deck1 Flashcards
fluoxetine
SSRI
paroxetine
SSRI
fluvoxamine
SSRI
citalopram
SSRI
escitalopram
SSRI
sertraline
SSRI (safe in pregnancy/breast feeding)
amitriptyline
TCA
nortriptyline
TCA
imipramine
TCA
trimipramine
TCA
clomipramine
TCA
lofepramine
TCA
dothiepin (dosulepin)
TCA
phenelzine
traditional MAOI
isocarboxazid
traditional MAOI
tranylcypromine
traditional MAOI
moclobemide
Reversible monoamine oxidase inhibitor (MAOI)
venlafaxine
SNRI
duloxetine
SNRI
reboxetine
noradrenaline reuptake inhibitor (NARI)
trazodone
serotonin antagonist reuptake inhibitor (SARI)
mianserin
tetracyclic antidepressant (TeCA)
mirtazapine
noradrenergic and specific serotonergic antidepressant (NaSSA)
bupriopion
noradrenergic and specific serotonergic antidepressant (NDRI)
agomelatine
melatonergic antidepressant
vortioxetine
multimodal - inhibits serotonin reuptake and modulates serotonin receptor activity
esketamine
NMDA receptor antagonist
lithium
mood stabiliser
carbamazepine
mood stabiliser
valproate
mood stabiliser
lamotrigine
mood stabiliser
chlorpromazine
1st gen typical antipsychotics
trifluoperazine
1st gen typical antipsychotics
sulpiride
1st gen typical antipsychotics
haloperidol
1st gen typical antipsychotics
flupentixol decanoate (depot)
1st gen typical antipsychotics
fluphenazine decanoate (depot)
1st gen typical antipsychotics
zuclopenthixol decanoate (depot)
1st gen typical antipsychotics
amisulpride
2nd gen atypical antipsychotics
olanzapine
2nd gen atypical antipsychotics
quetiapine
2nd gen atypical antipsychotics
risperidone
2nd gen atypical antipsychotics
paliperidone
2nd gen atypical antipsychotics
clozapine
2nd gen atypical antipsychotics
aripripazole
3rd gen atypical antipsychotics
cariprazine
3rd gen atypical antipsychotics
name short acting benzos
ALOT
alprazolam
lorazapam
oxazepam
temazepam (this is also a benzo hypnotic)
long acting benzo
diazepam
chlordiazepoxide
clonazepam
donepezil
acetylcholinesterase inhibitor (for alzeimhers)
rivastigmine
acetylcholinesterase inhibitor (for alzeimhers)
galantamine
acetylcholinesterase inhibitor (for alzeimhers)
3 z drugs - non benzo hypnotics
Zopiclone, eszopiclone, zaleplon and zolpidem
flurazepam
benzo hypnotics for sleep
temazepam
benzo hypnotics for sleep
first, second, third line tx for GAD
SSRI sertraline -> SNRI duloxetine and venlafaxine -> pregabalin
first line and what to add for PTSD
venlafaxine, SSRI sertraline
pt was on antidepressant reached remission and feels recovered, what to do next?
Continue for 6 more months before stopping/tapering
delirium what med to use first after de escalation?
if EPSE prone or c/i due to lewy body or parkinsons, use what?
haloperidol
quetiapine
concomitant lorazepam if severe agitation
lewy body cannot take what meds?
sensitivity to antipsychotic medication and to antiemetic medications that affect dopaminergic and cholinergic systems - can cause dramatic EPSEs and neuroleptic malignant syndrome.
sedation is greatest in which 3 antipsychotics
chlorpromazine,
clozapine,
olanzapine
impaired glucose tolerance and diabetes greatest risk with which 3 antipsychotics
chlorpromazine (basically all phenothiazine)
clozapine,
olanzapine
weight gain effects most in which 5? and least with which?
Clozapine > olanzapine > quetiapine > risperidone > amisulpride.
Aripiprazole is weight neutral and may be associated with weight loss.
which antipsychotic increases metabolic syndrome
Olanzapine
reduced seizure threshold most with?
Clozapine
hyperprolactinemia most with which 3 antipsychotic
risperidone, amisulpride and sulpiride
symptomatic hyperprolactinemia when on antipsychotic, add what to counter this?
aripiprazole
photosensitivity in which antipsychotic
Chlorpromazine
3% of olanzapine patients get what kind of SE (hint: HF)
ankle oedema
management of NMS
- stop antipsychotic
- Benzodiazepines (e.g. lorazepam).
- Supportive measures
- bromocriptine (a dopamine agonist).
- Reduce rigidity: dantrolene (a muscle relaxant).
- Stop antipsychotics for at least five days.
- Begin with a small dose and increase gradually while monitoring vital signs and CPK.
- Consider using a different antipsychotic (e.g. quetiapine or clozapine).
describe dystonia in EPSE
TOBO:
1. Cervical dystonia (torticollis): neck twists and turns to one side. In addition, the head may be pulled forward or backward.
- Opisthotonus: arching of the back.
- Blepharospasm: involuntary, forcible closure of the eyelids.
- Oculogyric crisis: upward deviation of the eyes.
describe parkinsonism in EPSE
Tremor.
Rigidity.
Bradykinesia.
describe tardive dyskinesia in EPSE
Repetitive, involuntary, purposeless movements
describe akathisia in EPSE
unable to sit or keep still, describe restlessness, fidget, rock from foot to foot and pace.
anticholinergic helps in which EPSE and does not help in which?
helps in dystonia and parkinsonism, does not help in akathisia and tardive dyskinesia (use clozapine)
indications for clozapine (5)
Treatment resistant schizophrenia (main indication).
Tardive dyskinesia.
Psychosis in Parkinson’s disease.
Huntington’s psychosis.
Resistant mania.
what is post injection syndrome?
occurs in olanzapine depot
The signs and symptoms of PIS include sedation (ranging from mild sedation to deep sleep and unconsciousness), and/or delirium (including confusion/confused state, disorientation, anxiety and agitation). Other symptoms include dizziness, weakness, altered speech/dysarthria, altered gait, muscle spasms, possible seizures and hypertension.
treatment for huntingtons disease
No treatment arrests the course of the disease.
Haloperidol (or other antipsychotics) may help reduce abnormal movements.
Tetrabenazine helps reduce abnormal movements.
treatment for parkinsons
Depression: SSRI or TCA.
Levodopa plus dopa-decarboxylase inhibitor (e.g. carbidopa) or dopamine agonist or monoamine oxidase B
inhibitor (e.g. selegiline which may be combined with levodopa and dopa-decarboxylase inhibitor in more advanced disease).
treatment for wilsons
Penicillamine
delirium tremens/alcohol withdrawal first line
Chlordiazepoxide or diazepam
SSRI discontinuation syndrome can give what symptoms?
Gastrointestinal side-effects
anticholinergic SE of TCA
dry mouth, blurred vision, drowsiness, constipation, urinary retension
Antihistaminic (H1) effects of TCA
sedation and weight gain
alpha 1 blockade effects of TCA
postural hypotension and sedation.
lithium duration of tx
Because of the risk of relapse following discontinuation, the need for prolonged treatment - at least 3 years
SSRI use during third trimester - risk of?
persistent pulmonary hypertension of the newborn
what medication exacerbates OCD symptoms.
what to add to counter this?
OCD
add SSRI
first line med for OCD
SSRIs or clomipramine (a TCA)
check what before starting SNRI (eg Venlafaxine)
check BP for HTN
SSRI + NSAID need to add on what?
GI bleeding risk - give a PPI
SSRI of choice post myocardial infarction
Sertraline
symptoms of SSRI discontinuation syndrome (3)
Dizziness, electric shock sensations and anxiety
torticollis as an SE is more in atypical or typical antipsychotics?
more in typical - first gen
opisthotonus as an SE is more in atypical or typical antipsychotics?
more in typical - first gen
dysarthria as an SE is more in atypical or typical antipsychotics?
more in typical - first gen
oculogyric crises as an SE is more in atypical or typical antipsychotics?
more in typical - first gen
weight gain, dyslipidemia, DM as an SE is more in atypical or typical antipsychotics?
more in atypical
SSRI of choice in children and adolescents
Fluoxetine
antipsychotic induced moderate/severe tardive dyskinesia can be treated with?
Tetrabenazine
antipsychotic induced akathisia (restlessness) can be treated with?
Propranolol
antipsychotic induced acute dystonia can be treated with?
Procyclidine and benztropine
‘stones, bones, abdominal moans, and psychic groans’ caused by which drug’s SE?
Long-term lithium use can result in hyperparathyroidism and resultant hypercalcaemia
how to stop an SSRI? over how long?
When stopping a SSRI the dose should be gradually reduced over a 4 week period
what kind of incontinence does TCA cause due to its anticholinergic effect
overflow
chronic lithium toxicity causes what endocrine disorder
hypothyroidism
cardiac abnormalities a/w citalopram
Citalopram is the most likely SSRI to lead to QT prolongation and Torsades de pointes
define acute dystonia
sustained muscle contraction (e.g. torticollis, oculogyric crisis)
may be managed with procyclidine
define akathisia
(severe restlessness)
define tardive dyskinesia
(late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)
