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Pharmacology Flashcards

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1
Q

What is Quetiapine?

A 
Atypical antipsychotic
Sedating
Anxiolytic at low dose
Used in bipolar depression (anti-mania)
Increased suicide rates if used for depression in under 25's
Avoid in cerebrovascular disease
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2
Q

What is Propranolol?

A 
ß-blocker
Avoid in asthma, heart failure
Anxiety symptoms
Migraine prophylaxis
Angina, MI, essential tremor
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3
Q

What is pregabalin?

A

Anti-convulsant for epilepsy
Neuropathic pain
GAD

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4
Q

What is sertraline?

A

SSRI, depression, social anxiety, panic, OCD, PTSD

SE: pancreatitis, hepatitis, tachycardia, bleeding

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5
Q

What is vortioxetine?

A

Serotonin receptor modulator
Major depression
Less impact on sexual function, discontinue if manic
SE: increased seizures,

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6
Q

What is olanzapine?

A

Atypical antipsychotic
Used in schizophrenia, severe anxiety, bipolar for mania
Weight gain and diabetes risks
Avoid in bone marrow disorders, cardiac issues

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7
Q

What is flupentixol deconoate? (depixol)

A 
Typical antipsychotic
Schizophrenia
Mood stabiliser in bipolar
Psychotic depression
SE: hypersalivation, dyspnoea, hyperglycaemia
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8
Q

What is zopiclone?

A

Z drug anxiolytic and hypnotic (insomnia)
Use for up to 4 weeks
Caution in respiratory insufficiency
Drowsiness the next day

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9
Q

What is clozapine?

A

Atypical antipsychotic
Used in treatment resistant schizophrenia
Treats negative symptoms
Less extrapyramidal side effects
Decreases fertility, nausea, agranular cytosis, cardiomyopathy, hypersalivation, hypotension

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10
Q

What is sodium valproate?

A 
Anti epileptic
Bipolar
Migraine prophylaxis
Monitor liver function
SE: weight gain, tremor, extrapyramidal, hair loss
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11
Q

What is chlordiazepoxide?

A

Anxiolytic

Anxiety, panic disorder, alcohol withdrawal (short term)

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12
Q

What is fluoxetine?

A

SSRI, major depression, bulimia nervosa, OCD

SE: bleeding, sexual dysfunction

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13
Q

What is diazepam?

A

Long acting benzodiazepine
Anxiety, sedative (only short term use)
Dependence, tolerance
Avoid in elderly-> confusion

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14
Q

What are extrapyramidal symptoms?

A

Parkinsonianisms caused by lack of dopamine in nigrostriatal pathway
Can be caused by D2 antagonists (eg antipsychotics)

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15
Q

Name 7 parkinsonianisms

A 
Cogwheeling and increased tone
Bradykinesia
Freezing, festinating gait (shuffling)
Pill rolling resting tremor
Blank face and quiet speech (hypomimia)
Postural instability and flexed posture
Orthostatic hypotension-> falls
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16
Q

What drugs are most likely to cause extrapyramidal SE?

A

Fluphenazine
Perphenazine
Haloperidol

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17
Q

Treatment of bipolar?

A

Cognitive behavioural therapy, interpersonal therapy or behavioural couples therapy
Anti manic therapy (Olanzapine/haloperidol/quetiapine) or anti-depressant fluoxetine depending on presentation
2nd line: Lithium + Valproate
Lamotrigine for prevention
Physical health monitoring (weight, BP, blood glucose, thyroid function, FBC, renal and liver function)

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18
Q

Treatment of bipolar in children

A

In children, Risperidone is used for grandiosity, no evidence for antidepressants or lithium. Sodium valproate is commonly used.

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19
Q

Treatment of anxiety

A

• CBT (16-20 sessions) is first line treatment
• Medication of an SSRI is 2nd line (higher dose than for depression, continued for at least 1yr)
• Self help and reading groups is 3rd line
Benzodiazepines in crisis

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20
Q

Treatment of mild depression

A

Watch and wait for 2 weeks
Psychological therapy (6-8 session)
SSRI, for 6 months after remission

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21
Q

Treatment of moderate depression

A

SSRI, for 6 months after remission
CBT 16-20 session
Add another drug (eg another SSRI, quetiapine, serotonin receptor modulator)

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22
Q

Treatment of severe depression

A

SSRI +CBT
Add another drug (mirtazipine, quetiapine, serotonin receptor modulator, lithium)
ECT

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23
Q

Treatment of depression in children?

A

Fluoxetine is only medication
Young children: family therapy, art therapy, play therapy, address triggers/problems surrounding child
Teenagers: CBT

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24
Q

Risk factors for poor prognosis in depression

A 
Early age of 1st episode (<20 years) 
Multiple previous episodes 
Chronic Dysthymia 
Comorbid substance misuse 
Severe psychotic depression
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25
Q

Treatment of schizophrenia

A 
Atypical antipsychotic (eg olanzapine, risperidone) as first line. Psychotherapy and social support is also necessary. 
If 2 atypicals don’t work, clozapine has superior efficacy. However careful monitoring is needed due to SE including agranularcytosis. 
ECT has similar efficacy as clozapine
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26
Q

Basic management of SSRI prescription

A
  • Antidepressants should be taken every day for at least 6 months after resolution of symptoms.
  • SSRIs and SNRIs increase the risk of self harm and suicide in the under 30s when first taken. Therefore these patients should be seen after a week of initiating treatment.
  • After 3-4 weeks with no effect, the dose can be increased of SSRIs or the medication can be switched.
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27
Q

What drugs can affect anxiety?

A 
o	B2 agonists (salbutamol)
o	Corticosteroids
o	Alcohol
o	Caffeine
o	Nicotine
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28
Q

Treatment of insomnia if coupled with depression

A

Sedating antidepressants include mirtazapine and trazodone

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29
Q

Treatment of insomnia

A

Sleep hygeine
If fails, short courses of Z-drug hypnotics (eg zopiclone)
Agomelatine can restore circadian rhythm

30
Q

Guidelines for rapid tranquilisation

A
  • Offer oral before parenteral
  • Use lowest effective dose
  • Benzodiazepines are first line (monitor temp, bp, hr)
  • Only use antipsychotic if a psychotic illness is present
  • Recent ECG MUST be available if haloperidol is being prescribed
  • Diazepam reached peak quickest out of the oral options but has the longest elimination half life
  • Olanzapine takes longest to reach peak
31
Q

Which antipsychotics are most likely to cause raised prolactin and sexual dysfunction?

A

Amisulpride & risperidone

32
Q

Which antipsychotic is least likely to cause EPSE and sexual dysfunction

A

Quetiapine

33
Q

Which antipsychotic is most likely to cause weight gain and impaired glucose tolerance?

A

Olanzapine

34
Q

Which antipsychotic is the least sedating?

A

Aripriprazole- alerting not sedating

35
Q

What can help with the hypersalivation caused by clozapine?

A

Atropine eye drops
Hyoscine pills
Absorbent pillows

36
Q

What in the social and PM history may affect dose of clozapine?

A

Coffee drinkers need less
Smokers need more
(CytP450)
Macrolide antibiotics should be avoided

37
Q

What happens is a dose of clozapine is missed?

A

Missed for more than 48hrs?

Start at 12.5mg and work up again

38
Q

How long do you treat someone with antipsychotics after an acute episode of schizophrenia?

A

5 years

High risk of relapse if stopped 1-2 years after

39
Q

What must be considered when prescribing an antidepressant in bipolar?

A

Antidepressants may precipitate mania
Should be prescribed with a mood stabilising drug
Discontinue antidepressant if pt present in an acute manic episode

40
Q

What needs to be considered when treating a pregnant woman with bipolar?

A

Lithium and valproate are both teratogenic

41
Q

Treatment of panic disorder

A

SSRI
CBT
TCAs if SSRIs are ineffective

42
Q

Name 3 typical antipsychotics

A

Chlorpromazine
Haloperidol
Fluoentixol

43
Q

Which antipsychotics can be given by IM depot injection?

A

Fupentixol (typical)
Fluphenazine (typical)
Risperidone (atypical)

44
Q

Which antipsychotics are licensed for acute mania?

A

Risperidone
Olanzapine
Quetiapine

45
Q

Name some anticholinergic SE of antipsychotics

A

Dry mouth
Urinary retention
Constipation
Confusion

46
Q

Name some antihistamine SE of antipsychotics

A

Sedation, weight gain

47
Q

Name some antiadrenergic SE of antipsychotics

A

Postural hypotension (esp chlorpromazine)
Impotence
Dizziness

48
Q

What is neuroleptic malignant syndrome?

A 
Hyperpyrexia
Autonomic instability
Confusion
Increased muscle tone
Increased creatine phosphokinase
Incontinence
Profuse sweating
Ataxia and convulsions if severe
49
Q

What cardiac SE are there with antipsychotics?

A

Prolonged QT interval
Arrythmias
2x risk of sudden cardiac death
esp with haloperidol and pimozide

50
Q

What can be given to patients with extrapyramidal dystonia and parkinsonism SE?

A

Procyclidine (anticholinergic)

51
Q

What can be given to patients with tardive dyskinesia?

A

Reduction of cessation of anticholinergics
Cessation of typical antipsychotics where possible
Clozapine?

52
Q

What is part of the physical health monitoring done for people on antipsychotics?

A

BMI + waist circumference
ECG
FBC, U+Es, lipid profile, LFTs, glucose, HBA1c, prolactin

53
Q

Name 2 SNRIs and main SEs

A 
Venlafaxine
Duloxetine
Suicidal ideation
BP changes
Sexual dysfunction, headache, anorexia
54
Q

Name 2 TCAs and main SEs

A 
Amitriptyline
Imipramine
Anticholinergic (eg dry mouth, urinary retention)
Antiadrenergic (eg postural hypotension)
Cardiac arrhythmias
Seziures
55
Q

Name a MAOi and main SEs

A

Phenelzine
Anticholinergic (eg dry mouth, urinary retention)
Antiadrenergic (eg postural hypotension)
Tyramine reaction

56
Q

What is St John’s Wort?

A

Herbal preparation
Similar to a MAOi
Lots of interactions

57
Q

How to MAOi work?

A

Inhibit breakdown of serotonin at synaptic cleft

58
Q

When is lithium prescribed?

A 
Prophylaxis of bipolar
Acute mania
Augmentation of antidepressants in resistant depression
Schizoaffective illness
The control of aggression
59
Q

What needs to be monitored in lithium prescribing?

A

Serum lithium levels (0.4-1mmol/L)
Thyroid and renal function
(dehydration and diuretics can lead to toxicity)
Pregnancy avoidance

60
Q

Signs of lithium toxicity

A 
D+V
Coarse tremor
Slurred speech
Ataxia
Drowsiness and confusion
Convulsions and coma
61
Q

When are benzodiazepines used? Mechanism?

A 
GABA agonist
Insomnia
Short term crisis in GAD
Alcohol withdrawal states
Control of violent behaviour
62
Q

Treatment of ADHD

A

Methylphenidate

Atomoxetine

63
Q

What must be taken into consideration when prescribing for someone with learning difficulties?

A 
Some medications (eg antipsychotics) are proconvulsant
Avoid polypharmacy as pts might not be able to communicate SEs
64
Q

Main SEs of dexamphetamine

A 
• Common
 - appetite decrease
 - sleep onset delay
 - abdominal pain
 - headache
• Uncommon-rare
 - angina
 - sweating
 - visual disturbances
65
Q

What needs to monitored in a child taking dexamphetamine

A

Growth (height and weight)
Appetite
Sleep
BP

66
Q

Name 2 old antidepressant classes and 2 examples

A

5-HT 2 antagonist and reuptake inhibitor (trazodone)

Noradrenaline and specific serotonergic antagonist (mirtazapine)

67
Q

4 uses of bezodiazepines and method of administration

A
  • Anxiolysis with low dose of long-acting compound
  • Sleep induction with high dose of short-acting compound
  • IV use in treatment of status epilepticus (diazepam, clonazepam)
  • IV use in anaesthetic pre-medication (lorazepam, diazepam)
68
Q

Adverse effects of bezodiazepines

A

Dangerous when combined with alcohol, barbiturates
Memory disturbance
Impaired driving ability
Tolerance to hypnotic effect
Discontinuation symptoms on stopping
Risk of dependence in vulnerable patients

Recommended for short-term treatment (4 weeks) only

69
Q

SE of lithium

A 
Thirst, polydipsia, polyuria
Fine tremor, weight gain
Mild impairment of attention and memory
Hypothyroidism (5%)
Impaired renal tubular function (5-10%)
Lithium toxicity
70
Q

When is the effect of antidepressants seen by?

A

2 weeks

Psych (9 decks)

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