DRUGS Flashcards
Typical/First gen anti-psychotics
Older drugs
- Sulpiride
- Trifluoperazine
- Haloperidol
- Flupentixol
- Pipothiazine
- Chlorpromazine
- Fluphenazine
- Zuclopenthixol
Atypical/second gen anti-psychotics
Newer drugs
- Clozapine
- Risperidone
- Olanzapine
- Quetiapine
- Aripiprazole
MoA typical anti-psychotics
Dopamine receptor 2 (D2) antagonism
MoA atypical anti-psychotics
Dopamine receptor 2 (D2) antagonism +/- 5-HT antagonism
Extrapyramidal side-effects
Akathisia - subjective feeling of restlessness w/ associated objective signs e.g. fidgeting (thought to increase risk of suicide
Parkinsonism - tremor, rigidity, bradykinesia (usually takes days/weeks)
Acute dystonia - involuntary mm spasms producing briefly sustained abnormal postures (usually occures w/in 48 hrs)
Tardive dyskinesia - abnormal hyperkinetic movements. POSSIBLY IRREVERSIBLE. Examples: tongue movements (fly catching), pouting, lip smaking, grimacing
Metabolic syndrome
- Central obesity
- Insulin resistance
- Impaired glucose regulation
- HTN
- Raised plasma triglycerides
- Raised LDL +/- HDL
What is Neuroleptic Malignant Syndrome and what are the sx
Potentially fatal side-effect of anti-psychotics STOP ALL ANTI PSYCHOTICS IMMEDIATELY
- Hyperthermia
- Mm rigidity
- Confusion
- Tachycardia
- Abnormal BP
- Tremor
- Raised creatine
- Metabolic acidosis
Depot anti-psychotics
Typicals
- Haloperidol
- Flupentixol
- Zuclopenthixol
- Fluphenazine
Atypicals
- Risperidone
- Olanzapine
- Aripiprazole
List atypical anti-psychotics in terms of wgt gain
++++ :Olanzapine, clozapine
++: Risperidone, Quetiapine
-: Aripiprazole
List atypical anti-psychotics in terms of sedation
++++: Clozapine
+++: Olanzapine
++: Quetiapine
+: Risperidone
-: Aripiprazole
List atypical anti-psychotics in terms of metabolic disturbances
++++: Clozapine
+++: Olanzapine
+: Riperidone, Quetiapine
-: Aripirazole
First line treatment for schizophrenia
An atypical anti-psychotic
What drug treats, treatment resistant schizophrenia
Clozapine
What are the serious side effects of clozapine
- Cardiomyopathy
- Postural HTN
- Agranulocystosis
MoA clozapine
Antagonist of D2, 5HT and D4 receptors
How do you define treatment resistant schizophrenia
Inadequate response/ongoing psychotic sx after undergoing trails of two different anti-psychotics at therapeutic dose and duration (ensure compliance)
List anti-depressants and their group
Selective serotonin reuptake inhibitors SSRI
- Citalopram
- Sertraline
- Fluoxetine
- Paroxetine
Serotonin-noradrenaline reuptake inhibitors SNRI
- Venlafaxine
Noradrenaline and specific serotonergic antidepressants (NASSAs)
- Mirtazapine
Tricyclic
- Amitriptyline
- Clomipramine
- Lofepramine
- Nortriptyline
- Imipramine
- Dosulepin
Monoamine oxidase inhibitor
- Phenelzine
What group of anti-depressants are 1st line
SSRI
MoA SSRI/SNRI +TCA
Reuptake of serotonin and/or noradrenaline in inhbited therefore increasing the concentration in the synaptic cleft
SSRI/SNRIs side effects
Common
- Nausea, anxiety and suicidal ideation exacerbation on initiation
Others
- Insomnia
- Apathy and fatigue
- Diarrhoea
- Dizziness
- Sweating
- Restlessness (akathesia)
- Sexual dysfunction
- Cardiac defects with 1st trimester exposure (Paroxetine)
TCA side effects
Anti-muscarinic
- Dry mouth
- Blurred vision
- Constipation
- Urinary retention
Other
- Sedation
- Weight gain
- Dizziness
- Hypotension
- Delirium
MOA side effects
Serious risk of drug/food interation (tyramine containing food - cheese reaction)
- Dry mouth
- Nausea, diarrhea or constipation
- Headache
- Sleep disturbance
- Postural Hypotension
NaSSA (Mirtazapine) side-effects
- Weight gain and increased appetite
- Drowsiness
- Dizziness
- Headache
What is important when starting and stopping anti-depressants
Starting
- They take 1-6 weeks to fully kick in
- If nothing has happened at 4 wks then switch
- If something is happening at 2-3 wks carry on
Finishing
- Continue anti-depressants at same dose 6 months after the resolution of sx
- Taper off slowly for 4 wks to avoid rebound sx (paroxetine and venlafaxine)
Rank anti-depressant groups accoring to risk of wgt gain
+++: NaSSA
++: TCA
-: SSRI SNRI
Rank anti-depressant groups accoring to risk of sexual dysfunction
++++: SSRI
+++: SNRI TCA
+: NaSSA
Rank anti-depressant groups accoring to risk of sedation
+++: NaSSA
++: TCA
+: SNRI
-: SSRI
Indication for mood stabilisers
- Prophylaxis for bipolar, characterised by:
- Single manic episode w/ significant risk
- Illness w/ significant impact on functioning
- Two of more acute episodes
- Treatment of bipolar depression
- Augmentation for anti-depressants in treatment resistant depression
List main mood stabilisers
- Lithium
- Valproate
- Lamotrigine
- Carbamazapine
List atypical anti-psychotics that can be used as mood stabilisers
- Quetiapine
- Olanzapine
- Aripiprazole
Lithium: indications, therapeutic range, side-effects, toxicity, monitoring
Indications
- Acute mania/hypomania (good evidence)
- Prophylaxis in bipolar disorder
- Bipolar depression
- Treatment-resistant depression
Therapeutic range/toxicity
- Narrow therapeutic range
- Levels must be checked 5 days after initiation
- Sx include
- Diarrhoea
- Course tremor
- Ataxia
- Dysarthria
- Nystagmus
- Confusion
- Convulsions
Side-effects
- Teratogenic
- GI upset
- Fine tremor
- Polyuria
- Polydipsia
- Metallic taste in mouth
- Weight gain
- Oedema
Monitoring
Due to narrow therapeutic range, nephrotoxicity and thyrotoxicity
- Lithium level (once every 3 months)
- Urea & Electrolytes (once every 6 months)
- Thyroid Function Test (once every 6 months)
Valproate: indications and contra-indications
Indications
- Acute mania/hypomania
- Prophylaxis in bipolar disorder (weaker evidence than lithium)
Contra-indications
- Pregnancy
Lamotrigine: indications and major side effects
Indications
- Bipolar depression
- Prophylaxis in bipolar disorder (limited evidence)
- Augmentation of antidepressants in treatment-resistant depression
Side effects
- Stevens-Johnson Syndrome
- Can cause cleft palate if used in 1st trimester
Carbamzepine: indications and contra-indications
Indications
- Acute mania/hypomania (weaker evidence than lithium or valproate)
- Prophylaxis in bipolar disorder (weak evidence)
- Bipolar depression
Contra-indications
- Pregnancy
Psychiatric drugs contraindicated in pregnancy
- Valproate
- Lithium
- Carbamazepine
- Benzos
- Lamotrigine
- Most anti-psychotics except
- quetiapine, olanzapine, or risperidone
List alcohol withdrawal symptoms
Severe/complicated withdrawal
- Day 1-2 after stopping seizures
- Day 2 after stopping onwards
- Confusion
- Amnesia
- Psychomotor agitation
- Psychosis
- Delirium tremens
Mild/uncomplicated withdrawal
- Day 1-4 after stopping
- Anxiety
- Perspiration
- Insomnia
- Nausea
- Inc HR and BP
- Coarse tremor
- Occasionally transient hallucinations
What is and Presentation of delirium tremens
Acute confusional state occurring in the context of severe alcohol withdrawal syndrome
- Dec AMT
- Amnesia
- Hallucinations and delusions (insects)
- Psychomotor agitation and tremor
- Fever
- Tachycardia
- Fluctuating BP
- Electrolyte imbalances
- Symptoms of mild/uncomplicated AWS
Treatment of alcohol withdrawal syndrome
Symptomatic relief and seizure prevention
- Reducing Benzos (Chlordiazepoxide)
Nutritional and vitamin supplementation
- Thiamine (vit B1)
- Multivitamin
Close monitoring for symptoms of complication
Follow up:
Indications for inpatient planned detox
- Prev complicated withdrawal
- Current psych sx
- Comorbid physical illness
- Severe nausea vomiting and biochemical abnormalities
Drug used as a preventative for alcohol abuse and sx it produced
Disulfiram
flushing, headache, tachycardia, nausea and vomiting.
Drug used to reduce alcohol cravings
Acamprosate
Treatment of delirium tremens
- Admit
- ABC
- Treat low blood glucose if needed
- Benzos for symptoms and des chance of seizure
- IV thiamine if wernickes-korskofs syndrome present
- Magnesium may also protect against seizures and arrythmias
What is Wernicke-Korsakoff syndrome, how does it present and treatment
Syndrome common in heavy drinkers due to thiamine deficiency.
Wernickes encephalopathy represents the acute phase
- Acute confusional state
- Ocular-motor signs (ophthalmoplegia, nystagmus)
- Ataxic gait
Korsakoffs syndrome represents the chronic phase
- anterograde amnesia
- confabulation (making up memories from times they can’t remember)
- Apathy
Both are treated with Thiamine (IV if nec), treat underlying alcohol dependence, refer approps for cognitive impairment
What screening tool can be used for alcohol abuse
CAGE
- Have you ever felt you should cut down on your drinking?
- Have people annoyed you by criticizing your drinking?
- Have you ever felt bad or guilty about your drinking?
- Eye Opener: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?
Symptoms of herion intoxication
- Respiratory depression
- Pin point pupils
- Dec conscioussness w/ risk of aspiration
- Nausea/vomiting
- Constipation
Drug used in herion intoxication
Naloxone
Drug used to treat opiod withdrawal sx
Lofexidine - generally
Loperamide and Metoclopramide - GI sx
Methadone - substitute
Herion withdrawal symptoms
8 hours after last dose
- Drug cravings
- Moodiness
8-24 hours
- Stomach cramps
- Runny nose
- Sweats
- Tears
- Restlessness
24hrs-3days
- Diarrhoea
- Fever/chills
- Muscle spasms
- Nausea/vomiting
- Inc HR and BP
Symptoms of cocaine intoxication
- Tachycardia
- HTN
- Vasoconstriction
- Anxiety
- Impulsivity
- Pupil dilation
Symptoms of marijuana intoxication
- Relaxed and happy
- Hallucinations
- Inc HR
- Dizziness
- Inc appetite
*
Symptoms of MDMA (amphetamine) intoxication
- Jaw clenching
- Teeth grinding
- Blurred vision
- Nausea
- Inc temp
*
symptoms of amphetamine come down
- Fatigue
- Depression
12-48 hours after taking
Symptoms of LSD intoxication
- Sensory distortion including tasting colours and seeing sounds
- Dilated pupils
- Tachycardia
- HTN
- Delusions and hallucinations
- Risk taking behaviour
Symptoms of benzo intoxication
- Drowsiness
- Dizziness and blurred vision
- Impaired concentration
- Impaired coordination
- HypOtension
- Resp depression
Symptoms of lithium toxicity
- Anorexia, diarrhoea and vomiting.
- Drowsiness, apathy, restlessness.
- Dysarthria.
- Dizziness, ataxia, inco-ordination, muscle twitching, coarse tremor.
- Hyperreflexia, convulsions.
- Collapse, coma.
- Renal failure, dehydration, circulatory collapse (may need haemodialysis).
- Hypokalaemia.
Lithium SEs
- Abdominal pain.
- Nausea.
- Metallic taste in the mouth (usually wears off).
- Fine tremor.
- Thirst, polyuria, impaired urinary concentration - avoid fluid restriction.
- Weight gain and oedema.
Treatment of lithium toxicity
Cessation from lithium
Gastric lavage
Hemodialysis
Sodium administration
Antidote to paracetamol OD
acetylcysteine
Drugs used in ADHD
Atomoxetine (noradrenaline reuptake inhibitor non stimulant)
Methylphenidate (ritalin aka stimulant)
Dextroamphetamine
symptoms of agranulocytosis
sudden fever.
chills.
sore throat.
weakness in your limbs.
sore mouth and gums.
mouth ulcers.
bleeding gums.
