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Psychiatry > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What kind of anti-depressant is Venlafaxine?

A

SNRI

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2
Q

Zopiclone is a benzodiazepine-like agent who’s side effects include…

A

metallic taste and headache

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3
Q

What kind of anti-depressant is imipramine?

A

tricyclic

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4
Q

Why do tricyclics cause urinary retention and overflow incontinence?

A

anti-cholinergic effect

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5
Q

What is a life threatening side effect of clozapine?

A

angranulocytosis/ neutropenia

monitor FBC

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6
Q

Which atypical anti-psychotic has a higher risk of dyslipidemia and obesity?

A

olanzapine

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7
Q

Name 6 atypical antipsychotics.

A 
olanzapine
risperidone
quetiapine
amisulpride
aripiprazole
clozapine
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8
Q

High WCC in patient taking lithium. Are you worried?

A

No, Lithium can cause benign leucocytosis

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9
Q

Which drug can help treat tardive dyskinesia (as SE of anti-psychotics)?

A

Tetrabenazine

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10
Q

Procyclidine is useful for treatment of what SEs of anti-psychotics?

A

Extra-pyramidal SEs (except tardive dyskinesia)

Acute dystonia

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11
Q

Which drug is useful to treat akathisia (restlessness) as anti-psychotic SE?

A

propanolol

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12
Q

What kind of drugs are anti-psychotics?

A

Dopamine2 receptor antagonists

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13
Q

Which types of anti-psychotic tend to cause extra-pyramidal SEs?

A

typical

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14
Q

Which anti-psychotic is particularly risky for prolonged QT ?

A

haloperidol

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15
Q

What kind of anti-depressant is duloxetine?

A

SNRI

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16
Q

What kind of anti-depressant is mirtazapine?

A

“Noradrenaline and specific serotonergic”

- a TETRACYCLIC

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17
Q

What drug to prescribe for an old person with depression who is also suffering from poor sleep and poor appetite?

A

mirtazapine

helps appetite and sleep

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18
Q

What is first line treatment for delirium tremens?

A

chlordiazepoxide

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19
Q

What kind of drug is chlordiazepoxide

A

benzodiazepine

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20
Q

Which neurotransmitter do benzodiazepines enhance the effect of?

A

GABA

by increasing the frequency of chloride channels

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21
Q

Give me an example of a sedating antihistamine

A

promethazine

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22
Q

Hx of 2 episodes up or down = diagnosis of ___

A

bipolar disorder (just down = depression)

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23
Q 
You MUST tell the DVLA if you've got a diagnosis of: 
bipolar disorder
paranoid schizophrenia
psychosis 
psychotic depression 
schizoaffective disorder 
schizophrenia

They might not stop you from driving but they need to know.

A

yes. a.k.a any of the psychoses

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24
Q

Why is it important to know if someone has been compliant with taking their clozapine?

A

you lose clozapine tolerance within 48hrs

if give again at normal dose then can be fatal

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25
Q

When an anti-depressant in indicated in child/adolescent, what is the drug of choice?

A

Fluoxetine

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26
Q

What kind of anti-psychotic is chlorpromazine?

A

typical

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27
Q

Describe tardive dyskinesia

A

abnormal involuntary movements
e.g. grimacing, tongue poking or excessive blinking

affects patients on typical antipsychotics

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28
Q

Which form of amnesia is commonest after ECT?

A

retrograde amnesia

other SEs include:
Drowsiness 
Confusion
Headache
Nausea 
Aching muscles
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29
Q

Does lithium toxicity cause hypo or hyper thyroid?

A

hypothyroidism

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30
Q

A patient on an SSRI is getting agitation, hyperthermia, hyperreflexia, sweating and dilated pupils. What could this be?

A

serotonin syndrome

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31
Q

What are the symptoms of serotonin syndrome?

A 
agitation, fluctuating GCS
hyperthermia
hyperreflexia
sweating
dilated pupils
diarrhoea
tachycardia

[NEUROMUSCULAR ABNORMALLITY + AUTONOMIC DYSFUNCTION + ALTERED MENTAL STATE ]

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32
Q

What are the monoamines?

A

serotonin and dopamine

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33
Q

Serotonin syndrome is most frequently mixed up with which differential…

A

neuroleptic malignant syndrome

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34
Q

How do you manage serotonin syndrome?

A

stop the antidepressant
supportive care
bad - cyproheptadine (5HT antagonist)

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35
Q

Antipsychotics are also known as

A

neuroleptics

36
Q

a rare but potentially life-threatening reaction to antipsychotics ?

A

neuroleptic malignant syndrome

37
Q

What antipsychotic is particularly bad for neuroleptic malignant syndrome?

A

haloperidol (the typicals)

38
Q

What are 3 key signs of neuroleptic malignant syndrome?

A

lead-pipe muscle rigidity
hyperthermia temp >38
autonomic instability

39
Q

What is the treatment for neuroleptic malignant syndrome?

A

stop the drug
rapid cooling + antipyretics
IV benzos for agitation

40
Q

What’s tetrabenazine for?

A

tardive dyskinesia

41
Q

What’s procyclidine for?

A

EPSEs except tardive dyskinesia

42
Q

What’s promethazine for?

A

sedating antihistamine

43
Q

What’s propanolol for?

A

akithisia (restlessness)

44
Q

Apart from helping sleep and weight gain, why else is mirtazipine often use for old people?

A

less interactions e.g. can take with warfarin

45
Q

Which antidepressant is best when someone has lots of physical health problems, because it doesnt interact with many drugs?

A

sertraline

46
Q

What common drugs are a bad common with SSRIs

A 
NSAIDs 
consider gastroprotection (PPI)
47
Q

Why are tricyclics not great?

A

more SEs

DANGEROUS IN OVERDOSE

48
Q

You’ve started a 27yr old on an anti-depressant at the GP. How soon should you review him?

A

within 1 week (<30)

49
Q

You’ve started a 35 yr old on an anti-depressant at the GP. How soon should you review her?

A

within 2 weeks (>30)

50
Q

You’ve reviewed your 27 yr old who you started on an anti-depressant a week ago. He is doing okay. When should you arrange subsequent reviews for?

A

every 2-4wks for the first 3 months

51
Q

What is the step wise drug treatment for depression?

A

SSRI (trial 2)
then Tricyclic
then SSRI + triyclic
then + adjuvant

52
Q

What is the triad for serotonin syndrome?

A 
NEUROMUSCULAR ABNORMALITY (hyperreflexia, tremor)
AUTONOMIC DYSFUNCTION (sweating, diarrhoea)
ALTERED MENTAL STATE (fluctuating GCS, agitation)
53
Q

Someone has neuromuscular abnormality, autonomic dysfunction, altered mental state. What’s this?

A

serotonin syndrome

54
Q

What is appropriate management of MILD depression by GP?

A

watchful waiting / IAPT

55
Q

What is appropriate management of MODERATE depression by GP?

A

anti-depressant

? psych referral

56
Q

Do you use hypnotics in generalised anxiety?

A

NO

57
Q

Name me some groups of hypotics (x3)

A

bezos
z-drugs
melatonin

58
Q

Name me some withdrawal effects of benzos and other hypnotics….

A

irritability, insomnia, anxiety, seizures!

59
Q

Who can you prescribe melatonin to?

A

> 55s
jet lagged ppl
<18s with ASD

60
Q

About anxiolytics, NB the first and second line treatments for generalised anxiety disorder are talking therapies. If low-intensity and high-intensity psychological therapies don’t work, what drugs?

A

sertraline (or other SSRI/SNRI)

no? pregabalin

61
Q

You’ve tried SSRIs and SNRIs for severe generalised anxiety disorder and they haven’t worked. What drug might you try next?

A

pregabalin

62
Q

When is the ONLY time you should use benzos in generalised anxiety disorder?

A

in short term crises

63
Q

Name me 4 SSRIs

A

sertraline
fluxetine
citalopram
paroxetine

64
Q

Give me three SEs of tricyclics

A

sedation
cardiac arrhythmias
anticholinergic SEs!

65
Q

Give me two SNRIs

A

venlafaxine

duloxetine

66
Q

3 Ss for SEs of SNRIs?

A

sexual dysfunction
serotonin syndrome
suicidality

67
Q

Two SEs of mirtazipine (tetracyclic)

A

weight gain

sedation

68
Q

What happens if you eat cheese and red wine if you’re on MAO inhibitors

A

hyptertensive crisis

69
Q

Cheese and red wine make you think of

A

MAO inhibitors, hypertensive crisis

70
Q

Name 3 typical antipsychotics

A

haloperidol
chlorpromazine
sulpiride
flupentixol

71
Q

Which kinds of antipsychotics cause metabolic syndrome > EPSEs?

A

atypical

olanzapine worst, aripiprazole best

72
Q

Give me three SEs of clozapine

A

weight gain
hypersalivation
agranulocytosis!

73
Q

Name 3 psychological interventions that can be done in primary care.

A

Counselling
Psychoeducation
CBT

74
Q

Name 3 psychological interventions that can be done in secondary care or specialist services.

A

DBT
group therapy
family therapy

75
Q

Side effects of atomoxetine (ADHD)? (impressed if you know this)

A

liver dysfunction, suicidality

76
Q

Side effects of methylphenidate? (impressed if you know)

A

appetite suppression, psychosis

77
Q

Give me two tricyclics.

A

imipramine

amitryptiline

78
Q

What do SSRIs do to your electrolytes?

A

HYPONATRAEMIA SSRIs

79
Q

What is the classic ‘monamine hypothesis’ of how anti-depressants work?

A

anti-depressants increase the level of serotonin and dopamine available in the brain

80
Q

What is the newer ‘neuroplasticity hypothesis’ of how anti-depressants work?

A

they decrease glutamate
and increase plasticity in hippocampal neurones
… new ways of thinking!
that’s why they’re best in conjunction with talking therapies

81
Q

How long should I take anti-depressant for doctor?

A

at least 6 months following remission of symptoms,

reduces risk of relapse

82
Q

Give me some examples of low-intensity psychological interventions for mild depression. (x3)

A

guided self-help
group-based peer support
computerized CBT

83
Q

Give me some examples of high-intensity psychological interventions for moderate-severe depression. (x3)

A

CBT (individual/group)
interpersonal therapy
MBCT!!!
behavioural activation

84
Q

Apart from all the stuff you usually think of, what unusual treatment for depression

A

transcranial magnetic stimulation

85
Q

cyproheptadine. What is it and when is it used?

A

5HT antagonist

in serotonin syndrome if rlly bad

86
Q

How do antipsychotics work?

A

dopamine antagonists

may be about attribution of salience to stimuli

Psychiatry (10 decks)

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