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Psychiatry > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Antipsychotic with best evidence for use in schizophrenia with substance misuse

A

Clozapine

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2
Q

Best antidepressant for a breastfeeding mother

A

Sertraline

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3
Q

ADTs with least sexual side effects

A

Bupropion, Agomelatine, Mirtazapine, Trintellix, Vilazodone. (Mnemonic: BAM TV)

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4
Q

CANMAT 2009 guidelines for continuing ADTs

A

6-9 months after symptomatic remission or 2 years or more for those with risk factors for recurrence

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5
Q

Cardiac defect in infants associated with lithium

A

Ebstein’s anomaly

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6
Q

Increase lithium levels

A

Thiazide diuretics
Low sodium diet
Ibuprofen

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7
Q

ADTs to reduce in renal impairment

A

Venlafaxine
Paroxetine
Mirtazepine
Bupropion

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8
Q

Valproate is associated with pancreatitis T/F

A

T

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9
Q

What does caffeine do to lithium levels

A

Reduces them bcs of diuresis

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10
Q

Investigations before starting lithium

A
  1. Renal
  2. TFTs
  3. ECG if > 50
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11
Q

Lithium range:

1) acute
2) maintenance
3) toxic

A

1) 1-1.5 mEq/L
2) 0.2-0.6 mEq/L
3) >2

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12
Q

ADT for breastfeeding

A

SSRIs & SNRIs - sertraline, fluvoxamine, paroxetine

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13
Q

Most acidic drugs (eg valproate) bind to what? And what do basic (eg phenothiazines, TCAs) bind to?

A

Acidic- Albumin

Basic- globulin

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14
Q

What are the two phases of drug metabolism?

A

Phase I (oxidation) - most psych meds, CYP450

Phase II (glucoronidation, sulfation, acetylation, methylation) - Benzos, paliperidone, desvenlafaxine

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15
Q

What’s the most important CYP450 enzyme

A

CYP3A4 metabolises 50% of drugs & accounts for 50% of cytochrome P450 enzyme in liver

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16
Q

Genetic polymorphism is most common in which CYP450 enzyme?

A

CYP2D6

7% Caucasians are slow metabolisers

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17
Q

ADTs with minimal effects on weight

A 
Venlafaxine 
Fluvoxamine
Sertraline
Trazodone
Moclobemide
Fluoxetine 
Desvenlafaxine
Bupropion
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18
Q

ADTs that cause weight gain

A

Paroxetine
Mirtazepine
Doxepin
Amitriptyline

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19
Q

ADTs cause weight gain on the whole yes or no

A

Yes > 5% increase in weight on average

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20
Q

Peripheral anticholinergic side effects

A
  1. Decreased salivation
  2. Decreased bronchial secretions
  3. Decreased sweating
  4. Increased pupil size - (photophobia, precipitation of acute narrow angle glaucoma)
  5. Inhibition of accommodation - blurred vision
  6. Increased heart rate (MI)
  7. Difficulty urinating (AUR)
  8. Decreased GI motility (constipation)
  9. Flushed skin
  10. Hot
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21
Q

Central anticholinergic side effects

A
  1. Impaired concentration
  2. Confusion
  3. Attention deficit
  4. Memory impairment
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22
Q

Highly anticholinergic psychotropics

A

All >15pmol/mL

Atropine

Amitriptyline

Clozapine

Doxepin

Thioridazine

Tolterodine

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23
Q

SSRIs do what to P450

A

Inhibit

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24
Q

Normal QTc in men and women

A

M <430msec

W <450msec

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25
Q

Being female is a RF for QTc prolongation T/F

A

T

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26
Q

Being old is a RF for QTc prolongation T/F

A

T

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27
Q

ADTs with the highest risk of QTc prolongation

A

Tricyclics

Also citalopram >40mg

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28
Q

Citalopram in cardiac disease?

A

Avoid if poss- QTc prolongation

Get a cardiology consult if there are risk factors

Get an ECG before starting citalopram if there aren’t risk factors

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29
Q

Benzos are mainly metabolised where

A

Liver

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30
Q

Renally excreted- reduce dose in renal impairment

A 
Paliperidone
Pregabalin & Gabapentin
Risperidone
Topiramate
Venlafaxine
Vortioxetine (not rec in renal failure)
Z hypnotics
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31
Q

Lithium excreted where?

A

Kidney

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32
Q

Psychotropic drugs with Health Canada warnings in liver disease (2)

A
  1. Valproic acid

2. Duloxetine

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33
Q

Excretion of gabapentin

A

Renal

Fine in liver disease

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34
Q

Is serotonin associated with bleeding

A

Yes, released by plts to promote aggregation

SSRIs inhibit 5HT transporter & cause 5HT depletion in platelets- reduces aggregation

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35
Q

Classic triad of serotonin syndrome

A
  1. Excitation (clonus, hyperreflexia)
  2. Autonomic NS excitation
  3. Altered mental state

nb can lead to hyperthermia, rhabdomyolysis, DIC, acute resp distress

Rapid onset (cf NMS which is days)

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36
Q

Clinical features of NMS

A

Hypersalivation

Diaphoresis

Pallor

Stupor

Mutism

Coma

Lead pipe rigidity

Bradyreflexia

Slower onset over days

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37
Q

Clonus with agitation or diaphoresis in a patient on ADTs- what’s going on?

A

Serotonin syndrome

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38
Q

Management of serotonin syndrome

A
  1. Stop offending drug
  2. Hydrate & monitor closely
  3. Consider cyproheptadine in moderate to severe cases
  4. Benzos for sedation if severe

Usually resolves within one week

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39
Q

The signs that characterise NMS

A
  1. Fever
  2. Autonomic instability
  3. Rigidity
  4. Tremor
  5. Elevated CK
  6. Leukocytosis
  7. Mental status change
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40
Q

Management of NMS

A
  1. Supportive
  2. Dantrolene 1-2.5 mg/kg iv then 1mg/kg q6h
  3. Bromocriptine (dopamine agonist)
  4. Benzos
  5. ECT

Usually resolves in 1-2 weeks

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41
Q

Contraindications to disulfiram

A
  1. Severe CAD, MI, cerebral thrombosis
  2. DM
  3. Alcohol use
  4. Metronidazole
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42
Q

How does clozapine cause sialorrhea?

A

Via agonism at M4

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43
Q

The neurotransmitter most often associated with alcohol & benzo a) intake and b) withdrawal

A

a) GABA b) Glutamate

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44
Q

Affect of lithium on psoriasis

A

Worsens it

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45
Q

Relationship between antipsychotic treatment and vulnerability to TD varies with age T/F

A

T

46
Q

Risk factors for developing TD

A
  1. Female
  2. Older age
  3. Prev brain injury or dementia
  4. African origin
47
Q

Management of TD

A
  • Switching to clozapine an option
  • Not much evidence for lowering antipsychotic dose
  • No to benztropene
48
Q

Which neurotransmitter is affected by LSD?

A

Serotonin

49
Q

At which receptor site does naltrexone act?

A

Naltrexone is a mu-opioid antagonist

50
Q

Benzos which are safe in liver failure

A

“LOT” Lorazepam, Oxazepam, Temazepam

51
Q

Signs of TCA overdose

A

tachycardia, hypotension, dilated pupils, red, warm to touch - anticholinergic toxidrome

52
Q

How is paliperidone cleared?

A

Renally

53
Q

SSRI use in later pregnancy is associated with persistent pulmonary hypertension of the newborn T/F

A

T but not a strong association and no recommendation to discontinue SSRI in preg

54
Q

What is the action of Wellbutrin?

A

It is a norepinephrine and dopamine reuptake inhibitor and a nicotinic receptor antagonist

55
Q

Which side effect of Wellbutrin delayed it’s development as a drug?

A

Seizures

56
Q

Wellbutrin causes weight loss T/F

A

T- one trial showed 2.7kg loss relative to placebo over 6 months. It has a role in treatment of obesity.

57
Q

Wellbutrin is used off label to treat hypoactive sexual desire disorder in women T/F

A

T

58
Q

What is Level 1 evidence?

A

Meta-analysis with narrow confidence intervals and/or 2 or more RCTs with adequate sample size, preferably placebo controlled

59
Q

What is level 4 evidence?

A

Expert opinion/consensus

60
Q

Which drug for PTSD related nightmares?

A

Prazosin

61
Q

Treatment for anticholinergic side effects

A

Physostigmine

62
Q

Name two dose dependent side effects of clozapine

A

Drooling

Seizures

63
Q

How can you differentiate NMS from anticholinergic toxicity

A

Diaphoresis

64
Q

SSRIs inhibit the serotonin transporter in platelets T/F

A

T

65
Q

Which antipsychotic do you have to eat a meal with?

A

Lurasidone

66
Q

Chinese people need lower doses of risperidone T/F

A

T

67
Q

Seizures in TCA overdose are caused by what?

A

Sodium channel blockade

68
Q

Buprenorphine mechanism of action

A

Opioid partial agonist

69
Q

Valproic acid can cause pancreatitis T/F

A

T

70
Q

Which cytochrome p450 interaction explains fluvoxamine’s ability to enhance the serotonergic activity of clomipramine?

A

1A2 inhibition

71
Q

MDMA (ecstasy) acts on which receptor for hallucinogenic effect?

A

Serotonin

72
Q

Which receptor is responsible for withdrawal effects from alcohol and benzos?

A

Glutamate

73
Q

What is the mechanism of action of Varenicicline?

A

Partial agonist of A4B2 nicotinic receptor

74
Q

Phenelzine is contraindicated with pethidine (meperidine) T/F

A

T

75
Q

The relative dose of a drug required to achieve certain effects is also known as what

A

Potency

76
Q

The most anticholinergic TCA

A

Amitriptyline

77
Q

GABA is an excitatory neurotransmitter T/F

A

F

78
Q

using higher doses of antidepressants is related to a higher likelihood of relapse after discontinuation T/F

A

T

79
Q

How is paliperidone cleared?

A

Renally

80
Q

MAOIs inhibit intraneuronal metabolism T/F

A

T

81
Q

What’s the minimum effective dose of ziprasidone?

A

80mg/ day

82
Q

Pramipexole can induce gambling disorder T/F

A

T

83
Q

Action potentials have an influx of K+ in the ascending phase T/F

A

F it’s Na

84
Q

Interferon can cause psychosis T/F

A

T

85
Q

Lamotrigine acts on voltage gated sodium channels T/F

A

T

86
Q

What is the half life and peak plasma of sodium valproate

A

15hours half life, peak after 2-3 days

87
Q

Giving up smoking results in a 30% increase in olanzapine levels T/F

A

T

88
Q

Which CYP metabolises carbamazepine?

A

CYP3A3/4

89
Q

The most sedating antidepressant

A

Mirtazepine

90
Q

The most nauseating antidepressants

A

Fluvoxamine and venlafaxine

91
Q

ADTs with minimal impact on weight

A
  1. Venlafaxine
  2. Fluvoxamine
  3. Sertraline
  4. Trazodone
  5. Moclobemide
  6. Fluoxetine
  7. Desvenlafaxine
92
Q

ADTs causing biggest weight gain

A
  1. Paroxetine
  2. Mirtazepine
  3. Doxepin
  4. Amitriptyline
  5. Citalopram
  6. Nortriptyline
  7. Clomipramine
  8. Desipramine
93
Q

Two ADTs which are safer to use in SSRI induced hyponatremia

A

Mirtazepine and bupropion

94
Q

How do antipsychotics affect the action potential to cause prolonged QTc?

A

Via the K ion channel

95
Q

Risk factors for prolonged QTc

A
  1. Female
  2. Increased age
  3. Electrolyte abnormalities
  4. Congenital long QT
  5. Structural cardiovascular disease
  6. Other meds that prolong QTc
  7. Metabolic inhibitors
96
Q

Three antipsychotics with the highest risk for QTc prolongation

A
  1. Thioridazine
  2. IV haloperidol
  3. Ziprasidone
97
Q

Antipsychotic with minimal risk for prolonged QTc

A

Aripiprazole

98
Q

Risperidone 50% reduction in renal impairment T/F

A

T

99
Q

Having liver disease increases the risk of developing drug induced hepatotoxicity T/F

A

F

100
Q

Pre-existing GI bleed is a risk factor for GI bleeding on SSRIs T/F

A

T

101
Q

ADT with the lowest risk for a GI bleed

A

Mirtazepine

102
Q

Which has the acute onset, serotonin syndrome or NMS?

A

Serotonin syndrome, onset is within 24hours. NMS is in days

103
Q

Opioid analgesics eg pethidine, fentanyl release serotonin T/F

A

T

104
Q

Bradyreflexia, serotonin syndrome or NMS?

A

NMS

105
Q

Spontaneous clonus = what?

A

Serotonin syndrome

106
Q

Drug used to treat serotonin syndrome and dose

A

Cyproheptadine 12mg followed by 2mg q2h max 32mg/day

107
Q

Maintenance treatment with MAOIs can result in which deficiency?

A

Pyridoxine (B6). Typically patients taking MAOI are also prescribed pyridoxine simultaneously. Otherwise there is a risk of peripheral neuropathy

108
Q

Aspirin increases lithium levels T/F

A

T

109
Q

Quetiapine has a very low affinity for dopamine receptors T/F

A

T

110
Q

ADT which is a super potent H1 antagonist

A

Mirtazepine

111
Q

Lithium toxicity can occur with normal levels T/F

A

T

112
Q

Phenobarbital can precipitate attacks of porphyria T/F

A

T

Psychiatry (27 decks)

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