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Drugs and side effects Flashcards

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
management of NMS?
withdraw drugs supportive care cool the patient benzodiazepine
26
if you want to avoid weight gain, which anti psychotics can you give?
aripiprazole and haloperidol
27
if you get treatment resistance, which drug would you give ?
clozapine
28
which drugs cause QT prolongation ?
typical antipsychotics
29
less sedating anti psychotics?
haloperidol and risperidone
30
what drugs do you give for alcohol withdrawl?
chlordiazepoxide or diazepam
31
side effects of chlordiazepoxide or diazepam
eye irritation, tremor, urinary retention
32
lithium side effects ?
``` Lethargy/leucocytosis Intentional tremor Teratogenic Hypothyroid (treated with thyroxin) Insipidus (diabetes insipidus, wishaw) Urine excess Metallic taste ``` Nausea, vomiting and tremor, weight gain
33
long term side effects of lithium ?
renal impairment and hpothroid (treated with thyroxin)
34
EPSEs more common in ?
typicals
35
how are panic disorders treated?
CBT +/- SSRI (sertraline or citalopram)
36
first line treatment of PTSD?
eye movement desensitisation reprocessing)
37
what is 5HT?
serotonin
38
In terms of diabetes, why would you use typical antipsychotics?
atypicals cause metabolic syndrome
39
Lithium, primary use?
bipolar disorder
40
lithium therapeutic range?
very low
41
how is lithium excreted?
kidneys - causes renal impairment in long term use
42
what ECG changes would you see in lithium?
T wave inversion/flattening
43
lithium mechanism of action ?
interferes with inositol triphosphate formation | interferes with cAMP formation
44
when should lithium levels be checked?
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
which SSRI is used post MI, as safer in this situation than other anti depressants?
sertraline
46
preferred SSRIs for depression?
citalopram and fluoxetine
47
in children, what is the SSRI of choice?
fluoxetine
48
most common side effects of SSRIs?
GI side effects
49
what should patients be counselled about following starting an SSRI?
increased anxiety and suicical thoughts
50
if you need to prescribe NSAIDS along with SSRIs, what should you prescribe along side?
a PPI
51
which SSRI has an increased risk of congenital malformations, particularly in the first trimester?
paroxetine
52
when stopping an SSRI, the dose should be gradually reduced over?
4 weeks
53
SSRI that helps with sleep
mirtazipine
54
which of the antipsychotics has the most tolerable side effects? particularly for prolactin elevation?
aripirazole
55
what is agranulocytosis?
a condition where someone has leucopenia
56
what investigation would you do if you suspected agranulocytosis?
FBC
57
why are TCAs used less commonly now?
due to their side effects and toxicity in overdose
58
what are the common side effects of TCAs?
``` drowsiness dry mouth blurred vision constipation urinary retention ```
59
what class of drug is mirtazipine?
tetracycline
60
what drug is most likely to interact with an SSRI?
triptan
61
which 2 antipsychotics are associated with sexual dysfunction ?
RH risperidone Haloperidol
62
TCA most dangerous in overdose?
dosulepin
63
which SSRI would you prescribe to someone who drinks a lot of alcohol?
mirtazipine
64
what should be offered to all patients with schizophrenia?
CBT
65
antipsychotics in elderly - increased risk of?
VTE and stroke

psych (29 decks)

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