CNS - Prescribing Flashcards
What drug class is diazepam?
Benzodiazepine
How do benzodiazepines work?
Increase the affinity for inhibitory neurotransmitter TA BA
opens chloride iron channels
hyper polarisation of the neuron membrane preventing further excitation
When is diazepam indicated?
Short-term treatment of severe anxiety
short-term treatment of insomnia
muscle spasms
status epilepticus
What are common side effects of benzodiazepines?
Amnesia confusion dependence drowsiness hangover effect the next day psychomotor impairment
What are severe side effects of benzodiazepines?
A taxi leading to increased risk of falls in elderly
dependence
respiratory depression
tolerance
When is benzodiazepine contraindicated?
Elderly respiratory disease muscle weakness my senior Gravis history of drug or alcohol abuse sleep apnoea pregnancy breastfeeding
What do benzodiazepines interact with?
Antihypertensives – increase hypotensive effect
clozapine has serious adverse effects with Lorazepam
What should be communicated to patients when taking benzodiazepines?
May impair their ability to perform skilled tasks such as drivingA whole starting this
should not be taken for longer than four weeks
alcohol increases their effect
How do you treat benzodiazepine overdose?
IV flumazenil
What are examples of typical antipsychotics?
Haloperidol
chlorpromazine
prochlorperazine
What are examples of atypical antipsychotics?
Risperidone
quetiapine
clozapine
When would you prescribe antipsychotics?
Schizophrenia and other psychoses
mania
if needing to sedate someone who is elderly use haloperidol
What are side effects of antipsychotics?
Drowsiness
agitation
extrapyramidal symptoms (postural hypotension positive dyskinesia neuroleptic malignant syndrome)
agranulosatosis in clozapine only
What drugs do antipsychotics interact with?
Antihypertensives – increased hypertension
drugs which prolonged QT intervals
anti-epileptics – lower seizure threshold
opioids and alcohol– increased sedation
What should be monitored with clozapine?
SBC
What class is lithium?
A mood stabiliser
What are side effects of lithium?
Fine tremor
weight gain
hypothyroidism
hyperparathyroidism - hypercalcaemia
lithium toxicity
What are symptoms of lithium toxicity?
blurred vision muscle cramps drowsiness course tremor slurred speech ataxia confusion convulsions nausea vomiting ECG changes
What drugs does lithium interact with?
Increase conc: NSAIDS ACEi ARB diuretics
decrease conc:
caffieie
sodium salts
-phallines
amiodarone - increase risk of ventricular tachycardias
When should lithium be checked?
Every three months
check baseline (U+E, eGFR, T4, TSH, FBC, ECG) every six months
BMI every 12 months
What drug class is amitriptyline?
Tricyclic antidepressant
How you try psychics work?
Rent reuptake and degradation of serotonin and noradrenaline
When would you prescribe tricyclic antidepressants?
Depression
neuralgia
nocturnal enuresis in children
sedatives
What are side effects of amitriptyline?
Can cause anti-muscarinic facts
anxiety, dizziness, agitation in the elderly
can cause overdose and recall you toxic
hyponatraemia
What drug names of SSRIs?
Fluoxetine
sertraline
citalopram
Why would you use SSRIs
Depressive illness
Panic disorder
Obsessive compulsive disorder
What are side effects of SSRIs
GI upset the increased risk of bleeding hypersensitivity reactions risk of withdrawal convulsions neuroleptic malignant syndrome
what drugs interact with SSRIs?
Alcohol increase edited
NSAIDs increased risk of bleeding
antiepileptic’s lower threshold for seizures
MAOIs do not start SSRI until two weeks of stopping MAOIs and vice versa
What drugs are there in the class of SNRI?
venlafaxine
duloxetine
When all SNRIs indicated?
Major depressive disorder
Generalised anxiety disorder
Duloxetine is also used for stress incontinence
What are important side-effects of SNRIS
SIADH; Rhabdomyolysis
Neuroleptic malignant syndrome
Withdrawal (particularly with venlafaxine)
GI disturbance,
anxiety, dizziness, paraesthesia, tremor, sleep disturbance, sweating
