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Psychiatry > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

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?

A

discontinuation syndrome

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2
Q

what is the main side effect you have to be aware of when prescribing tricyclic antidepressants?

A

prolongation of QT interval

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3
Q

what are the side effects of tricyclic antidepressants?

A

anticholinergic
antihistaminic
antiadrenergic
prolongation of QT interval

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4
Q

what are the side effects from monoamine oxidase inhibitors?

A 
dry mouth
sedation
weight gain
sexual dysfunction
sleep disturbance
orthostatic hypotension
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5
Q

what are the side effects of amitryptilline?

A

anticholinergic - dry mouth, dry eyes, constipation, memory deficit, delirium

antiadrenergic - sedation, orthostatic hypotension, sexual dysfunction

antihistaminergic - weight gain, sedation

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6
Q

what type of drug is nortryptiline and what are its side effects?

A

secondary tricyclic antidepressant
often metabolite of tertiary TCA
same side effects as tertiary TCA i.e. antiadrenergic, antihistaminergic, anticholinergic, but less severe

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7
Q

what is serotonin syndrome?

A

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)

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8
Q

what is the presentation of serotonin syndrome?

A 
abdominal pain 
diarrhoea
sweats
tachycardia
hypertension
myoclonus
irritability
delirium
hyperpyrexia
shock
death
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9
Q

what SSRI is most likely to induce mania than any other SSRI?

A

fluoxetine

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10
Q

what is the maximum dose of citalopram and why?

A

30 - 40mg/day
this can cause severe QT prolongation

QT prolongation occurs at doses of 10-30mg !

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11
Q

what SSRIs can cause QT prolongation and at what doses is this side effect likely to occur?

A

citalopram

escitalopram

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12
Q

name 2 serotonin noradrenaline re-uptake inhibitors (SNRI).

A

venlafaxine

duloxetine

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13
Q

what are the main side effects of venlafaxine?

A

QT prolongation
increase diastolic blood pressure (10-15mmHg)
Discontinuation syndrome
sexual side effects

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14
Q

name 2 novel antidepressants.

A

buproprion

mirtazapine

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15
Q

what class of drug is mirtazapine and what are the side effects?

A

Novel antidepressant

weight gain
increase in cholesterol
sedating

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16
Q

what class of antidepressant is the first line of choice in a new patient who has been diagnosed with depression?

A

SSRI

i.e. fluoxetine, citalopram, sertraline

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17
Q

what factors determine a good response to lithium?

A

family history of positive response to lithium
pure mania
mania followed by depression

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18
Q

at what blood level should you aim lithium to be?

A

0.6 - 1.2

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19
Q

before starting lithium what baseline tests would you carry out?

A

TSH
U&E
b-HCG in women

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20
Q

how frequent is a patient on lithium monitored?

A

every 3 months for blood levels

every 6 months - creatinine and TSH

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21
Q

what are the side effects of lithium ?

A 
GI distress
thyroid abnormalities
nonsignificant leukocytosis
polyuria/polydypsia
hair loss
acne 
reduces seizure threshold, cognitive slowing and intention tremor
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22
Q

what are the symptoms of lithium poisoning?

A 
vomiting
diarrhoea
ataxia
dizziness
anorexia
slurred speech
nystagmus
blurred visions
clonic climb movements
delirium 
oligouria
seizures
renal failure
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23
Q

before starting a patient on sodium valproate, what baseline tests should you cary out?

A

FBC
LFT’s
b-HCG in women

24
Q

before starting sodium valproate, what supplement would you put a a female patient on and why?

A

folic acid

risk of neural tube defects

25
Q

what tests are carried out to monitor a patient on sodium valproate?

A

FBC

LFTs

26
Q

what are the side effects of sodium valproate?

A 
thrombocytopenia and platelet dysfunction
nausea, vomiting
weight gain 
sedation
tremor
hair loss
neural tube defect
27
Q

what is the first line treatment for acute mania and mania prophylaxis?

A

carbamazepine

28
Q

what baseline tests should be carried out before starting a patient on carbamezapine?

A

LFTs
FBC
ECG

29
Q

when monitoring a patient who is on carbamazepine, what tests are carried out?

A

FBC

LFT

30
Q

what are the side effects of carbamazepine?

A 
low sodium levels / hyponatraemia 
nystagmus 
rash 
ataxia 
aplastic anaemia and agranulocytosis 
drug-drug interactions 
sedation
dizziness
confusion
31
Q

what are the side effects of lamotrigine?

A

toxic epiderimal necrolysis / SJS
nausea/ vomiting
blood dyscrasia

32
Q

what are the side effects of low potency antipsychotic drugs?

A

anticholinergic (dry mouth, dry eyes, constipation, memory deficit, delirium)
cardiotoxic

33
Q

give 3 examples of atypical antipsychotics.

A

olanzapine, risperidone, quetiapine

34
Q

what are the adverse effects associated with typical antipsychotics?

A

tardive dyskinesia (involuntary muscle movements)
neuroleptic malignant syndrome (muscle rigidity)
extrapyramidal side effects (dystonia, parkinson symptoms, akathisia)

35
Q

what is the difference in the action between typical and atypical antipsychotics?

A

typical = D2 dopamine receptor antagonist

atypical = serotonin-dopamine 2 antagonist

36
Q

what basic blood wok should be carried out before starting a patient on antipsychotics?

A

fasting lipid profile
fasting blood glucose
LFTs
FBC

37
Q

if a patient is requiring an antipsychotic but on baseline testing they show a high cholesterol, what medication do you chose?

A

risperidone

don’t use olazapine or quetiapine.

38
Q

what disorders is benzodiazepine used to treat?

A

insomnia
parainsomnia
anxiety

39
Q

what are the side effects of benzodiazepines?

A 
dependancy 
somnolence
cognitive deficits
amnesia 
disinhibition
40
Q

what’s the main difference in the effects of benzodiazepine vs buspirone?

A

buspirone won’t give an effect to a patient who has previously been on benzos as buspirone doesn’t give a sedation affect

41
Q

what is the minimum length of time antidepressants should be continued after a response?

A

6 months

42
Q

what mood stabiliser (anticonvulsant) can cause TEN/SJS?

A

lamotrigine

43
Q

you see a patient who has had 5 episodes of elevated mood, irritability and impulsivity.
what medication is best to give?

A

sodium valproate / valproic acid

- rapid cycling bipolar = 4 or more episodes of mania and/or depression within 12 months

44
Q

what is tardive dyskinesia?

A

involuntary movements of the facial and body muscles

results in involuntary facial expressions i.e. sticking out tongue, frowning etc

45
Q

what are the extrapyramidal effects associated with adverse effects of antipsychotics?

A

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

46
Q

what are the consequences of severe lithium toxicity? at what level does this occur at?

A

> 2.5

oliguria
renal failure (distal tubular acidosis)
generalised convulsions

47
Q

what are the symptoms of lithium poisoning?

A 
ataxia
dizziness
nystagmus 
blurred vision 
slurred speech 
nausea / vomiting 
anorexia 
confusion, delirium 
syncope 
clonic limb movements 
convulsions
oliguria and renal failure
48
Q

what type of drug is olanzapine and what are the side effects?

A

atypical antipsychotic

weight gain 
hyperglycaemia
hypertriglyceridemia 
hypercholesterolaemia 
hyperprolactinaemia 
abnormal LFTs
49
Q

what are the side effects of clozapine?

A 
agranulocytosis 
sedation 
weight gain 
abnormal LFTs 
hypertryglyceridemia 
hypercholesterolaemia 
hyperglycaemia 
nonketonic hyperosmolar coma and death
50
Q

what are the side effects of risperidone?

A

weight gain
sedation
hyperprolactinaemia
extrapyramidal effects

51
Q

what are the side effects of quetiapine?

A 
weight gain 
hyperglycaemia 
hypertriglyceridemia 
hypercholesterolaemia 
orthostatic hypotension
52
Q

dual therapy with clozapine and what drug will increase risk of seizures

A

lithium

53
Q

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?

A

neuroepileptic malignant syndrome

54
Q

what its he treatment for akathisia?

A

anxiolytic (i.e. benzodiazepines) or propranolol

55
Q

what is the main side effect of clozapine?

A

agranulocytosis

Psychiatry (13 decks)

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