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Maud- Phase 3a > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Name 3 first generation antipsychotic medications?

A

Haloperidol, Chlorpromazine, Prochlorperazine

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2
Q

Haloperidol is in what class of drugs?

A

Antipsychotic (first gen- typical)

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3
Q

What are the indications for prescribing a first generation antipsychotic?

A

Urgent treatment severe psychomotor agitation, Schizophrenia, Bipolar disorder, N+V (particularly in palliative)

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4
Q

Anti-psychotics work by blocking the _____ post-synaptic receptors in the 3 main pathways?

A

Blocking dopamine D2 receptors

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5
Q

What are the Extra-Pyramidal Side Effects (EPSEs)?

A

Acute dystonic reactions, Akathisia, Neuroleptic malignant syndrome

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6
Q

What is meant by akathisia?

A

Feeling of inner restlessness

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7
Q

What is tardive dyskinesia and what drug therapy can cause it?

A

Pointless, involuntary or repetitive movements such as lip smacking.

Develop months/years after long term treatment with antipsychotics

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8
Q

Antipsychotics can prolong the QT interval. Name other drugs that also do this (drug interactions)?

A

Amiodarone, Macrolides (Abx), Quinine, SSRIs

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9
Q

Routes of administration for antipsychotics?

A

Oral, Slow-release IM, IV (emergency only)

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10
Q

4 examples of Second generation antipsychotics?

A

Quetiapine, Olanzapine, Risperidone, Clozapine

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11
Q

Indications for second generation antipsychotics?

*what circumstances indicate second gen >first

A

Severe psychomotor agitation *that leads to dangerous/harmful behaviour.
Schizophrenia *ESPEs complicate use of first gen/negative symptoms present
Bipolar *acute episodes mania/hypomania

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12
Q

Difference between first gen and second gen antipsychotic mechanism?

A
  • Second generation have a higher affinity for other receptors (5-HT2A)
  • Looser binding to D2 receptors.
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13
Q

Which antipsychotic is particularly effective for treatment resistant schizophrenia?

A

Clozapine

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14
Q

Give 6 side effect categories caused by second genetation antipsychotics?

A

Sedation, EPSEs, metabolic, cardiovascular, prolactin, agranulocytosis

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15
Q

Metabolic SEs are common with second generation antipsychotics, what 3 changes might occur?

A

Weight change, developing DM and lipid changes.

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16
Q

Agranulocytosis means what? This occurs in 1% of patients being treated with what antipsychotic?

A

Agranulocytosis= decreased white cell count. Occurs in 1% ptx.

CLOZAPINE

17
Q

Risperidone can have effects on prolactin secretion, what might the patient complain of?

A

Prolactin SEs= sexual dysfunction, breast changes

18
Q

What time of day is it best to take oral antipsychotic medication?

A

Bedtime

19
Q 
Name the class of drug: 
Diazepam, Temazepam, Lorazepam, Midazolam, Chlordiazepoxide.
A

Benzodiazepine

20
Q

What are the indications for benzodiazepines?

A
  • First line tx seizures and status epilepticus.
  • Short term disabling Insomnia/Anxiety.
  • Alcohol withdrawal.
  • Sedation for interventional procedures instead of gen anaesthetic
21
Q

Which receptor does benzodiazepine act on and what is the effect?

A

GABAA receptor-
Chloride channel in the brain- binding causes it to open. Influx of chloride increases resistance to depolarisation and therefore decreases synaptic transmissions and excitability.

Benzodiazepines facilitate and enhance the binding of GABA to GABAA

22
Q

Give the 3 main side effect areas that can occur with benzodiazepines.?

A 
Consciousness= Drowsiness, sedation, coma. 
Dependence= Abrupt cessation withdrawal reaction. 
Airways= Loss of airway reflexes-->  obstruction-->death.
23
Q

Patients taking benzodiazepines do not need to inform the DVLA- true or false?

A

Patients do not need to inform the DVLA
You should advise them not to drive/operate heavy machinery after taking the drug.

(they do if its being prescribed for a seizure)

24
Q

Which benzodiazepine is prescribed for alcohol withdrawal?

A

Chrodiazepoxide

+IV pabrinex

25
Q 
Name the benzodiazepine  prescribed for:
seizures,
alcohol withdrawal,
interventional sedation,
insomnia/anxiety?
A

Seizure= Lorazepam.
Alcohol withdrawal= oral chlordiazepoxide.
Interventional sedation = midazolam.
Insomnia/anxiety= Temazepam.

26
Q

Give 3 examples of SSRIs?

A

Sertraline, Fluozetine, Citalopram

27
Q

What are the 3 indications for prescribing SSRIs?

A

Moderate-severe depression, Panic disorder, Obsessive compulsive disorder

28
Q

Why do the following patient groups need extra consideration/monitoring when prescribing SSRIs:
Young patients,
Patients with liver impairment
Patients with epilepsy

A

Young- increased suicidal thoughts.
Liver impairment- SSRIs are metabolised by the liver.
Epilepsy- lower seizure threshold.

29
Q

Why are Monoamine Oxidase Inhibitors contraindicated with SSRIs?

A

MAOIs also increase serotonin (can be used in tx for atypical depression)

30
Q

Amitritptyline is what type of drug?

A

Tricyclic antodepressant

31
Q

Indication for tricyclic antidepressant?

A

Second line mod-severe depression (when SSRIs ineffective)

32
Q

Tricyclics inhibit neuronal uptake of…

A

Serotonin (5-HT) and noradrenaline

33
Q

Tricyclics block muscarinic receptors. What are the 4 side effects of this?

A

Dry mouth, Blurred vision, Constipation, Urinary retention.

34
Q

True or False. SSRIs have more SEs than Tricyclics

A

False.

SE’s:
Tricyclics>SSRIs

35
Q

When coming off tricyclics there should be a slow reduction over the course of how long?

A

4 weeks

36
Q

What are valproates indicated for?

A

Epilepsy, Bipolar

First line for generalised/absence seizure. Tx option for focal seizure

37
Q

Mechanism of valproates?

A

Weak inhibitors of neuronal Na+ channels: increasing membrane stability.
Increase GABA levels in brain.

38
Q

What are the driving regulations in relation to epilepsy and anti-epileptic drugs such as valproate?

A

You shouldn’t drive within 12 months of a seizure or within 6 months of stopping or changing anti-epileptic drug

Maud- Phase 3a (3 decks)

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