and chlorpheniramine
Opiods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which dietary products lead to the cheese reaction?

A

Dairy:
- All mature/aged cheese

Meat/fish/poultry:
- Fermented meat - salami
- Improperly stored meat

Fruit/veg:
- Fava or broad bean pods
- Banna peel

Drinks:
- Tap beer

Misc:
- Marmite
- Saurkraut
- Soy sauce
- Tyramine containing nutritional supplements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Outline the Gell and Coombs system that classifies immune mediated drug reactions

A

Type I - IgE mediated - these occurs minutes to hours after drug. Drug IgE complex get detected by mast cells and release histamine - classic urticaria, anaphylaxis, rash, angioedema

Type II - IgG and IgM mediated these occur longer after - neutropenia, thrombocytopenia

Type III - complement mediated reaction, symptoms include rash, fever, vasculitis occur 1-3 weeks after

Type IV - MHC system presents drug complexes to T cells occurs 2-7 days after drug and includes symptoms of dermatitis and rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which ADHD drugs are metabolised by CYP450

A

Atomoxetine - CYP2D6

Guanfanacine - CYP3A4/5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does sodium valproate work as a mood stabiliser?

A

GABA agonism and NMDA antagonism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why does a proportional increase body fat in the elderly matter regarding pharmacokinetics?

A

Lipid-soluble drugs will be distributed more readily - therefore lipid-soluble drugs half lives decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which anti-depressants have the highest risk on sexual desire, sexual arousal and orgasm?

A

SSRIs, MAOI, TCAs & Venlafaxine: ++ in all domains

Duloxetine ++ on sexual desire, + on sexual arousal and ++ on orgam

Mirtazapine, Bupropion, Vortioxetine, Moclobemide, Reboxetine and Nefazadone lower effecting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the half-lives of the following drugs

Diazepam
Lorazepam
Chlordiazepoxide
Nitrazepam
Temazepam
Zopiclone
Zolpidem

A

Diazepam 20-100 hrs (36-200 hrs for active metabolite)
Lorazepam 10-20hrs
Chlordiazepoxide 5-30 hrs (36-200 hrs for active metabolite)
Nitrazepam 15-38 hrs
Temazepam 8-22 hrs

Zopiclone 4-6 hrs
Zolpidem 2-6 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is pethidine?

A

An opioid - has been associated to the onset of delirium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name some GABA agonists

A

BDZ
Z-drugs
Valproate
Topiramate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which enzyme is encoded for by CYP2D6

A

Debrisoquine hydroxylase.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Name the active metabolite of Fluoxetine

A

Norfluoxetine - has a very long half life of up to 14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the most selective SSRI?

A

Citalopram and Escitalopram

  • Fluoxetine is a weak noradrenaline reuptake inhibitor
  • Setraline weakly inhibits noradrenaline and dopamine
  • At high doses Paroxetine has anticholinergic effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Name some interactions with Fluvoxamine?

A

Reduces the clearance of diazepam - do not generally co-administer both

Inhibits CYP1A2 - can increase level of theophylline therefore 1/3 of the original dose & can increase levels of warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which SSRIs have non-linear kinetics

A

Fluoxetine, Fluvoxamine and Paroxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What SSRI has the longest half-life?

A

Fluoxetine 1.9 days

Shortest half life is Paroxetine (10hr), Fluvoxamine and then Sertraline (26hr)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How does Buspirone work?

A

5HT-1A agonism - inhibits release of serotonin presynaptically reducing anxiety

Post-synaptic agonism leads to anti-D properties

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the half-life of Mirtazapine?

A

20-40hrs

Paroxetine/Fluoxetine can increase levels but no clinical consequences
Carbamezepine can reduce levels

Mirtazapine does not inhibited CYP enzymes.

It undergoes extensive 1st pass metabolism producing a bioavailability of 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Why is it important to maintain a steady sodium intake with lithium?

A

Sodium is excreted in the proximal tubules and as a compensatory mechanism Lithium is reabsorbed. Increasing sodium intake can lead to toxicity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the half life of Lithium

A

Initially 18hrs then increases to 36hrs

  • Lithium takes 4-5 days to reach a steady state
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What agents may increase Lithium levels?

A

ACEi, loop diuretics, thiazide diuretics, Fluoxetine and NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Name some agents that may decrease Lithium levels?

A

Osmotic diuretics
Caffeine
Carbonic anhydrase inhibitors
Aminophylline and Theophylline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Divide benzodiazepines into long, intermediate/short and very short acting:

A

Long acting
- Diazepam: 30-hr half life, metabolite desmethyldiazepam
- Clonazepam
- Chlordiazepoxide

Intermediate or short acting (less daytime impairment, rebound insomnia and anterograde amnesia)
- Lorzepam - 15 hrs half life
- Oxazepam
- Temezepam - 10hrs
- Alprazolam

Very short acting:
- Triazolam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How do the Z drugs differ with regards to effect on sleep onset or maintenance?

A

Zopiclone - for maintenance. Onset within 45 minutes, half life of 4-5hrs. Acts up to 8hrs

Zolpidem - for sleep onset problems. Onset within 30 mins, half life of 1-4hrs. Acts up to 6hrs

Zaleplon - for sleep onset problems. Onset within 30 mins, half life 1-2hrs, acts up to 4hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How does Agomelatine work?

A

5HT2C antagonism - DA and NAA release in frontal cortex

M1 and M2 melatnonin receptor agonism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Name two anti-D licensed for PTSD

A

Sertraline and Paroxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How long does Olanzapine take to reach a steady state?

A

7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Moclobemide has a minimum effective dose of what for depression?

A

300mg a day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are biogenic amines?

A

Compounds derived from amino acids they include

HANDS

Histamine
Adrenaline
Noradrenaline
Dopamine
Serotonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are biogenic amines?

A

Compounds derived from amino acids they include

HANDS

Histamine
Adrenaline
Noradrenaline
Dopamine
Serotonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is zopiclone contraindicated in?

A

Unstable myasthenia gravis
Sleep apnoea
Respiratory failure
Neuromuscular respiratory weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Which antipsychotics are least likely to result in EEG changes?

A

Quetiapine

  • Clozapine most likely to cause EEG changes
37
Q

5% of patients per year taking a typical antipsychotic develop…

A

Tardive Dyskinesia
- More commonly seen in elderly patients, those with an affective illness, those with EPSE’s earlier on
- Switch to atypical (Clozapine/Quetiapine) if develop
- Takes months to years to develop
- Can also prescribe Tetrabenazine, Ginkgo biloba

38
Q

5% of patients per year taking a typical antipsychotic develop…

A

Tardive Dyskinesia
- More commonly seen in elderly patients, those with an affective illness, those with EPSE’s earlier on
- Switch to atypical (Clozapine/Quetiapine) if develop
- Takes months to years to develop
- Can also prescribe Tetrabenazine, Ginkgo biloba

39
Q

Outline the treatments for

a) Dystonia
b) Akasthesia
c) Parkinsonism
d) Tardive dyskinesia

A

a) Botulism toxim, anticholinergic drugs (trihexyphenidyl, procyclidine,, orphenadrine, benztropine. Note diphenhydramine (an antihistamine is also used due to its anticholinergic properties)

b) Beta-blockers, BDZs, Cryprohepadine, Clonidine, Mirtazapine or Mianserin (low dose)

c) Tetrabenazine, Ginko Biloba

Note for all reducing the dose and alternative atypical options should be considered

40
Q

How does Disulfiram put individuals off alcohol?

A

Bind irreversibly to aldehyde dehydrogenase - this leads to a build up of acetaldehyde that causes facial flushing, N&V, hypertension, respiratory distress.

These effects start within 15-30 minutes of starting and can last several hours

41
Q

Name the secondary amines?

A

Nortryptiline
Desipramine
Protriptyline
Amoxapine

42
Q

What does the Amdisen scale assess for?

A

Lithium toxicty:
- 0 = no clinical signs
- 1 = mild, nausea + vomiting, coarse tremor, hyperreflexia, agitation
- 2 = moderate. stupor, rigidity, hypertonia and hypotension
- 3 = severe toxicity (myoclonus, coma)

43
Q

Name some notable contraindications for Carbamazepine?

A

Bone marrow suppression
MAOIs

44
Q

What are the indications of Carbamazepine?

A

Neuropathic pain
Partial focal epilepsy
Maintenance bipolar disorder

45
Q

Name some very common side effects with Carbamazepine?

A

Leucopenia
Ataxia, Dizziness, Somnolence
Nausea and vomiting
Urticaria
Fatigue

45
Q

Name some very common side effects with Carbamazepine?

A

Leucopenia
Ataxia, Dizziness, Somnolence
Nausea and vomiting
Urticaria
Fatigue

46
Q

Does Diazepam or Clonazepam have longer half lives?

A

Diazepam (20-100hrs) > Clonazepam (18-50hrs)

47
Q

How does Flumazenil work?

A

GABA-A receptor antagonism to stop BDZ binding to receptor and reverses effects of substances bound

Given IV
Short half life of 60 mins
Reverses other agents like Zopiclone

48
Q

How is a diagnosis of SIADH confirmed?

A

Low serum osmolality < 275 mOsm/kg
Increased urine osmolality > 100 mOsm/kg
Euvolaemic
Raised urinary sodium > 20ml/L
No other caused of hyponatraemia

49
Q

Name some psychotropic drugs that can cause SIADH

A

Carbamazepine, oxcarbazepine, chlorpropamide, cyclophosphamide, and selective serotonin reuptake inhibitors (SSRI).

50
Q

How is SIADH treated?

A

Fluid restriction or demeclocycline

51
Q

Which antipsychotics have a low propensity for elevating prolactin?

A

Aripiprazole
Quetiapine
Clozapine
Asenapine

Low - moderate risk:
- Olanzapine
- Lurasidone
- Ziprasidone

High risk:
- All typicals
- Palpileridone/Rispeidone
- Amisulpride/Sulpride

52
Q

Name the side effects of Topiramate

A

Weight loss, nephrolithiasis and metabollic acidosis - it does this as it inhibits carbonic anhydrase - calcium phosphate stones can develop

Used epilepsy and as a mood stabiliser in BPAD - inhibits voltage gated sodium channels suppressing action potentials, it also increases GABA

53
Q

Name the minimum effective doses of Agomelatine, Trazadone, Duloxetine, Fluvoxamine, Moclobemide

A

Agomelatine - 25mg/day
Fluvoxamine - 50mg/day
Trazadone - 150mg/day
Moclobemide - 300mg/day
Duloxetine - 60mg/day

54
Q

What medications can be added to Olanzapine or Clozapine to reduce weight gain

A

Aripiprazole
- Orlistat
- Liraglutide
- Metformin

55
Q

Name some non-psychiatric drugs that can increase QTc?

A

Antimalarials - chloroquinine and quinine

Antibiotics - Erythromycin and Ampicilin

Anti-arrhythmics - sotalol and amiodarone

Methadone
Tamoxifen
Amantadine

56
Q

What percentage of D2 receptors need to be blocked for a therapeutic effect and for ESPE’s to occur?

A

65-80% is the therapeutic window
> 80% EPSE’s likely

57
Q

Which anti-D is least likely to associate with withdrawal syndrome?

A

Agomelatine

58
Q

Outline the triad of symptom clusters for serotonin syndrome?

A

Confusion/altered mental state, neuromuscular abnormalities and autonomic dysfunction

Neuromuscular abnormalities are more prominent in the lower limbs and include:
- Clonus - nearly always present - contraction on stretching of the muscle
- Hyperreflexia
- Rigidity
- Tremor

A temperature indicates immediate action

59
Q

What tool is helpful in diagnosis of serotonin syndrome?

A

Hunter’s tool

60
Q

What pharmacological changes may induce serotonin syndrome?

A

Over dose of a serotonergic drug - 16% of SSRI overdoses may lead to serotonin syndrome

Increasing the dose of a serotonergic drug

Combination of two serotonergic drugs

Administration of drugs that inhibit the P450 enzyme system

  • typically symptoms begin within 24hrs however subacute presentations ma occur
61
Q

How do you treat serotonin syndrome?

A

Remove serotonergic agent

BDZ and fluids if mild case

May administer 5HT2A antagonist - cyproheptadine

62
Q

How may one differentiate between NMS and Serotonin syndrome?

A

NMS - develops slower and remits slower 9-14 days of appropriate treatment. Often associated with bradykinesia and leadpiping rigidity (uniform) and hyporeflexia. Pupils will be normal

SS - faster onset and rapid improvement with treatment. Pupillary dilatation. Hyperactive bowel sounds. Hyperreflexia

63
Q

Which antipsychotic has the longest half life (75hrs)?

A

Aripiprazole

64
Q

Name some features of hydrophilic drugs?

A

Poorly absorbed

Rapidly excreted

Little 1st pass metabolism

Little protein binding

Experience tubular reabsorption

65
Q

Name the features of NMS

A
  • Mental state changes
  • Muscular rigidity (also hyporeflexia)
  • Autonomic instability - especially tachycardia

Fever
Diaphoresis
Rigidity
Confusion
Flutuating consciousness
Fluctuating blood pressure
Tachycardia
Elevated CK
Leukocytosis
Altered LFTs

66
Q

What is the treatment of NMS

A
  • Stop antipsychotic + BDZ in psychiatric unit
  • Bromocriptine + Dantrolene in medical unit
  • When re-starting choose low dose monitoring temp, BP and HR
  • Choose structurally different or that with low D2 affinity (Quetiapine/Clozapine)
  • Avoid depot
  • Avoid FGA
67
Q

Is anti-depressant induced hyponatraemia dose related?

A

No

  • Often begins within 30 days of initiation
68
Q

What diuretics are safer with a patient on Lithium?

A

Loop diuretics and K+ sparing diuretics

69
Q

Name the teratogenic effects of Carbamazepine?

A

Fingernail hypoplasia and craniofacial defects

70
Q

Name some anti-D that undergo little metabolism via the Liver and therefore would be suitable if hepatic impairment is present?

A

Citalopram
Sertraline
Paroxetine
Vortioxetine

Avoid TCAs and MAOI

71
Q

What heart rate is optimum for Bazzett’s formula?

A

60-100 BPM

At < 60 bpm it under-corrects
At > 100 bpm it over corrects

72
Q

Name some of the side effects of alpha 1 blockade?

A

Orthostatic hypotension
Sexual dysfunction
Sedation
Priapism

73
Q

What are the side effects of Varencicline?

A

Nasopharyngitis
Headaches
Nausea
Abnormal dreams

74
Q

Name some medications associated with priapism?

A

Tazadone
Chlorpromazine
Thioridazine

75
Q

What are the risk factors for prolonged QT interval?

A

Cardiac:
- Bru

76
Q

What are the risk factors for prolonged QT interval?

A

Cardiac:
- Bradycardia
- Long QT syndrome
- IHD
- Myopathy
- LVH

Electrolyte:
- Hypomagnesia
- Hypokalaemia
- Hypocalcaemia

Other:
- Female
- Anorexia Nervosa
- Stress/Shock
- Extremities of age

77
Q

Which antipsychotics are/are not associated with postural hypotension

A

Are associated with postural hypotension:
- Risperidone
- Olanzapine
- Quetiapine
- Clozapine
- Ziprasidone

Are not:
- Aripiprazole
- Amisulpride
- Sulpride
- Haloperidol
- Trifluperozine

78
Q

Severe liver damage and Pancreatitis are the severe/rare complications of which AED?

A

Sodium Valproate

79
Q

Name some drugs that should not be included in dosette boxes due to poor drug stability?

A

Sodium valproate
Zopiclone
Venlafaxine
Topiramate
Methylphenidate
Mirtazapine
Olanzapine
Amisulpride
Aripiprazole

80
Q

What anti-depressant is licenced for Bullimia?

A

Fluoxetine

81
Q

What are the contraindications for first generation anti-histamines?

A

Acute angle closure glaucoma
Pyloric stenosis
BPH

1st generation anti-histamines include:
Diphenhydramine
Promethazine
Hydroxyzine
Chlorpheniramine
Cyproheptadine
Cyclizine
Ketotifen

82
Q

Acamprosate is a positive allosteric modulator of what?

A

GABA-A

Acamprosate is also an NMDA antagonist

83
Q

Which is the least cardiotoxic TCA?

A

Lofepramine

84
Q

Is teratogenicity in valproate dose dependent?

A

Yes

Valproate is a GABA agonist and NMDA antagonist

85
Q

Vitamin involved in Carbohydrate catabolism?

A

Thiamine

86
Q

Is Duloxetine allowed in hepatic impairment?

A

No

87
Q

Which SSRI has been linked to ESPE?

A

Fluoxetine

88
Q

Which SSRI has been linked to ESPE?

A

Fluoxetine

89
Q

Is Reboxetine associated with sexual dysfunction?

A

No

90
Q

Do depot or oral antipsychotics carry a higher risk for NMS?

A

The risk is the same!

Pharmacology - MRCPsych A (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions