Set 4 Flashcards by Lucy M

Clozapine induced agranulocytosis % after one year
- 0.5%
- 5%
- 0.01%
- 0.1%
- 1%

0.01%

prevalance of agranulocytosis during clozapine treatment is 0.4%
typically occurs within first 18 weeks
after 1 year –> 0.39/1000 –> <0.01%

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which antidepressant is least likely to cause manic switch when stable on long term treatment for bipolar disorder
- sertraline
- venlafaxine
- vortioxetine
- phenelzine
- paroxetine

sertraline ??

Risk of switch:
- HIGHEST= TCAs
- MAOIs
- SNRIs
- SSRIs

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Disulfram: side effect in the absence of alcohol consumption
- headache
- excessive sweating
- fushing
- palpitations
- nausea

headache

in absence of alcohol, SE include halitosis, metallic taste, headche, dermatitis, sedation

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SE sildenefil (phosphodiesterase inhibitors)
- nausea
- polydipsia
- diarrhoea
- constipation
- nasal congestion

nasal congestion
(also mild headaches, dizziness)

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When is lamorigine rash more likely to occur

when with valproate
exceeding recommended initial dose
rapid dose excalation

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How doe MAOI impact Qtc?

unclear by may shortern it

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Which antidepressants increase QTc?

At usual doses:
1. ciralopram/ escitalopram
2. tricyclics

At overdose:
- buproprion shorterns it but prolongation has been reported in cases of overdose
- venlafaxine/ desvenlafaxine has possible prolongation in overdose
- moclobemide
- lofepramine

duloxetine (isolated reports)

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QTc and antipsychotics:
how do the following compare:
- aripiprazokle
- clozapine
- olanzapine
- risperidone
- sulpiride
- quetiapine
- haloperidol
- chlorpromasie
- amisulpride

NO:
- caripraszine
- lurasidone
- lumateperone
- brexipiprazole

LOW
- aripiprazole
- clozapine
- flupenxiol
- prochlorprerazine
- olanzapine
- paliperidone
- sulpride

MODERATE
- amisulpride
- chlorpromazine
- haloperidol
- lveopromazine
- quetiapine

HIGH
- any IV
- any combo
- sertindol
- pimozide

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Antidepressant and overdose - which caused prolonged QTc
- reboxetine
- sertraline
- moclobemide
- mirtazapine
- venlafaxine

Moclobemide is a reversible inhibitor of monoamine oxidase A (RIMA)
–> prolonged QT in overdose

the others don’t really impact it (sertraline only small increase at higher doses)

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Carbemazepine can rasie plasma levels of what dug
- phenytoin
- lithium
- sodium valproate
- lamotrigine
- topiramate

phenytoin

(also clomipramine and primidone)

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Lithium and ACEi

ACEi reduces thirst –> dehydration –> renal sodium loss –> increased sodium reabsorrpton –> INCREASED lithium leveles

risk increased in heart failure
dehydration
renal impairment
elderly

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Which is a slow rhythmic movement disorder affecting the extremities?
- athetosis
- akathisia
- dystonia
- sydenham chorea
- tic

athetosis

slow involuntary writing movements esp of fijngers, hadns, head and tongue

Sydenham chorea= rapid uncoordinted jerky movement
Tic= habituatl spasmodic contraction of muscles

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methyphenidate MoA
- blocking dopamine transporter
- blocking orexin
- histamine antagonist
- serotonin reuptake inhibitor
- inhibition of the hypothalamus

blocking dopamine transporter

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Pt with opidate dependance wants an alpha-2-agonist medication to prevent withdrawals. She has Hx of marked hypotension. Which to start?
- tizanidine
- romididine
- lofexidine
- clonidine
- guanfacine

lofexidine

both chlonidine and lofexidine are used to treat withdrwarl Sx of opiates. Clonidine –> hypotynesion.

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Patinet with amitriptyline who gets postural hypotension is due to which receptor blockage
- D2
- 5-HT2A
- alpha-1
- beta
- histamine

alpha-1

amitriptyline works on serotonin and norepinephrine reuptake inhibitor
also blocks alpha adrenergic 1 receptor –> dizziness, sedation, and hypotenison

sedative effects and weight gain due to antihistaminic properties

anticholinergic= sedative, dry mouth, constipation, blurred vision

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Zopiclone acts on:
- alpha-1 subunit of omega 1 receptor
- alpha-2 subunit of omega 1 receptor
- delta-1 subunit of omega 1 receptor
- omega-1 subunit of Sigma 1 receptor
- omega-1 subunit of alpha 1 receptor

alpha-1 subunit of omega 1 receptor

Z drugs bind to benzodiazepine-sensitive GABA-A receptors

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Mechanism of action of pregabalin?
- idential action to GABA
- binds to GABA-A sites
- potentiates effects of GABA
- blocks glutamate
- binds to voltage-gated calcium channels

binds to voltage-gated calcium channels

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Collapse on venlafazine with sweating and altered concious state after taking weight loss pills. what are they?
- guarana
- sibutramine
- magnesium
- saffron extract
- orlistate

Sibutramine - MOAI acts on appetite suppressant

SSRI and SNRI –> serotonin syndrome

sibutramine withdrawn from UK market

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Which is the most teratogenic:
- lamotrigine
- carbemazepine
- valproate
- dosulepin
- lithium

valproate

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Patient with opioid dependence. Medicaiton which will counteract the impact of opioids and help her stp the use.
- baclofen
- methadone
- naltrexone
- naloxone
- clonidine

naltrexone

(ABSTINENCE PROGRAMME VS SUBSTITUTE PROGRAMME)

Substitute= methadone or buprenorpine
Abstinence= naloxone and naltrexone

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which neurotransmitter released primary from medial and dorsal raphe nucleus
- acetylcholine
- dopamine
- noradrenaline
- serotonin
- GABA

serotonin

ascending and descending projections

Ascending= regulate mood, anxiety, sleep and other functions
Descending= regulate pain

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Which to avoid prescribing with warfarin:
- venlafaxine
- trazadone
- duloxetine
- mirtazapine
- fluoxetine

fluoxetine as may displace high protein-bound drugs like warfarin (ALSO fluoxetine strong inihibiton of CYP)

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which depot has longest half life after 1st dose?
- zucloprenthixol deconate
- haloperidol deconate
- paliperidone palmitate
- fluphenazine deconate
- olanzapine pamoate monohydrate

paliperidone palmitate= 40 days
zucloprenthixol deconate= 19 days
haloperidol deconate= 21 days
fluphenazine deconate= 6-9 days
olanzapine pamoate monohydrate =30 days

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Narcolepsy is caucse by:
- excess melatonin
- loss of orexin-secreting neurons
- histamine defieicny
- circadian rhythm disturbance
- deficiency of leptin

loss of orexin secreting neurons

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Which has LOWEST risk hyponatramia - fluoxetine - venlafaxine - sertraline - amitriptyline - trazadone

amitriptyline MODERATE risk= TCA HIGHER risk= trazodoe (SARI) and even higher for SSRIs and SNRI

WHich is pure D2 antagonist - sulpiride - aripiprazole - perospirone - amisulpride - olnazapine

sulpiride

Most effective antipsychotic for patients with hyponatramia - chlorpromazine - haloperidol - flupentixol - clozapine - quetiapie

clozapine

which is the most weight neutral - quetiapine - risperidone - aripiprazole - olanzapine - clozapine

aripiprazole

Which least likely to result in mania - imipramine - mirtazapine - amitriptyline - venlafaxine - buproprion

bupropion

Pharmaokinetics in elderly which most likely for a lipophilic drug - increased creatinine clearance - lower GIT absorption - increased volume of distribution - 25% reduction of GFR by 80

increased volume of distribution (increased body fat --> distributes due to increased sequestration in fat) decreased in GFR are 10% per decade after 40th decade

72yo man with memory decline and stiff arms. Which imaging best - PET - structural MRI - CT - DAT - fMRI

DAT scan Lewy body dementia vs AD DAT can demonstrate specific loss of dopaminergic nuerons in the basal ganglia (note Lewy body demenia diagnosis is clinical but DAT helpful)

What neurotransmitted for modafinil work on - serotonin - dopamine - acetylcholine - glutamate - GABA

dopamine (inhibitor)

Oligodendrocytes vs Schwann cells. Which are PNS and CNS?

Schwann = PNS Oligodendrocytes= CNS both provide myelination to each system

which neuroglial cells transport glutamate to promote clearance from the synapse

astrocyte

which cells line the ventricles of the brain and the central canal of the spinal cord

ependymal cells

Aripiprazole and risperidone: impact on Qtc

Aripiprazole= NO EFFECT Risperidone= LOW EFFECT

process of producign protein from RNA molceule

translation

What % of the cerebrum is the frontal cortex - 37-41% - 15-20% - 20-25% - 5-10% - 70-75%

37-41% (temporal is 22-24$, parietal is 19-20%, occipital is 18-19%)

heritability is - genetic contribution of phenotypic variation in a population - genetic contributon ofn disease in an individual

genetic contribution to phenotypic variation in a population

FTD: what gene products - tau protein - amyloid beta protein - gamma-synuclein - beta synuclein

tau protein Alpha and beta-synuclein are Parkinsons disase alpha synuclein is Lewy body demenia

what does endosome do?

degredation of lipids

which gene most associated with schizophrenia - dysregulin - huntington - progranulin - corticotrophin-releasing hormone receptor 1 - dysbindin

dysbindin (dysbindin and neuregulin are associated with schizophrenia) CRH= depression progranulin= frontotemporal degrenation

Which epigenetic mehcanism is most associated with schizophrenia

DNA methylation

How can Williams diagnosis be confirmed - southern blot - CISH - FISH - karyotyping - western blot

FISH (identifies specific DNA sequence on chromosomes to detect abnormalities) 7q11 on choromosome 7

Which impacts oral contraceptives the most - citalopram - tobacco - quetialine - grapefruit juice - St Johns wort

St Johns Wort

Which shuttle through astrocytes - GABA - serotonin - dopamine - glutamate - glycine

glutamate (astrocytes also release ATP, nitric oxide, various prostglandins)

mirtazapine MoA - noradrenaline reuptake inhibitor - MOAI - noradrenergic and specific serotonergic antidepressant - serotonin and noradenaline reuptake inbitior - RIMA

noradrenergic and specific serotnergic antidepressant NaSSI

Most abundant in locus coeruleus - glutamate - serotonin - noradrenaline - acetylcholine - dopamie

noradrenaline located in the pons as part of rhe reticular activating system

heterozygous for ApoE4 - what is the increased risk of AD? - 2x - 6x - 10x - 4x - 1.5x

4x (increases to 10-15x if they homozygous)

ASD: what neurological finding - decreased caudate nuclues - decreased overall brain volume - increased cingulate volume - decreased colume of corpus callosum - decreased amygdala volume

decreased volume corpus callosum (also increased cudate nuclues and amygdala, as well as overlal brain size increased) smalled cingulate gyrus

Which part of brain most impacted by amphetamines - striatum - corpus callosum - parietal lobe - prefrontal cortex - temporal lobe

striatum --> changes in dopainergic neurons in the striatum particularly in caudate and putamen

which is EEG most helpful in - familiar CJD - Huntingtons - pseudoementia - schizophrenia - Parkinsons

Huntingtons initial loss of alpha wave activity and flattneted trace the others would show no typical abnormalities

Rod shaped inclusion bodies seen in normal aging and Alzheimers disease - TDP-43 - amyloid proteins - hirano bodies - lewy bodies - tau protein

hirano bodies

Which stage of sleep associated with 12-16Hz frequnecy on EEG

stage 2

which neurotransmitter is produced by glutamate decarboxylase? - glutamaate - GABA - adrenaline - sertraline - dopamine

GABA glutamate --> GABA

unable to recognise point coin in hand with eyes closed - astereognosis - prospognosis - simultagnosia - anosognoia

astereognosis (anosognoia= unaware of their neurological problem)

Comntrol delusions are related to what information processing - parallel distributed processing - sequential processing - snesory prediction - working memory - analytic processing

sensory prediction

Autonomic ganglia: what neurotransmitter is most abundant - noradrenaline - acetylcholine - serotonin - histamine - dopamine

acetylcholine (PNS and CNS)

carrot shaped eosinophilic intracellular inclusion: histological feature in organic brain disorder - senile plaque - neurofibrillary tangle - lewy body - rosenthal fibre - hirano body

- rosenthal fibre

In schizophrenia, what pathways thought to have excessive dopamine transmission

mesolimbic

where is initial release of dopamine in alcohol addiction - hippocampus - ventral tegmental area - periaqueductal area - nuclues accumbens - amygdala

ventral-tegmental area mesolimbic dopamine pathway

REM sleep disruptiuon in PTSD: which would benefit the most: - reducing amoung of waking from REM - increasing stage 3 and 4 - increased number of non-REM cycles - shortening latency - reducing jerks during sleep

shortening REM latency

What does the Stroop test assess: - selective attention - problem solving - set shiting - working memory - organisation and planning

selective attention invovles matching the colour of a word, which may or may not match the word itself

lack of regnoising faces; - abulia - anosognosia - prosopagnosia - akinestopsia - astereognosis what do the other things mean?

prosopagnosia abulia= profound lack of will and initiative anosognosia= inability ro recognise neurolgocial or physical impariments akinestopsia= inability to perceive visual motion

ADHD medications: how does atomoxetine act (receptor) - noradrenaline - dopamine - glutamate - GABA - serotonin

noradrenaline

WHich is most associated with Lewy body demenia - amyloid A protein - ubiquitin - beta synuclein - alpha synuclein - tau protein

alpha synuclein

Which is common in depression - reduced TSH - raised CRH - reduced cortisol - raised ACTH - raised thyrotropin releasing horomone

rasied CRH (corticotrophin releasing horomone) and raised cortisol blunted ACTH also associated with depression

Which tests executive function - WAIS - pargraph retention test - national adult reading test - weschler memory scale - Wisconsin card sorting test

Wisconsin card sorting test abnormal response if: - frontal lobe damate - schizophrenia - caudate damage

which ion flows into neurosn to propogate action potentials

sodium

amphetamine challenge (give people amphetamines and see which part of brain metabolises glucose or has dopaminergic release. which areas increased dopaminergic release in schizophrenia - striatum - anterior temporal lobes - prefrontal cortex - periverntricular area - hippocampus

striatum

ASD: hypoplasia of which brain area - Pareto-occipital - hippocampal formication - prefrontal - cerebrallar vermis - hypothalamus

cerebellar vermis

Lewy body dementia: which mocules accumulating in brain (2) - FUS protein - ubiquitin - alpha synyclein - tau protein

- ubiquitin - alpha synyclein (Tau = frontal-temporal dementia)

Cell types in CNS and PNS: which commonly use glutamate as a neurotransmitter - chandlelier cells - astrocytes - double bouquet cells - pyramidal cells - schwann cells - grnaular cells - epndymal cells - oligodendrocyte cells

granular and pyramidal cells glutamate is shuttled by the astrocytes but they do not use it as a neurotransmitter primarily

Cell types in CNS and PNS: lines the cererbral ventricles - chandlelier cells - astrocytes - double bouquet cells - pyramidal cells - schwann cells - grnaular cells - epndymal cells - oligodendrocyte cells

ependymal

Cell types in CNS and PNS: which transmits motor signals from cortex to spinal cord - chandlelier cells - astrocytes - double bouquet cells - pyramidal cells - schwann cells - grnaular cells - epndymal cells - oligodendrocyte cells

pyramidal cells (Betz cells particularly)

Antidepressant switching - amitriptyline -> citalopram - fluoxetine -> duloxetine - fluoxetine -> tranylcypromaine - phenelzine -> sertraline - trazodone -> mirtazapine

- amitriptyline -> citalopram: half dose, start new drug, slow withdrawal - fluoxetine -> duloxetine: stop and start other drug immediately - fluoxetine -> tranylcypromaine: withdraw and wait 5-6 weeks - phenelzine -> sertraline: withdraw and wait for 2 weeks - trazodone -> mirtazapine: cross taper with caution

Set 4 Flashcards

(78 cards)