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psychiatry Flashcards

1
Q

important side effects of high potency typical antipsychotic drugs

A

EPS extrapyramidal symotoms

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2
Q

Low potency typical antipsychotic have propensity to cause what side effects

A

anticholinergic –dry mouth constipation
antihistaminic – sedation
alpha1 blockade—orthostatic hypotension

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3
Q

neuroleptic – ie antipsychotics cause what types of extrapyramidal symptoms

A
  1. within hours to 5 days — acute dystonia torticollis oculogyric crisis and opisthotonic crisis
  2. within days or months— akathisia restlessness and parkinsonism ie bradykinesia
  3. over several years– related to length of treatment is tardive dyskinesia–esp orofacial chorea
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4
Q

treatment of acute dystonia from neuroleptics

A

Antihistaminics with anticholinergic effects – diphenhydramina
benztropine

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5
Q

treatment of Akathisia

A

beta blockers
benztropine
benzodiazepines

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6
Q

treatment of drug induced parkinsonism

A

benztropine

if not in options tick amantadine

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7
Q

treatment of tardive dyskinesia

A

switch to atypical antipsychotics —clozapine
velbenazine (VMAT 2 inhibitor)
deu-tetra-benazine (VMAT 2 inhibitor)

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8
Q

difference between neuroleptic malignant syndrome and serotonin syndrome

A

both will have autonomic instablility – vitals are unstable and AMS
but hyperreflexia and clonus is seen with serotonin syndrome
dystonias like rigidity is seen with neuroleptics

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9
Q

antidote for serotonin syndrome

A

cyproheptadine— 5HT2 receptor antagonism

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10
Q

antidote for neuroleptic malignant syndrome

Neuroleptics cause D2 blockade– increases cAMP

A

dantrolene (RYR receptor blockade on sarcoplasmic reticulum)
Bromocriptine – dopamine agonist
remove the antipsychotic drug / discontinue it

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11
Q

drugs causing DRESS syndrome and SJS are similar they are

A

anticonvulsants
sulfa drugs -sulfasalazine
allopurinol
penicillin antibiotics- minocycline / amoxicillin vancomycin

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12
Q

drug induced ANCA vasculitis is seen with

A

hyperthyroidism drugs – PTU and methimazole

Hydralazine (vasodilator)

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13
Q 
drug started
after 2- 8 weeks there is fever, generalised lymphadenopathy 
rash ---erythematous morbilliform rash
facial edema 
EOSINOPHILIA
A

DRESS— drug reaction with eosinophilia and systemic symptoms
Cause is drug induced herpes virus reactivation –>Tcell clonal expansion which cross reacts with drug.

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14
Q

ophthalmic side effect of chlorpromazine antipsychotic

A

corneal deposits

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15
Q

OPh side effect of thioridazine antipsychotic

A

retinal deposits

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16
Q

5 important facts about clozapine –atypical antipsychotic

A

used in treatment resistant schizophrenia and suicidality in schizophrenia
causes obesity agranulocytosis and seizures
need to monitor BM and WBC counts strictly.

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17
Q

lithium toxicity would cause which symptoms

A

tremors– slurred speech hyperreflexia ataxia
seizures
excessive urination — nephrogenic diabetes inspidus

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18
Q

treament of lithium toxicity

A

no antidote–
normal saline and hemodialysis because lithium toxicity is usually seen with renal failure pts and lithium is primarily excreted by kidneys.

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19
Q

How does kidney handles lithium

A

100 percent filtrered
near completely re absorbed by PCT via sodium channels
thiazides NSAIDS and other drugs affecting kidneys are implicated in lithium toxicity

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20
Q

drugs acting on NE neurons causing inhibition of NE reuptake

A

SNRI
TCA
bupro-prion

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21
Q

drugs acting on Serotonergic neurons – inhibiting the serotonin reuptake are

A 
SSRI and SNRI
TCA 
trazodone (weak)
vilazodone
vorti-oxetine
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22
Q

What is the main mechanism of action of trazodone

A

trazodone is atypical antidepressant with sedative action
blocks 5HT2,
blocks alpha 1 adrenergic (postural hypotension and priapism) and H1 receptor

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23
Q

in NE neurons there is an autoreceptor in presynaptic membrane which detects the NE In synaptic cleft and inhibits further release of vesicle fusion. What class is that autoreceptor

A

Alpha 2 adrengergic

24
Q

if alpha 2 adrenergic receptor which is an autoreceptor in presynaptic membrane is inhibited it causes what effect.
which drug acts on it

A

if autoreceptor is inhibited it increases the NE release.
MIRTAZAPINE is one suc alpha 2 autoreceptor blocker
and is used as atypical antidepressant

25
receptors on which mirtazapine acts
Alpha 2 blockade- hence NE and serotonin release increases (hence used in depression) potent 5HT2 and 5HT3 antagonists Histamine H1 antganonist (hence sedation is SE).
26
name the SNRI ones to remember
Venlafaxine duloxetine milna-cipran
27
what is the non psychiatric uses of milnacipran or duloxetine
fibromyalgia
28
name the TCAs
amitriptyline - nortryptyline imipramine - desipramine- clomipramine doxepin-amoxapine
29
treatment of TCA toxicity
TCA toxicity is fatal due to arrhythmias because of prolonged QT interval from sodium channel inhibition. Treatment is Sodium bicarbonate
30
Olanzapine is used to treat which eating disorder
Anorexia nervosa
31
Doc for bedwetting noturnal enuresis
Desmopressin | Imipramine
32
Which anti psychotic causes ejaculatory disturbances
Thioridazone
33
Drugs for alcohol use disorder
Disulfiram Naltrexone Acamprosate Gabapentin topiramate
34
Which two drugs which lower seizure threshold are not given to a person with alcoholism
Haloperidol | Buproprion
35
Repititive outburst with irrational behaviour throughout the day in a child
Dmdd | Dysruptive mood dysregulation disorder
36
Sjs/ Ten rash causing anticonvulsant drugs
Lamotrigine CBZ PHENOBARBITAL PHENYTOIN
37
Two mechanisms by which nimedipine a selective CCB is neuroprotective in SAH
prevents vasospasm by causing cerebral vasodilatation Decreases calcium mediated excitotoxicity
38
A very important adv reaction of succinyl choline in patients with burns crush injury denervation like GBS or quadriplegia is
Hyperkalemia and later arythmias Because succinylcholine causes prolonged blockade due to increase in number of nAChR in these patients Rhabdomyolysis may occur also contributing to hyperkalemia ach receptor is non specific for ion allows sodium in and k out
39
Important side effect of atracurium
It releases histamine— hence hypotension flushing and bronchoconstriction Its metabolite laudanosine causes seizures
40
Four important uses of diazepam
Anxiolytic in GAD or panic attacks Sedative hyponotic for short term insomnia treatment As anticonvulsant in status epilepticus or as first line with chlordiazepoxide for seizures in alcohol withdrawl Or as muscle relaxant to relieve umn spasticity in stroke pts and tetanus
41
Benzodiazepines as a class should not be give with which other drugs
Barbiturates— excessive cns depression Alcohol Gen 1 antihistaminics— sedation Neuroleptics
42
``` Name the condition Pt has unpleasant sensation in legs Urge to move them which releases tht sensation Worst at night So pts usually have sleep onset insomnia ```
Restless leg syndrome
43
causes of restless leg syndrome are
Idiopathic or iron deficiency Uremia Diabetes esp with neuropathy
44
What is the treatment of restless leg syndrome
Avoiding alcohol or sleep deprivation Dopamine agonists like pramipexole Gabapentin pregabalin
45
Pathology for restless leg syndrome
Cns iron def even though serum iron is normal | Abnormalities in dopaminergic transmission
46
Name the drugs inducing restless leg syndrome | Why
The following drugs interfere with brain dopaminergic transmission and hence cause worsening of rls symptoms Dopamine antagonists—antipsychotics and antiemetics like metoclopramide First gen antihistaminics- diphenhydramine Antidepressants—like ssri and mirtazapine
47
Spasticity in cerebral palsy is because of
Loss of descending inhibitory control | Hence there is hyperreflexia clonus
48
Spasticity in cerebral palsy is treated with
Drugs that increase Gaba inhibitory neurotransmittor Bzd acts via gaba A receptor which is fast because it is a chloride channel Baclofen acts via GABA b which is slow because it is a gpcr opening potassium channels
49
What is glycine in neurology
It is a inhibitory neurotranmitter in spinal cord rather than brain
50
Blockage of glycine receptors is seen in
Strychnine poisoning leading to increased muscle contraction
51
Name three drugs for ga induction
Propofol- shud not be used in cvs collapse pts Etomidate— cvs neutral but shud not be used used in septic shock because of adrenocortical suppression Ketamine—has sympathomimetic effects— helps respiratory failure pts but can cause cvs risk and raised ict
52
Mechanism of action of three ga inducers
Propofol and etomidate are gaba agonists Ketamine is nmda antagonist Of these only propofol is highly lipophillic hence used for long term sedation, causes elevated triglycerides and lipase
53
Opiates act on meu receptors. | What is is effect at presynaptic membrane
Meu receptors are transmem receptors linked to inhibitory G proteins Results in closure of calcium channels and hence reduced calcium influx which is needed for vesicular fusion and release Hence it reduces release of excitatory neurotransmittors like Ach, norepinephrine, serotonin, glutamate and substance P
54
Opiates act on meu receptors in post synaptic membrane as well. What are its effects there
Hyperpolarisation | Because of opening of potassium channels and outflux of potassium ions
55
Levels of action of opiates
Spinal as well as supraspinal in brain to produce analgesia | At cord it acts at both presynaptic and post synaptic membrane but effects are different
56
Most serious side effect of clozapine is
Agranulocytosis | Seizures
57
Gingival hyperplasia is a side effect of which drug
Phenytoin Because it increases expression of platelet derived growth factor Gingival macrophages get activated because of PDGF and cause gingival and bone hyperplasia

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