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Psychiatry > Drugs > Flashcards

Drugs Flashcards

1
Q

Lithium level goals

A

Maintenance: 0,5-0,9
Manic episode: up to 1,5

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2
Q

When do lithium levels need to be checked?

A

4 days after starting treatment or changing dose
Then 6 monthly when pt is in maintenance phase and stable blood levels in therapeutic range

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3
Q

Side effects of lithium

A

Nausea, vomiting, diarrhoea
Weight gain and fluid retention
Postural tremor
Renal effects - Polyuria with secondary polydipsia, Hypokalaemia
Thyroid effects - hypothyroidism, hyperthyroidism, goitre and exophthalmos
Cardiac effects - T wave flattening or inversion, dysrrhythmias, heart block, syncopal episodes
Teratogenesis - Epstein anomaly

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4
Q

Signs of lithium toxicity

A

Tremor
Dysarthria
Ataxia
CV changes and renal dysfunction
Myoclonus and muscular fasciculations
Seizures
Impaired LOC
Coma
Medical emergency = stop lithium and push IV fluids in medical facility

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5
Q

Prelithium treatment tests

A

Bloods - FBC (leukocytes), U&E (K and kidney fxn), creatinine clearance (lithium excreted by kidneys), TSH, BHCG
ECG

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6
Q

Common side effects of sodium valproate (epilim)

A

Sedation
Weight gain
Thrombocytopenia
Hair loss at high doses
Tremor
PCOS
Teratogenesis - neural tube defects

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7
Q

Monitoring of patient on Valproate

A

LFT (drug metabolised by liver) baseline then 6monthly
BHCG (pregnancy screening periodically)
Pelvic sonar in females (to check for PCOS)

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8
Q

List some atypical antipsychotics used as a moodstabiliser

A

Olanzapine
Quetiapine
Aripiprazole

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9
Q

Signs of lithium toxicity

A

LITHIUM

Lots of urine = Polyuria, polydipsia
Impaired LOC, coma
Tremors, tongue (dysarthria)
Heart = ECG changes
Increased N&V&D
Unbalanced = ataxia, electrolytes
Myoclonus, muscle fasiculations
Seizures

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10
Q

Dosing of lithium

A

Start at 500mg PO morne, titration up slowly, change based on trough level (take blood just before next dose)

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11
Q

Dose of valproate

A

250-1250mg PO BD (able to titration up quickly if needed)

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12
Q

Dose of lamotrigine in bipolar

A

25mg PO nocte -> titration upwards of 25mg every two weeks up to 100-200mg PO nocte

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13
Q

Dose of carbamazepine in bipolar

A

200mg PO BD - titration by 200mg up to 600-1200mg PO BD

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14
Q

Side effects of lamotrigine

A

STEVENS JOHNSONS = stop immediately
Headache
N&V
Sedation
Blurred vision and diplopia
Dizziness and ataxia

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15
Q

Dose of olanzipine in bipolar disorder

A

10-20mg PO nocte

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16
Q

Dose of quetiapine in bipolar disorder

A

300-800mg PO nocte

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17
Q

Dose of aripripazole in bipolar disorder

A

10-30mg PO nocte

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18
Q

Venlafaxine dose

A

75-300mg PO morne

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19
Q

Buproprion class and dose

A

Noradrenalin and dopamine resp take inhibitor
150-300mg PO morne

20
Q

Side effects of buproprion

A

Decreased seizure threshold
Nausea
Headache
Insomnia

21
Q

Amitriptyline class and dose

A

TCA
30-200mg PO nocte

22
Q

Side effects of TCA

A

Anticholinergic = constipation, blurry vision, dry mouth
Arrhythmias
Orthostatic hypotension (alpha and beta R)
Sedation (histamine R)

23
Q

Side effects of MAOI

A

Tyramine induced hypertensive crisis
= unmetabolized tyramine = release of noradrenalin = alpha receptors = vasoconstriction = HPT

24
Q

Example of MAOI and dose

A

Tranycypromine 5-100mg PO BD

25
Q

Example of RIMA and dose

A

Reversible inhibitors of mono amine oxidase Type A
Moclobemide 75-300mg PO BD

26
Q

Side effects of MAOI and RIMA’s

A

Tyramine induced hypertensive crisis
Sexual dysfunction
Oedema
Insomnia
Weight gain
Orthostatic hypotension

27
Q

Example if NaSSA and dose

A

Noradrenaline and specific serotonin antagonists
Mirtazapine 15-45mg PO nocte

28
Q

Example of SARI and dose

A

Serotonin antagonist/reuptake inhibitor
Trazodone 75-300mg PO BD

29
Q

Example of melatonin agonist and dose

A

Agomelatine 25-50mg PO nocte

30
Q

Symptoms of discontinuation syndrome of antidepressants

A

FINISH

Flu-like symptoms
Insomnia, poor concentration
Nausea, needles (paraethesia)
Imbalance (dizziness, weakness)
Six weeks after stopping, spont resolution after 3 weeks
Hyperarousal (anxiety), headache

31
Q

Symptoms of serotonin syndrome

A

Diarrhoea = irritable and restless = hyper reflexes, autonomic instability = myoclonus, seizures, hyperthermia, uncontrollable shivering and rigidity = delirium, coma, CV collapse, status epilepticus, death

HARMED
Hyper-reflexia, hyperthermia, hyponatraemia
Autonomic instability, abnormal bleeding, agitation
Rigidity, restlessness
Myoclonus
Excessive shivering, epilepticus,
Death, coma, CV collapse

32
Q

Treatment of serotonin syndrome

A

Transfer to ICU
Withhold antidepressants/medications
Cooling blanket and IV fluids
Drugs - nitroglycerin, dandrolene, benzo’s, anticonvulsant
Muscle relaxant and mechanical ventilation

33
Q

How do typical antipsychotics work? (Receptor and neurotransmitter)

A

Dopamine Receptor antagonist (D2)

34
Q

How do atypical antipsychotics work? (Receptor and neurotransmitter)

A

Dopamine and serotonin antagonists

35
Q

Indications for clozapine

A

Treatment resistant schizophrenia
Intolerable EPSE
Aggression
Tardive dyskinesia

36
Q

Side effects of clozapine

A

Agranulocytosis
Neutropenia
Constipation
Weight gain
Benign tachycardia
Myocarditis
Hyper/hypotension
Hyper-salivation
Seizures
Hypersomnia

37
Q

Dose of haloperidol

A

0,5-15mg nocte

38
Q

Dosage of chlorpromazine

A

200-800mg nocte (max 1g/24hrs)

39
Q

Dose of trifluperazine

A

2-15mg daily in divided doses

40
Q

Dose of pimozide

A

2-12mg daily

41
Q

Dose of risperidone

A

2-8mg daily

42
Q

Dose of clozapine

A

100-800mg daily

43
Q

Indications for atypical antipsychotics

A

Severe EPSE
Mood symptoms and suicide risk
Treatment resistant schizophrenia
Tardive dyskinesia
Better for negative symptoms
Low prolactin levels
Rechallenge after malignant neuroleptic syndrome
Elderly with behavioural symptoms
Young with first episode psychosis

44
Q

Advantages of atypical vs typical antipsychotics

A

Typical
> affordable
> effective

Atypical
> less EPSE
> benefit negative symptoms, neurocognitive symptoms and mood problems in schizophrenia

45
Q

Disadvantages of typical vs atypical antipsychotics

A

Typical
> EPSE and Tardive dyskinesia
> limited effectiveness in negative symptoms and neurocognitive symptoms
> 20% don’t respond

Atypical
> metabolic symdrome
> hyperprolactinaemia
> expensive
> cardiac conduction abnormalities

46
Q

What is acute dystonia

A

Painful, prolonged muscle contractions causing abnormal movements and posture

Psychiatry (21 decks)

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