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Year 3 - Mental Health > Anxiolytics, Hypnotics, Mood Stabilisers, Dementia Drugs, and ADD and ADHD Drugs > Flashcards

Anxiolytics, Hypnotics, Mood Stabilisers, Dementia Drugs, and ADD and ADHD Drugs Flashcards

1
Q

What classes of drugs can be used to treat anxiety?

A

Beta-blockers

Benzodiazepines

Pregabalin

Antidepressants

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2
Q

How do beta-blockers work?

A

Reduce the autonomic nervous system activation by acting as adrenaline/noradrenaline antagonists

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3
Q

What beta-blockers is most commonly used in psychiatry?

A

Propranolol

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4
Q

What condition are beta-blockers contraindicated in?

A

Asthma

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5
Q

When do beta-blockers have limited effectiveness?

A

In enduring anxiety disorders

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6
Q

What is the most typically used benzodiazepines?

A

Diazepam

Lorazepam

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7
Q

What kind of half-life does diazepam have?

A

Long half-life

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8
Q

What kind of half-life does lorazepam have?

A

Short half-life

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9
Q

What receptors do benzodiazepines bind to?

A

GABA receptors

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10
Q

What effect do benzodiazepines have on GABA receptors?

A

Act as agonists

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11
Q

What is the result of GABA receptor agonism by benzodiazepines?

A

Reduced excitability of neurones

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12
Q

What kind of neurotransmitter is GABA?

A

Inhibitory

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13
Q

What do benzodiazepines have significant potential for?

A

Tolerance

Dependence

Misuse

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14
Q

When prescribing benzodiazepines what precautions should be taken?

A

Use cautiously

Use for no more than 6 weeks

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15
Q

What can benzodiazepines occasionally cause?

A

Paradoxical disinhibition

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16
Q

What is paradoxical disinhibition?

A

A poorly understood state of acute excitement that occurs occasionally in benzodiazepine use

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17
Q

Where does pregabalin bind?

A

Voltage-gated calcium channels in neurones

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18
Q

What effect does pregabalin have?

A

Increases the extra-cellular amounts of enzyme responsible for synthesis of GABA and therefore increases GABA concentration in the brain

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19
Q

What effect does pregabalin have on the brain?

A

Acts as a CNS depressant

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20
Q

What other conditions is pregabalin indicated in?

A

Neuropathic pain

Epilepsy

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21
Q

In what ways is pregabalin generally safer than benzodiazepines?

A

Less potential for misuse, dependence and tolerance

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22
Q

Is pregabalin misused?

A

Yes

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23
Q

For how long does the BNF recommend to sue pregabalin for?

A

Short term

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24
Q

What side-effects can pregabalin have?

A

Sedation

Weight gain

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25
Q

What are the most common and effective pharmacological agents used to treat anxiety?

A

Antidepressants

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26
Q

What are the two types of hypnotics used?

A

Benzodiazepines

Nonbenzodiazepines

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27
Q

What are some benzodiazepines used as hypnotics?

A

Temazepam

Lormatazepam

Nitrazepam

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28
Q

How do nonbenzodiazepines exert their effects?

A

In a similar way to benzodiazepines (positive allosteric modulator) but are structurally different

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29
Q

What is another name for nonbenzodiazepines?

A

Z drugs

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30
Q

What are two nonbenzodiazepines?

A

Zopiclone

Zolpidem

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31
Q

Which class of hypnotics are usually favoured?

A

Z-drugs

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32
Q

What do both classes of hypnotics have significant potential for?

A

Misuse

Dependence

Rebound insomnia

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33
Q

For how long should hypnotics be used?

A

Only two weeks and take only 5/7 days per week to reduce potential for tolerance

34
Q

What disorder are mood stabilisers used to treat?

A

Bipolar disorder

35
Q

What are the main classes of mood stabilisers?

A

Lithium

Anticonvulsants

Second generation (atypical) antipsychotics

36
Q

What is one of the most effective mood stabilisers?

37
Q

What is the mechanism of action of lithium?

38
Q

What sort of therapeutic window does lithium have?

39
Q

How often should serum lithium levels be checked in a patient who is stable on lithium?

40
Q

How is lithium excreted?

41
Q

What does evidence show lithium reduces?

A

Risk of suicide

42
Q

What can lithium also be used for?

A

Augmenting antidepressants

43
Q

What are the side-effects of lithium use?

A

GI disturbance

Metallic taste in mouth

Dry mouth

Fine tremor

Polydipsia and polyuria

Weight gain

44
Q

What are the long term effects of lithium use?

A

Hypothyroidism (usually reversible)

Renal impairment (usually only occurs at above therapeutic doses)

45
Q

What tests must be conducted annually in patients on lithium?

A

U&E’s

TFT’s

46
Q

What can lithium toxicity cause?

A

Death

Confusion

Coarse tremor

N&V

Ataxia

Seizures

47
Q

What can increase the potential for lithium toxicity?

A

Dehydration

48
Q

What advice should patients on lithium be given to avoid toxicity?

A

Drink lots of water

Avoid hot climates

49
Q

What drugs can lithium interact with?

A

NSAIDs

Loop diuretics

ACE inhibitors

50
Q

What atypical antipsychotic is first line treatment for bipolar?

A

Quetiapine

51
Q

What are the most commonly used anticonvulsants used to treat bipolar disorder?

A

Sodium valproate

Carbamazepine

Lamotrigine

Pregabalin

52
Q

When should sodium valproate be avoided?

A

In women of child bearing age due to teratogenicity

53
Q

What does lamotrigine have the potential to cause?

A

Stevens Johnson Syndrome

54
Q

What do most anticonvulsants have the potential to cause?

A

Thrombocytopenia

55
Q

What are the side-effects of anticonvulsants?

A

Sedation

Weight gain

56
Q

What do dementia drugs do?

A

Treat cognitive and emotional symptoms

Don’t prolong life or slow changes

57
Q

What are the two classes of dementia drugs?

A

Acetylcholinesterase inhibitors

Memantine

58
Q

What are acetylcholinesterase inhibitors also known as?

A

Cholinesterase inhibitors

59
Q

How do cholinesterase inhibitors work?

A

They inhibit the breakdown of acetylcholine and therefore increase the levels of acetylcholine in the brain

60
Q

What is Alzheimer’s associated with?

A

Lower levels of activity in the cholinergic system

61
Q

What symptom are cholinesterase inhibitors particularly used to treat?

62
Q

What severity of dementia are cholinesterase inhibitors indicated in?

A

Mild to moderate

63
Q

What are the side-effects of cholinesterase inhibitors?

A

Nausea

Diarrhoea

Vomiting

Insomnia

Muscle cramps

Anorexia

64
Q

What is usually performed before commencing treatment with cholinesterase inhibitors?

65
Q

What should be checked at every appointment with a patient on a cholinesterase inhibitor?

A

Pulse check

66
Q

What are some cholinesterase inhibitors?

A

Donepezil

Galantamine

Rivastigmine

67
Q

What are the advantage of rivastigmine?

A

Can be given as a patch to increase adherence

Less GI side effects

68
Q

What sort of drug is memantine?

A

A glutamate (NMDA) receptor antagonist

69
Q

What is the effect of memantine?

A

Lower neuronal excitability

70
Q

What condition is memantine indicated in?

A

Moderate to severe Alzheimer’s disease

71
Q

What is memantine used to treat most in Alzheimer’s disease?

A

Agitated patients/challenging behaviour

72
Q

How should memantine be initiated?

73
Q

What are the side-effects of memantine?

A

Headaches

Drowsiness

Insomnia

Nausea

74
Q

What type of drugs are most commonly used in ADHD?

A

CNS stimulants

75
Q

Which CNS stimulants are used in ADHD treatment?

A

Methylphenidate

Dextroamphetamine

76
Q

Which CNS stimulant is most commonly prescribed in ADHD?

A

Methylphenidate

77
Q

What sort of release is used?

A

Combination of immediate and sustained in the same tablet

78
Q

What stimulants have the potential for?

A

Misuse

Dependency

79
Q

What should be monitored in CNS stimulant use?

A

Weight and height (in children)

Pulse

80
Q

What other drug is used to treat ADHD?

A

Atomoxetine

81
Q

What sort of drug is atomoxetine?

A

Noradrenaline re-uptake inhibitor

82
Q

When is atomoxetine used to treat ADHD?

A

When patients are unable to tolerate stimulants or in previous drug dependency

Year 3 - Mental Health (12 decks)

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