deck1 Flashcards by ming chuen | Brainscape

Q

fluoxetine

A

SSRI

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Q

paroxetine

A

SSRI

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Q

fluvoxamine

A

SSRI

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Q

citalopram

A

SSRI

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Q

escitalopram

A

SSRI

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Q

sertraline

A

SSRI (safe in pregnancy/breast feeding)

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Q

amitriptyline

A

TCA

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Q

nortriptyline

A

TCA

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Q

imipramine

A

TCA

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Q

trimipramine

A

TCA

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Q

clomipramine

A

TCA

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Q

lofepramine

A

TCA

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Q

dothiepin (dosulepin)

A

TCA

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Q

phenelzine

A

traditional MAOI

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Q

isocarboxazid

A

traditional MAOI

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Q

tranylcypromine

A

traditional MAOI

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Q

moclobemide

A

Reversible monoamine oxidase inhibitor (MAOI)

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Q

venlafaxine

A

SNRI

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Q

duloxetine

A

SNRI

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Q

reboxetine

A

noradrenaline reuptake inhibitor (NARI)

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Q

trazodone

A

serotonin antagonist reuptake inhibitor (SARI)

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Q

mianserin

A

tetracyclic antidepressant (TeCA)

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Q

mirtazapine

A

noradrenergic and specific serotonergic antidepressant (NaSSA)

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Q

bupriopion

A

noradrenergic and specific serotonergic antidepressant (NDRI)

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Q

agomelatine

A

melatonergic antidepressant

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Q

vortioxetine

A

multimodal - inhibits serotonin reuptake and modulates serotonin receptor activity

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Q

esketamine

A

NMDA receptor antagonist

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Q

lithium

A

mood stabiliser

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Q

carbamazepine

A

mood stabiliser

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Q

valproate

A

mood stabiliser

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Q

lamotrigine

A

mood stabiliser

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Q

chlorpromazine

A

1st gen typical antipsychotics

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Q

trifluoperazine

A

1st gen typical antipsychotics

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Q

sulpiride

A

1st gen typical antipsychotics

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Q

haloperidol

A

1st gen typical antipsychotics

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Q

flupentixol decanoate (depot)

A

1st gen typical antipsychotics

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Q

fluphenazine decanoate (depot)

A

1st gen typical antipsychotics

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Q

zuclopenthixol decanoate (depot)

A

1st gen typical antipsychotics

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Q

amisulpride

A

2nd gen atypical antipsychotics

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Q

olanzapine

A

2nd gen atypical antipsychotics

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Q

quetiapine

A

2nd gen atypical antipsychotics

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Q

risperidone

A

2nd gen atypical antipsychotics

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Q

paliperidone

A

2nd gen atypical antipsychotics

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Q

clozapine

A

2nd gen atypical antipsychotics

Q

aripripazole

A

3rd gen atypical antipsychotics

Q

cariprazine

A

3rd gen atypical antipsychotics

Q

name short acting benzos

A

ALOT
alprazolam
lorazapam
oxazepam
temazepam (this is also a benzo hypnotic)

Q

long acting benzo

A

diazepam
chlordiazepoxide
clonazepam

Q

donepezil

A

acetylcholinesterase inhibitor (for alzeimhers)

Q

rivastigmine

A

acetylcholinesterase inhibitor (for alzeimhers)

Q

galantamine

A

acetylcholinesterase inhibitor (for alzeimhers)

Q

3 z drugs - non benzo hypnotics

A

Zopiclone, eszopiclone, zaleplon and zolpidem

Q

flurazepam

A

benzo hypnotics for sleep

Q

temazepam

A

benzo hypnotics for sleep

Q

first, second, third line tx for GAD

A

SSRI sertraline -> SNRI duloxetine and venlafaxine -> pregabalin

Q

first line and what to add for PTSD

A

venlafaxine, SSRI sertraline

Q

pt was on antidepressant reached remission and feels recovered, what to do next?

A

Continue for 6 more months before stopping/tapering

Q

delirium what med to use first after de escalation?
if EPSE prone or c/i due to lewy body or parkinsons, use what?

A

haloperidol

quetiapine

concomitant lorazepam if severe agitation

Q

lewy body cannot take what meds?

A

sensitivity to antipsychotic medication and to antiemetic medications that affect dopaminergic and cholinergic systems - can cause dramatic EPSEs and neuroleptic malignant syndrome.

Q

sedation is greatest in which 3 antipsychotics

A

chlorpromazine,
clozapine,
olanzapine

Q

impaired glucose tolerance and diabetes greatest risk with which 3 antipsychotics

A

chlorpromazine (basically all phenothiazine)
clozapine,
olanzapine

Q

weight gain effects most in which 5? and least with which?

A

Clozapine > olanzapine > quetiapine > risperidone > amisulpride.

Aripiprazole is weight neutral and may be associated with weight loss.

Q

which antipsychotic increases metabolic syndrome

A

Olanzapine

Q

reduced seizure threshold most with?

A

Clozapine

Q

hyperprolactinemia most with which 3 antipsychotic

A

risperidone, amisulpride and sulpiride

Q

symptomatic hyperprolactinemia when on antipsychotic, add what to counter this?

A

aripiprazole

Q

photosensitivity in which antipsychotic

A

Chlorpromazine

Q

3% of olanzapine patients get what kind of SE (hint: HF)

A

ankle oedema

Q

management of NMS

A

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).

Q

describe dystonia in EPSE

A

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.

Q

describe parkinsonism in EPSE

A

Tremor.
Rigidity.
Bradykinesia.

Q

describe tardive dyskinesia in EPSE

A

Repetitive, involuntary, purposeless movements

Q

describe akathisia in EPSE

A

unable to sit or keep still, describe restlessness, fidget, rock from foot to foot and pace.

Q

anticholinergic helps in which EPSE and does not help in which?

A

helps in dystonia and parkinsonism, does not help in akathisia and tardive dyskinesia (use clozapine)

Q

indications for clozapine (5)

A

Treatment resistant schizophrenia (main indication).

Tardive dyskinesia.

Psychosis in Parkinson’s disease.

Huntington’s psychosis.

Resistant mania.

Q

what is post injection syndrome?

A

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.

Q

treatment for huntingtons disease

A

No treatment arrests the course of the disease.

Haloperidol (or other antipsychotics) may help reduce abnormal movements.

Tetrabenazine helps reduce abnormal movements.

Q

treatment for parkinsons

A

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).

Q

treatment for wilsons

A

Penicillamine

Q

delirium tremens/alcohol withdrawal first line

A

Chlordiazepoxide or diazepam

Q

SSRI discontinuation syndrome can give what symptoms?

A

Gastrointestinal side-effects

Q

anticholinergic SE of TCA

A

dry mouth, blurred vision, drowsiness, constipation, urinary retension

Q

Antihistaminic (H1) effects of TCA

A

sedation and weight gain

Q

alpha 1 blockade effects of TCA

A

postural hypotension and sedation.

Q

lithium duration of tx

A

Because of the risk of relapse following discontinuation, the need for prolonged treatment - at least 3 years

Q

SSRI use during third trimester - risk of?

A

persistent pulmonary hypertension of the newborn

Q

what medication exacerbates OCD symptoms.

what to add to counter this?

A

OCD

add SSRI

Q

first line med for OCD

A

SSRIs or clomipramine (a TCA)

Q

check what before starting SNRI (eg Venlafaxine)

A

check BP for HTN

Q

SSRI + NSAID need to add on what?

A

GI bleeding risk - give a PPI

Q

SSRI of choice post myocardial infarction

A

Sertraline

Q

symptoms of SSRI discontinuation syndrome (3)

A

Dizziness, electric shock sensations and anxiety

Q

torticollis as an SE is more in atypical or typical antipsychotics?

A

more in typical - first gen

Q

opisthotonus as an SE is more in atypical or typical antipsychotics?

A

more in typical - first gen

Q

dysarthria as an SE is more in atypical or typical antipsychotics?

A

more in typical - first gen

Q

oculogyric crises as an SE is more in atypical or typical antipsychotics?

A

more in typical - first gen

Q

weight gain, dyslipidemia, DM as an SE is more in atypical or typical antipsychotics?

A

more in atypical

Q

SSRI of choice in children and adolescents

A

Fluoxetine

Q

antipsychotic induced moderate/severe tardive dyskinesia can be treated with?

A

Tetrabenazine

Q

antipsychotic induced akathisia (restlessness) can be treated with?

A

Propranolol

Q

antipsychotic induced acute dystonia can be treated with?

A

Procyclidine and benztropine

Q

‘stones, bones, abdominal moans, and psychic groans’ caused by which drug’s SE?

A

Long-term lithium use can result in hyperparathyroidism and resultant hypercalcaemia

Q

how to stop an SSRI? over how long?

A

When stopping a SSRI the dose should be gradually reduced over a 4 week period

Q

what kind of incontinence does TCA cause due to its anticholinergic effect

A

overflow

Q

chronic lithium toxicity causes what endocrine disorder

A

hypothyroidism

Q

cardiac abnormalities a/w citalopram

A

Citalopram is the most likely SSRI to lead to QT prolongation and Torsades de pointes

Q

define acute dystonia

A

sustained muscle contraction (e.g. torticollis, oculogyric crisis)
may be managed with procyclidine

Q

define akathisia

A

(severe restlessness)

Q

define tardive dyskinesia

A

(late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)