Drugs Flashcards
examples of SSRIs
fluoxetine
paroxetine
citalopram
sertraline
SSRI used in < 18
fluoxetine
S.E of SSRI
N+V, diarrhoea, constipation
Abdomen pain
Weight loss
restlessness, insomnia, drowsiness
tremor, headache
SIADH
what is a contraindication of a SSRI/drugs they shouldn’t be used with
Mania
NSAIDs [would need to prescribe PPI as well]
Warfarin
Aspirin
Triptans
what are examples of TCAs
Amitrityline, Clomipramine, Dosulepin, Doxepin, Lofepramine
what are anti-cholinergic side effects of TCAs
weight gain
dry mouth, nose
urinary retention
blurred vision
what are anti-adrenergic side effects of TCAs
postural hypotension
what are cardiac Side effects seen in TCA
tachycardia
arrhythmias
heart block
syncope
what changes on an ECG can be seen in TCA
QT interval prolongation
ST segment elevation
what are contraindications in TCAs
recent MI arrhythmias severe liver disease mania high risk of over dose
what group should anti-depressants be used with cautions
patients with epilepsy
> they lower seizures threshold
what drug class is used in atypical depression
MOAI
what are examples of MOAI
phenelzine, isocarboxazid, tranylcypromine
what are side effects of MOAI
hypertensive crisis
serotonin syndrome
what leads to a hypertensive crisis with the use of MOAI
- large amounts of tyramine (from diet) increases norepinephrine causing vasoconstriction
- MAO would normally destroy excess NE
- hypertensive crisis
what are Sx of a hypertensive crisis
flushing, headache, increased BP, CVA
what is the Tx of hypertensive crisis
alpha blockade e.g. phentolamine, chlorpromazine
what causes serotonin syndrome
if MOAI combined with another anti-depressant
what are Sx of serotonin syndrome
neuromuscular abnormalities, altered consciousness level and autonomic instability
what are contraindications of MOAI
phaechromocytoma
cerebrovascular disease
hepatic impairment
mania
what are examples of SNRI
e.g. Venlafaxine, Duloxetine
what anti-depressant causes the least sedation
SSRI
what is an example of an NaSSA
Mirtazapine
what are Side effects of Mirtazapine
increased appetite, weight gain sedation headache dry mouth dizziness, postural hypotension
tremor
peripheral oedema
what drugs should be avoided/prescribed with caution when a patient is on lithium
NSAIDs
ACEi
Diuretics
what is the mnemonic for lithium side effects
LITHIVM (side effects)
Leukocytosis Insipidus (diabetes) Tremor Hypothyroidism Increased weight Vomiting (and nausea) Miscellaneous
what are the other side effects seen in lithium
- confusion, headache, concentration problems
- constipation
- dry mouth, polydipsia
- muscle weakness
- nephrotoxic
what side effects of lithium are seen on an ECG
T-wave flattening or inversion
what are signs go lithium toxicity
- worsening vision, nystagmus
- diarrhoea, N+V
- decreased potassium
- ataxia, myoclonus
- coarse tremor
- dysarthria, slurred speech
- convulsions, coma
contraindications of lithium
pregnancy breastfeeding impaired renal function thyroid disease cardiac conditions neurological conditions (e.g. Parkinson’s or Huntington’s disease)
what are the side effects of Lamotrigine
N/V, diarrhoea
ataxia, dizziness, diplopia, headache
agression, irritability
somnolence and sedation
skin rash (risk of Stevens-Johnson Syndrome)
what are side effects of Carbamazepine
Agranulocytosis, aplastic anaemia
N/V, diarrhoea,
ataxia, dizziness, slurred speech, nystagmus, diplopia
drowsiness, confusion
raised liver enzymes, hepatic toxicity
hyponatraemia, fluid retention
what are side effects of valproate
increased appetite, weight gain, hair loss, N+V
sedation, dizziness, tremor
ankle swelling
haematological abnormalities (thrombocytopenia, leucopenia)
what are the first generation anti-psychotics
Typical
Chlorpromazine
Haloperidol
Sulpiride
what are the second generation anti-psychotics
Atypical
Clozapine
Olanzapine
Risperidone
contraindications to anti-psychotics
reduced consciousness level pheochromocytoma Parkinson’s disease epilepsy cardiac disease metabolic syndrome
what are side effects of anti-psychotics
prolonged QT interval, arrhythmias, myocarditis, sudden death
photosensitivity, skin rashes
lowers seizures threshold
hepatotoxic
pancytopenia, agranulocytosis
hyperprolactinaemia
extrapyramidal side-effects
what causes extra-pyramidal side effects (EPSE)
excessive of acetylcholine and relative deficiency of dopamine
what are EPSE
parkinsonism motor Sx
acute dystonia
akathisia
tardive dyskinesia
Tx for parkinsonism motor Sx as EPSE of anti-psychotics
Anticholinergics
e.g. procyclidine
what is acute dystonia
involuntary sustained muscular contractions or spasm
usually occurs 72 hours into treatment
what is akathisia
feeling of inner restlessness and muscular discomfort
occurs with 6-10 days
what its the Tx for akathisia in EPSE
Tx = Propranolol or short term benzodiazepines
what is tardive dyskinesia
rhythmic involuntary movement of head, limbs and trunk
e.g. chewing, grimacing, darting movements of the tongue
what dangerous side effects are associated with clozapine
agranulocytosis, myocarditis and cardiomyopathy
what general side effects are seen with clozapine
sedation, weight gain, metabolic syndrome, hypersalviation
when is clozapine reserved for
treatment-resistant schizophrenia
what odd side effect does chlorpromazine cause
blue-grey discolouration in the sun
how do benzodiazepines work
- bind to specific benzodiazepine receptors on the GABAa receptor complex,
- an increased affinity of the complex for GABA
- causes increased flow of chloride ions into the cell,
- hyper polarising the post-synaptic membrane
- reduces neuronal excitability
what are the Z drugs and how do they work
e.g. Zaleplon, Zolpidem, Zopiclone
act at a different site on the benzodiazepine receptors in the GABAa receptor complex, also potentiating chloride entry
what are side effects of Benzos and Z drugs
developing dependence
potential dangerous driving due to drowsiness, ataxia and reduced motor coordination
can lead to falls or delirium
can cause depress respiration in patients with COPD
can make dissociation worse
anterograde amnesia
impaired co-ordination
what are indications for ECT
severe depression
established mania
certain types of schizophrenia
what is suggestive of severe depression
life threatening poor fluid intake
strong suicidal intent
psychotic features or stupor
antidepressants ineffective
what types of schizophrenia can be treated with ECT
catatonic states
positive psychotic symptoms
schizoaffective disorder
what are side effects of ECT
loss of memory (particularly before and after ECT)
confusion, headache, nausea, muscle pain
true or false - patients do not need any more treatment after ECT
false
- they still need to continue medication
