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Year 3 > Neuro/Psych/Rheumatology drug SE > Flashcards

Neuro/Psych/Rheumatology drug SE Flashcards

1
Q

9 Valproate?

Interaction?

A 
Alopecia
Encephalitis
Liver failure/Pancreatitis
Weight gain
Tremor
Thrombocytopaenia
Teratogenic
Oedema
Ataxia

Interaction - P450 inhibitor

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2
Q

4 Lamotrigine?

Breastfeeding?

A

Rash
Steven Johnson syndrome
Tremor
Agitation

Avoid in breastfeeding - risk of SJS in kid

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3
Q

5 Carbamazepine?

Interaction?

A 
Worsening of generalised epilepsy
Leucopaenia
Drowsiness
Double vision
Impaired balance

Interaction - P450 inducer

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4
Q

1 Levetiracetam?

A

Depression/mood swings

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5
Q

3 Topiramate?

A

Sedation
Dysphasia
Weight loss

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6
Q

Phenytoin - 6 chronic SE?

Interaction

A 
Gingival hyperplasia
Hirsutism
Megaloblastic anaemia
Osteomalacia
Lymphadenopathy
Aplastic anaemia

Interaction - P450 inducer

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7
Q

Phenytoin - 5 acute toxicity?

A

Cerebellar signs - confusion, drowsy, ataxia, nystagmus, slurred speech

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8
Q

Lithium - 7 chronic SE?

Drugs to avoid?

A 
Fine tremor
Metallic taste/dry mouth
Weight gain
Hypothyroidism
QT prolongation
Renal function decline - diabetes insipidus
Teratogenic - Ebstein's anomaly

Avoid: ACEI, NSAIDs, Diuretics

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9
Q

Lithium - 5 toxicity?

A 
D&V
Coarse tremor
Myoclonus
Confusion & drowsiness
Kidney failure
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10
Q

General SSRI?

A 
GI upset
Vivid dreams
GI bleeding - give with PPI, avoid NSAIDs
Sexual dysfunction
Transient worsening of symptoms
Hyponatraemia in elderly
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11
Q

TCA?

A 
Sedation
Weight gain
QT prolongation
Postural hypotension
Dry mouth, urinary retention, blurred vision etc
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12
Q

MOAI? (4)
What to avoid with?
Reversible and Irreversible?

A

Hypertensive crisis if have cheese, red wine, game meat
(Rx: phentolamine infusion)

Also anticholinergic effects, seizures and hepatic impairment

Avoid with other antidepressants/sedatives e.g. barbiturates (P450 inhibitor - potentiates them)

Reversible - Moclobemide (less SE but less effective)
Irreversible - Phenelzine

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13
Q

Mirtazapine?

A

Weight gain
Sedation (caution with other sedatives)

Rarely, blood dyscrasias or seizures

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14
Q

Trazodone:

  • MOA
  • Use?
A

SARI - Serotonin/NA reuptake inhibitor and antagonist

Can be used to augment SSRI

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15
Q

Typical antipsychotics?

A

EPSE:

  • Acute dystonia (procyclidine)
  • Akathisia (propranolol)
  • Parkinsonism (levodopa/stop drug)
  • Tardive dyskinesia (tetrabenazine symptomatically)
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16
Q

Atypical antipsychotics:

A 
Metabolic syndrome - insulin resistance/high BP, obesity, high cholesterol
Drowsiness
Hyperprolactinaemia
Sexual dysfunction
Risk of stroke in elderly
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17
Q

Clozapine?

A

Agranulocytosis (bloods weekly for 6 months, then 2 weekly for 6 months, then 4 weekly)
Myocarditis (ECG 3 monthly)

18
Q

Aripiprazole?

A

Postural hypotension
Constipation
Headache

19
Q

What SSRI is:

  • safest in cardiac problems?
  • safest in epilepsy?
  • assoc w QTc prolongation?
  • more alerting?
  • assoc w anticholinergic SE? (e.g. drowsiness)
  • used post-MI?
A

safe in cardiac - sertraline

safe in epilepsy - citalopram

assoc w QTc prolongation - citalopram

more alerting - fluoxetine

anticholinergic - paroxetine (drowsiness)

post-MI - sertraline

20
Q

Who to avoid TCA in? (4)

A

Recent MI or cardiac problems
Older people
Suicidal ideation (cardiotoxic)
Mania

21
Q

Antidepressant best for atypical depression?

A

MAOI

22
Q

Indications for ECT?

A

Depression:

  • life-threatening poor fluid intake
  • strong suicidal ideation
  • psychotic features
  • antidepressants not working

Established Mania

Schizophrenia:

  • catatonia
  • positive psychotic symptoms
  • schizoaffective disorder
23
Q

SE of ECT?

A

Memory loss

Confusion, headache, nausea, muscle pain

24
Q

ECG changes that can occur with:

  • TCA?
  • Lithium?
A

TCA - QT prolongation, ST elevation

Lithium - T-wave flattening/inversion

25
Q

Monitoring of Lithium?

prior, initiation, 3 monthly, 6 monthly

A

Prior: U&E, TFT, ECG

Initiation: Li level 12 hour post-dose and every 5 days until level stable

3 monthly: Li and U&E

6 monthly: TFT

26
Q

What to check prior to initiation of valproate?

A

PLT count

LFT

27
Q

What receptors does Clozapine work on?

A

5-HT2

D4

28
Q

Effects of anti-psychotics blocking:

  • alpha-adrenergic receptors?
  • cholinergic?
  • Histamine?
  • 5HT2c?
A

postural hypotension

Dry mouth, blurred vision, constipation, urinary retention

Sedation & weight gain

Weight gain (mainly Olanzapine and Clozapine)

29
Q

What antipsychotics are most likely to cause weight gain?

A

Olanzapine
Clozapine

(due to 5-HT2c blockade)

30
Q

What antipsychotic is most likely to cause:

  • QT prolongation?
  • EPSE/neuroleptic malignant syndrome?
  • blue-grey discolouration?
A

QT - Haloperidol

EPSE/Neuro mal - Typicals

Blue-grey - chlorpromazine

31
Q

Within atypical psychotics, what drugs does EPSE happen in higher doses?

A

Risperidone, olanzapine

uncommon with aripiprazole, rare with clozapine

32
Q

What antipsychotic to use for:

  • avoidance of EPSE?
  • least sedating?
  • most sedating?
  • avoid weight gain?
  • treatment-resistant?
  • depot? (poor compliance)
A

avoid EPSE - atypicals

least sedating - Haloperidol, Risperidone

Most sedating - Olanzapine, Chlorpromazine

Avoid weight gain - Aripiprazole, Haloperidol

Treatment-resistant - Clozapine

Depot - Risperidone

33
Q

Methotrexate SE? (4)

A

Pulmonary fibrosis
Liver cirrhosis
Teratogenic
Marrow suppression

34
Q

Prednisolone SE? (8)

A 
Osteoporosis
impaired glucose tolerance
hypertension
cushingoid features
adrenal suppression
AVN femoral head
immunosuppression
glaucoma/cataracts
35
Q

Anti-TNF drugs?
Etanercept?
Infliximab?

A

TB reactivation

Etanercept - demyelination

Infliximab - given IV

36
Q

Sulfasalazine?(1)

A

reduced sperm

37
Q

hydroxychloroquine?(1)

A

Irreversible retinopathy

Corneal deposits

38
Q

leflunomide? (1)

A

interstitial lung disease

39
Q

IM gold? (2)

A

proteinuria

peripheral neuropathy

40
Q

Penicillamine? (5)

A 
Rash
myasthenia syndrome
goodpastures
proteinuria
anaemia
41
Q

Azathioprine? (1)

A

Marrow suppression (aka myelosuppression)

42
Q

Which rheumatoid drugs are teratogenic?

A

Methotrexate - both male and female stop 3 months before pregnancy

Leflunomide

Year 3 (19 decks)

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