Pharmacology Flashcards
A patient attends the GP complaining of agitation, nausea and general feeling of being fed up with life. He recently stopped taking SSRI’s 2 weeks ago.
what is the diagnosis?
discontinuation syndrome
what is the main side effect you have to be aware of when prescribing tricyclic antidepressants?
prolongation of QT interval
what are the side effects of tricyclic antidepressants?
anticholinergic
antihistaminic
antiadrenergic
prolongation of QT interval
what are the side effects from monoamine oxidase inhibitors?
dry mouth sedation weight gain sexual dysfunction sleep disturbance orthostatic hypotension
what are the side effects of amitryptilline?
anticholinergic - dry mouth, dry eyes, constipation, memory deficit, delirium
antiadrenergic - sedation, orthostatic hypotension, sexual dysfunction
antihistaminergic - weight gain, sedation
what type of drug is nortryptiline and what are its side effects?
secondary tricyclic antidepressant
often metabolite of tertiary TCA
same side effects as tertiary TCA i.e. antiadrenergic, antihistaminergic, anticholinergic, but less severe
what is serotonin syndrome?
complication of taking monoamine oxidase inhibitors with meds that increase serotonin levels i.e. SSRI
therefore if switching from SSRI to MOI, you have to wait for 2 weeks before starting MOI (exception with fluoxetine - wait 5 weeks)
what is the presentation of serotonin syndrome?
abdominal pain diarrhoea sweats tachycardia hypertension myoclonus irritability delirium hyperpyrexia shock death
what SSRI is most likely to induce mania than any other SSRI?
fluoxetine
what is the maximum dose of citalopram and why?
30 - 40mg/day
this can cause severe QT prolongation
QT prolongation occurs at doses of 10-30mg !
what SSRIs can cause QT prolongation and at what doses is this side effect likely to occur?
citalopram
escitalopram
name 2 serotonin noradrenaline re-uptake inhibitors (SNRI).
venlafaxine
duloxetine
what are the main side effects of venlafaxine?
QT prolongation
increase diastolic blood pressure (10-15mmHg)
Discontinuation syndrome
sexual side effects
name 2 novel antidepressants.
buproprion
mirtazapine
what class of drug is mirtazapine and what are the side effects?
Novel antidepressant
weight gain
increase in cholesterol
sedating
what class of antidepressant is the first line of choice in a new patient who has been diagnosed with depression?
SSRI
i.e. fluoxetine, citalopram, sertraline
what factors determine a good response to lithium?
family history of positive response to lithium
pure mania
mania followed by depression
at what blood level should you aim lithium to be?
0.6 - 1.2
before starting lithium what baseline tests would you carry out?
TSH
U&E
b-HCG in women
how frequent is a patient on lithium monitored?
every 3 months for blood levels
every 6 months - creatinine and TSH
what are the side effects of lithium ?
GI distress thyroid abnormalities nonsignificant leukocytosis polyuria/polydypsia hair loss acne reduces seizure threshold, cognitive slowing and intention tremor
what are the symptoms of lithium poisoning?
vomiting diarrhoea ataxia dizziness anorexia slurred speech nystagmus blurred visions clonic climb movements delirium oligouria seizures renal failure
before starting a patient on sodium valproate, what baseline tests should you cary out?
FBC
LFT’s
b-HCG in women
before starting sodium valproate, what supplement would you put a a female patient on and why?
folic acid
risk of neural tube defects
what tests are carried out to monitor a patient on sodium valproate?
FBC
LFTs
what are the side effects of sodium valproate?
thrombocytopenia and platelet dysfunction nausea, vomiting weight gain sedation tremor hair loss neural tube defect
what is the first line treatment for acute mania and mania prophylaxis?
carbamazepine
what baseline tests should be carried out before starting a patient on carbamezapine?
LFTs
FBC
ECG
when monitoring a patient who is on carbamazepine, what tests are carried out?
FBC
LFT
what are the side effects of carbamazepine?
low sodium levels / hyponatraemia nystagmus rash ataxia aplastic anaemia and agranulocytosis drug-drug interactions sedation dizziness confusion
what are the side effects of lamotrigine?
toxic epiderimal necrolysis / SJS
nausea/ vomiting
blood dyscrasia
what are the side effects of low potency antipsychotic drugs?
anticholinergic (dry mouth, dry eyes, constipation, memory deficit, delirium)
cardiotoxic
give 3 examples of atypical antipsychotics.
olanzapine, risperidone, quetiapine
what are the adverse effects associated with typical antipsychotics?
tardive dyskinesia (involuntary muscle movements)
neuroleptic malignant syndrome (muscle rigidity)
extrapyramidal side effects (dystonia, parkinson symptoms, akathisia)
what is the difference in the action between typical and atypical antipsychotics?
typical = D2 dopamine receptor antagonist
atypical = serotonin-dopamine 2 antagonist
what basic blood wok should be carried out before starting a patient on antipsychotics?
fasting lipid profile
fasting blood glucose
LFTs
FBC
if a patient is requiring an antipsychotic but on baseline testing they show a high cholesterol, what medication do you chose?
risperidone
don’t use olazapine or quetiapine.
what disorders is benzodiazepine used to treat?
insomnia
parainsomnia
anxiety
what are the side effects of benzodiazepines?
dependancy somnolence cognitive deficits amnesia disinhibition
what’s the main difference in the effects of benzodiazepine vs buspirone?
buspirone won’t give an effect to a patient who has previously been on benzos as buspirone doesn’t give a sedation affect
what is the minimum length of time antidepressants should be continued after a response?
6 months
what mood stabiliser (anticonvulsant) can cause TEN/SJS?
lamotrigine
you see a patient who has had 5 episodes of elevated mood, irritability and impulsivity.
what medication is best to give?
sodium valproate / valproic acid
- rapid cycling bipolar = 4 or more episodes of mania and/or depression within 12 months
what is tardive dyskinesia?
involuntary movements of the facial and body muscles
results in involuntary facial expressions i.e. sticking out tongue, frowning etc
what are the extrapyramidal effects associated with adverse effects of antipsychotics?
parkinsonism
akathisia - don’t feel comfortable in skin, agitation
acute dystonia - abnormal muscle tone resulting in muscle spasms and involuntary movements
neuroepileptic malignant syndrome
tardive dyskinesia - inapprpriate muscle movement i.e. sticking out tongue, lip smacking
what are the consequences of severe lithium toxicity? at what level does this occur at?
> 2.5
oliguria
renal failure (distal tubular acidosis)
generalised convulsions
what are the symptoms of lithium poisoning?
ataxia dizziness nystagmus blurred vision slurred speech nausea / vomiting anorexia confusion, delirium syncope clonic limb movements convulsions oliguria and renal failure
what type of drug is olanzapine and what are the side effects?
atypical antipsychotic
weight gain hyperglycaemia hypertriglyceridemia hypercholesterolaemia hyperprolactinaemia abnormal LFTs
what are the side effects of clozapine?
agranulocytosis sedation weight gain abnormal LFTs hypertryglyceridemia hypercholesterolaemia hyperglycaemia nonketonic hyperosmolar coma and death
what are the side effects of risperidone?
weight gain
sedation
hyperprolactinaemia
extrapyramidal effects
what are the side effects of quetiapine?
weight gain hyperglycaemia hypertriglyceridemia hypercholesterolaemia orthostatic hypotension
dual therapy with clozapine and what drug will increase risk of seizures
lithium
a patient presents with fever, confusion and severe muscle rigidity. he is on chlorpromazine for schizophrenia.
his WCC, CK and LFTs are elevated.
what is your diagnosis?
neuroepileptic malignant syndrome
what its he treatment for akathisia?
anxiolytic (i.e. benzodiazepines) or propranolol
what is the main side effect of clozapine?
agranulocytosis
