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DRUGS Flashcards

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1
Q

Typical/First gen anti-psychotics

A

Older drugs

  • Sulpiride
  • Trifluoperazine
  • Haloperidol
  • Flupentixol
  • Pipothiazine
  • Chlorpromazine
  • Fluphenazine
  • Zuclopenthixol
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2
Q

Atypical/second gen anti-psychotics

A

Newer drugs

  • Clozapine
  • Risperidone
  • Olanzapine
  • Quetiapine
  • Aripiprazole
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3
Q

MoA typical anti-psychotics

A

Dopamine receptor 2 (D2) antagonism

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4
Q

MoA atypical anti-psychotics

A

Dopamine receptor 2 (D2) antagonism +/- 5-HT antagonism

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5
Q

Extrapyramidal side-effects

A

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

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6
Q

Metabolic syndrome

A
  • Central obesity
  • Insulin resistance
  • Impaired glucose regulation
  • HTN
  • Raised plasma triglycerides
  • Raised LDL +/- HDL
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7
Q

What is Neuroleptic Malignant Syndrome and what are the sx

A

Potentially fatal side-effect of anti-psychotics STOP ALL ANTI PSYCHOTICS IMMEDIATELY

  • Hyperthermia
  • Mm rigidity
  • Confusion
  • Tachycardia
  • Abnormal BP
  • Tremor
  • Raised creatine
  • Metabolic acidosis
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8
Q

Depot anti-psychotics

A

Typicals

  • Haloperidol
  • Flupentixol
  • Zuclopenthixol
  • Fluphenazine

Atypicals

  • Risperidone
  • Olanzapine
  • Aripiprazole
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9
Q

List atypical anti-psychotics in terms of wgt gain

A

++++ :Olanzapine, clozapine

++: Risperidone, Quetiapine

-: Aripiprazole

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10
Q

List atypical anti-psychotics in terms of sedation

A

++++: Clozapine

+++: Olanzapine

++: Quetiapine

+: Risperidone

-: Aripiprazole

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11
Q

List atypical anti-psychotics in terms of metabolic disturbances

A

++++: Clozapine

+++: Olanzapine

+: Riperidone, Quetiapine

-: Aripirazole

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12
Q

First line treatment for schizophrenia

A

An atypical anti-psychotic

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13
Q

What drug treats, treatment resistant schizophrenia

A

Clozapine

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14
Q

What are the serious side effects of clozapine

A
  • Cardiomyopathy
  • Postural HTN
  • Agranulocystosis
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15
Q

MoA clozapine

A

Antagonist of D2, 5HT and D4 receptors

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16
Q

How do you define treatment resistant schizophrenia

A

Inadequate response/ongoing psychotic sx after undergoing trails of two different anti-psychotics at therapeutic dose and duration (ensure compliance)

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17
Q

List anti-depressants and their group

A

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
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18
Q

What group of anti-depressants are 1st line

A

SSRI

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19
Q

MoA SSRI/SNRI +TCA

A

Reuptake of serotonin and/or noradrenaline in inhbited therefore increasing the concentration in the synaptic cleft

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20
Q

SSRI/SNRIs side effects

A

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)
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21
Q

TCA side effects

A

Anti-muscarinic

  • Dry mouth
  • Blurred vision
  • Constipation
  • Urinary retention

Other

  • Sedation
  • Weight gain
  • Dizziness
  • Hypotension
  • Delirium
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22
Q

MOA side effects

A

Serious risk of drug/food interation (tyramine containing food - cheese reaction)

  • Dry mouth
  • Nausea, diarrhea or constipation
  • Headache
  • Sleep disturbance
  • Postural Hypotension
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23
Q

NaSSA (Mirtazapine) side-effects

A
  • Weight gain and increased appetite
  • Drowsiness
  • Dizziness
  • Headache
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24
Q

What is important when starting and stopping anti-depressants

A

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)
25
Q

Rank anti-depressant groups accoring to risk of wgt gain

A

+++: NaSSA

++: TCA

-: SSRI SNRI

26
Q

Rank anti-depressant groups accoring to risk of sexual dysfunction

A

++++: SSRI

+++: SNRI TCA

+: NaSSA

27
Q

Rank anti-depressant groups accoring to risk of sedation

A

+++: NaSSA

++: TCA

+: SNRI

-: SSRI

28
Q

Indication for mood stabilisers

A
  1. Prophylaxis for bipolar, characterised by:
    1. Single manic episode w/ significant risk
    2. Illness w/ significant impact on functioning
    3. Two of more acute episodes
  2. Treatment of bipolar depression
  3. Augmentation for anti-depressants in treatment resistant depression
29
Q

List main mood stabilisers

A
  • Lithium
  • Valproate
  • Lamotrigine
  • Carbamazapine
30
Q

List atypical anti-psychotics that can be used as mood stabilisers

A
  • Quetiapine
  • Olanzapine
  • Aripiprazole
31
Q

Lithium: indications, therapeutic range, side-effects, toxicity, monitoring

A

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)
32
Q

Valproate: indications and contra-indications

A

Indications

  • Acute mania/hypomania
  • Prophylaxis in bipolar disorder (weaker evidence than lithium)

Contra-indications

  • Pregnancy
33
Q

Lamotrigine: indications and major side effects

A

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
34
Q

Carbamzepine: indications and contra-indications

A

Indications

  • Acute mania/hypomania (weaker evidence than lithium or valproate)
  • Prophylaxis in bipolar disorder (weak evidence)
  • Bipolar depression

Contra-indications

  • Pregnancy
35
Q

Psychiatric drugs contraindicated in pregnancy

A
  • Valproate
  • Lithium
  • Carbamazepine
  • Benzos
  • Lamotrigine
  • Most anti-psychotics except
    • quetiapine, olanzapine, or risperidone
36
Q

List alcohol withdrawal symptoms

A

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
37
Q

What is and Presentation of delirium tremens

A

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
38
Q

Treatment of alcohol withdrawal syndrome

A

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
39
Q

Drug used as a preventative for alcohol abuse and sx it produced

A

Disulfiram

flushing, headache, tachycardia, nausea and vomiting.

40
Q

Drug used to reduce alcohol cravings

A

Acamprosate

41
Q

Treatment of delirium tremens

A
  • 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
42
Q

What is Wernicke-Korsakoff syndrome, how does it present and treatment

A

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

43
Q

What screening tool can be used for alcohol abuse

A

CAGE

  1. Have you ever felt you should cut down on your drinking?
  2. Have people annoyed you by criticizing your drinking?
  3. Have you ever felt bad or guilty about your drinking?
  4. Eye Opener: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?
44
Q

Symptoms of herion intoxication

A
  • Respiratory depression
  • Pin point pupils
  • Dec conscioussness w/ risk of aspiration
  • Nausea/vomiting
  • Constipation
45
Q

Drug used in herion intoxication

A

Naloxone

46
Q

Drug used to treat opiod withdrawal sx

A

Lofexidine - generally

Loperamide and Metoclopramide - GI sx

Methadone - substitute

47
Q

Herion withdrawal symptoms

A

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
48
Q

Symptoms of cocaine intoxication

A
  • Tachycardia
  • HTN
  • Vasoconstriction
  • Anxiety
  • Impulsivity
  • Pupil dilation
49
Q

Symptoms of marijuana intoxication

A
  • Relaxed and happy
  • Hallucinations
  • Inc HR
  • Dizziness
  • Inc appetite
    *
50
Q

Symptoms of MDMA (amphetamine) intoxication

A
  • Jaw clenching
  • Teeth grinding
  • Blurred vision
  • Nausea
  • Inc temp
    *
51
Q

symptoms of amphetamine come down

A
  • Fatigue
  • Depression

12-48 hours after taking

52
Q

Symptoms of LSD intoxication

A
  • Sensory distortion including tasting colours and seeing sounds
  • Dilated pupils
  • Tachycardia
  • HTN
  • Delusions and hallucinations
  • Risk taking behaviour
53
Q

Symptoms of benzo intoxication

A
  • Drowsiness
  • Dizziness and blurred vision
  • Impaired concentration
  • Impaired coordination
  • HypOtension
  • Resp depression
54
Q

Symptoms of lithium toxicity

A
  • 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.
55
Q

Lithium SEs

A
  • 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.
56
Q

Treatment of lithium toxicity

A

Cessation from lithium

Gastric lavage

Hemodialysis

Sodium administration

57
Q

Antidote to paracetamol OD

A

acetylcysteine

58
Q

Drugs used in ADHD

A

Atomoxetine (noradrenaline reuptake inhibitor non stimulant)

Methylphenidate (ritalin aka stimulant)

Dextroamphetamine

59
Q

symptoms of agranulocytosis

A

sudden fever.

chills.

sore throat.

weakness in your limbs.

sore mouth and gums.

mouth ulcers.

bleeding gums.

Psych CP2 (8 decks)

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