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Drugs and side effects Flashcards

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1
Q

examples of typical anti psychotics ?

A

haloperidol and chlorpromazine

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2
Q

mechanism of action of typicals?

A

block D2

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3
Q

side effect of haloperidol? seen on ECG

A

torsades de pointes or prolonged QT

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4
Q

what is 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

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5
Q

what causes tardive dyskinesia?

A

typical antipsychotics

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6
Q

example of atypical antipsychotics ?

A

olanzipine, quetiapine, aripiprazole, risperidone

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7
Q

what drugs do you use in schizophrenia?

A

atypicals

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8
Q

anti psychotics block dopamine transmission in which pathway?

A

mesolimbic

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9
Q

what is akisthisia

A

restlesness

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10
Q

side effects with typical antipsychotics ?

A

extra pyramidal ( dystonia, akisthisia, parkinsonism, tardive dyskinesia)

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11
Q

what is tariff dyskinesia?

A

repetitive, uncontrollable, involuntary contractions of the muscles of the face, tongue and upper body

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12
Q

is tardive dyskinesia reversible?

A

no

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13
Q

mechanisms of action of atypical antipsychotics?

A

block D2 receptors

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14
Q

side effects of atypical ?

A 
drowsiness
increased risk of seizures 
sexual dysfunction 
T2DM 
hyperprolactinaemia
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15
Q

in elderly people, what is there a risk of ?

A

stroke

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16
Q

which 2 drugs are thought to be worst for weight gain?

A

olanzipine and clozipine

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17
Q

second generation anti psychotic that has been shown to improve positive as well as negative symptoms in schizophrenia?

A

clozapine

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18
Q

clozapine is only used when?

A

in resistant schizophrenia. schizophrenia which has not responded to two anti psychotics, one of which is an atypical

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19
Q

side effects of clozapine?

A

regular blood monitoring for agranulocytosis

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20
Q

side effects of ClozAPine?

A

cardiomyopathy
agranulocytosis
Pure spitting all time (hyper salivation) + pulmonary embolism
weight gain just like olanzipine

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21
Q

what happens when you stop smoking on clozapine?

A

smoking reduces level of clazapine, so suddenly stopping can increase levels

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22
Q

what is NMS? how does it present?

A

confusion, agitation, stupor, tachycardia, dilated pupils, sweating,

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23
Q

how do you get NMS?

A

a complication of anti psychotics, especially typical antipsychotics

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24
Q

how do you diagnose NMS?

A

raised white cell and CK

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25
Q

management of NMS?

A

withdraw drugs
supportive care
cool the patient
benzodiazepine

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26
Q

if you want to avoid weight gain, which anti psychotics can you give?

A

aripiprazole and haloperidol

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27
Q

if you get treatment resistance, which drug would you give ?

A

clozapine

28
Q

which drugs cause QT prolongation ?

A

typical antipsychotics

29
Q

less sedating anti psychotics?

A

haloperidol and risperidone

30
Q

what drugs do you give for alcohol withdrawl?

A

chlordiazepoxide or diazepam

31
Q

side effects of chlordiazepoxide or diazepam

A

eye irritation, tremor, urinary retention

32
Q

lithium side effects ?

A 
Lethargy/leucocytosis
Intentional tremor
Teratogenic
Hypothyroid (treated with thyroxin)
Insipidus (diabetes insipidus, wishaw)
Urine excess
Metallic taste

Nausea, vomiting and tremor, weight gain

33
Q

long term side effects of lithium ?

A

renal impairment and hpothroid (treated with thyroxin)

34
Q

EPSEs more common in ?

A

typicals

35
Q

how are panic disorders treated?

A

CBT +/- SSRI (sertraline or citalopram)

36
Q

first line treatment of PTSD?

A

eye movement desensitisation reprocessing)

37
Q

what is 5HT?

A

serotonin

38
Q

In terms of diabetes, why would you use typical antipsychotics?

A

atypicals cause metabolic syndrome

39
Q

Lithium, primary use?

A

bipolar disorder

40
Q

lithium therapeutic range?

A

very low

41
Q

how is lithium excreted?

A

kidneys - causes renal impairment in long term use

42
Q

what ECG changes would you see in lithium?

A

T wave inversion/flattening

43
Q

lithium mechanism of action ?

A

interferes with inositol triphosphate formation

interferes with cAMP formation

44
Q

when should lithium levels be checked?

A

after starting lithium levels should be performed weekly and after each dose change until concentrations are stable
once established, lithium blood level should ‘normally’ be checked every 3 months.

45
Q

which SSRI is used post MI, as safer in this situation than other anti depressants?

A

sertraline

46
Q

preferred SSRIs for depression?

A

citalopram and fluoxetine

47
Q

in children, what is the SSRI of choice?

A

fluoxetine

48
Q

most common side effects of SSRIs?

A

GI side effects

49
Q

what should patients be counselled about following starting an SSRI?

A

increased anxiety and suicical thoughts

50
Q

if you need to prescribe NSAIDS along with SSRIs, what should you prescribe along side?

A

a PPI

51
Q

which SSRI has an increased risk of congenital malformations, particularly in the first trimester?

A

paroxetine

52
Q

when stopping an SSRI, the dose should be gradually reduced over?

A

4 weeks

53
Q

SSRI that helps with sleep

A

mirtazipine

54
Q

which of the antipsychotics has the most tolerable side effects? particularly for prolactin elevation?

A

aripirazole

55
Q

what is agranulocytosis?

A

a condition where someone has leucopenia

56
Q

what investigation would you do if you suspected agranulocytosis?

A

FBC

57
Q

why are TCAs used less commonly now?

A

due to their side effects and toxicity in overdose

58
Q

what are the common side effects of TCAs?

A 
drowsiness
dry mouth
blurred vision
constipation
urinary retention
59
Q

what class of drug is mirtazipine?

A

tetracycline

60
Q

what drug is most likely to interact with an SSRI?

A

triptan

61
Q

which 2 antipsychotics are associated with sexual dysfunction ?

A

RH
risperidone
Haloperidol

62
Q

TCA most dangerous in overdose?

A

dosulepin

63
Q

which SSRI would you prescribe to someone who drinks a lot of alcohol?

A

mirtazipine

64
Q

what should be offered to all patients with schizophrenia?

A

CBT

65
Q

antipsychotics in elderly - increased risk of?

A

VTE and stroke

psych (29 decks)

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