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Year 4 Psych- A > Formulary > Flashcards

Formulary Flashcards

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1
Q

MOA SSRIs

A

Inhibits reuptake of serotonin, causing increase in local concentrations. Takes several weeks to have full effect. Recommended to continue for at least 6/12 following remission of depression.

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2
Q

Clinical indications SSRIs

A

Depression, Anxiety disorders (GAD, OCD, PTSD),
Fluoxetine licensed for bulimia nervosa.

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3
Q

Side effects of SSRIs

A

Agitation, sexual dysfunction, nausea, diarrhoea, dizziness, headaches, insomnia

Rare but important: platelet dysfunction (upper GI bleed), hyponatraemia, initial increase in suicide risk in <25 year olds

Abrupt withdrawal causes discontinuation syndrome – dizziness, diarrhoea, fatigue, headaches, gait instability. Withdraw slowly over weeks.

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4
Q

SSRIs monitoring

A

Nil routine. Citalopram can cause QT prolongation.

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5
Q

Tricyclic Antidepressants examples

A

Amitriptyline, Clomipramine, Imipramine.

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6
Q

MOA Tricyclic Antidepressants

A

Inhibit the reuptake of sertraline and noradrenaline.
Also act as antagonists and several other neurotransmitter receptors e.g muscarinic, alpha1 and H1

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7
Q

Clinical indications Tricyclic Antidepressants

A

Depression, Clomipramine licensed for OCD

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8
Q

SE Tricyclic Antidepressants

A
  • Anticholinergic – dry mouth, urinary retention, constipation, postural hypotension, worsening of glaucoma
  • Drowsiness, headache
  • Cardiovascular – tachycardia, QT prolongation
  • Withdrawal effect – nausea, anxiety, sweating, insomnia.

High toxicity in OD due to membrane stabilising properties – cardiac arrhythmias (VF), seizures, hypotension.

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9
Q

Monitoring in tricyclic antidepressants

A

ECG

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10
Q

MAOIs (Monoamine Oxidase Inhibitors) e.g.

A

Phenelzine, Isocarboxazid, Moclobemide

Rarely used now due to interactions with foods and other medications. Reserved for patients who have not responded to other treatments.

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11
Q

MOA MAOIs (Monoamine Oxidase Inhibitors)

A

Inactivate enzymes (monoamine oxidase) that oxidise noradrenaline, serotonin, dopamine, tyramine and other amines.

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12
Q

MAOIs (Monoamine Oxidase Inhibitors)
SE

A

Dry mouth, postural hypotension, headache, confusion, constipation

Interaction with foods – food containing tyramine causes accumulation of tyramine which cannot be broken down. Can cause hypertensive crisis. Avoid all cheeses, red wine, beer, smoked fish, Marmite, liver, salami, pepperoni amongst others. Also interact with local anaesthetics, some opiates, cocaine.

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13
Q

MAOIs (Monoamine Oxidase Inhibitors)
Clinical indications

A

Depression, refractory anxiety

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14
Q

Mirtazapine

Mechanism of action

A

Potent agonist at several serotonin receptor subtypes, competitive agonist of H1 α1 and α2

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15
Q

Mirtazapine clinical indications

A

Depression, anxiety

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16
Q

Mirtazapine SE

A

Drowsiness, dry mouth. Increased appetite and weight gain.

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17
Q

Venlafaxine, Duloxetine MOA

A

Blocks serotonin reuptake and noradrenaline reuptake at higher doses (SNRI).

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18
Q

Venlafaxine, Duloxetine clinical indication

A

Usually second line treatment for depression. Generalised anxiety disorder.

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19
Q

Venlafaxine, Duloxetine SE

A

Nausea, headache, sedation, dry mouth, dizziness. Sexual dysfunction. Can cause increased BP.

Abrupt withdrawal causes discontinuation syndrome – dizziness, diarrhoea, fatigue, headaches, gait instability. Withdraw slowly over weeks.

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20
Q

Venlafaxine, Duloxetine monitoring

A

Check BP in patients on higher doses.

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21
Q

Serotonin syndrome cause and symptoms

A

can be caused by any drugs which potentiate brain serotonin function. Usually occurs when combination of these drugs are used. (SSRIs, SNRIs, tricyclic antidepressants)

Symptoms – myoclonus, nystagmus, headache, tremor, seizures, confusion, hyperpyrexia, sweating, arrhythmias.

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22
Q

Lithium MOA

A

Inhibits the formation of cAMP affecting a wide range of neurotransmitter pathways.
May also promote cell survival and synaptic plasticity.
Renally excreted.

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23
Q

Lithium clinical indications

A

Acute treatment of mania, prophylaxis in recurrent depression and bipolar mood disorder, augmentation therapy in resistant depression, prevention of aggression in patients with learning disability.

24
Q

Lithium SE

A
  • Polyuria, mild tremor, metallic taste, fatigue, thirst, weight gain
  • Hypothyroidism – 20%
  • Hyperparathyroidism
  • Renal complications – occasionally long-term use can cause nephrogenic diabetes insipidus. Additionally, over many years Li can cause decline in tubular function and associated with increased risk of chronic kidney disease.

TOXICITY – Generally at concentrations >1.2mmol/L. Ataxia, coarse tremor, poor coordination, slurred speech, confusion, muscle twitching progressing to coma, seizures and death at levels >2mmol/L. Stop Li, rehydrate, may require dialysis if severe.

Pregnancy – risk of foetal cardiac defects (Ebstein’s anomaly 20 x more common to 1:1000)

25
Q

Lithium monitoring and interactions

A
  • Plasma concentrations monitored due to narrow therapeutic window. Li levels 7/7 after initiation and dose changes. Once steady state reached can be monitored every 3/12. Usually aim for dose of 0.6-0.8 mmol/L for prophylaxis. Higher levels may be needed for treatment of acute illness. Level should be taken 12 hours post dose.
  • Weight, U&Es inc. eGFR, Ca2+, TFTs at baseline then every 6/12
  • ECG at baseline if cardiovascular risk factors

Multiple interactions - diuretics, NSAIDs, ACE inhibitors, Angiotensin-II antagonists, metronidazole can all increased Li levels.

26
Q

Sodium Valproate MOA

A

Unclear, may slow breakdown of GABA

27
Q

sodium valproate clinical indications

A

Acute management of mania, prophylaxis in bipolar illness.

28
Q

Sodium valproate SE

A

GI disturbances, tremor, sedation, weight gain, hair loss

LFT derangement, thrombocytopenia, acute pancreatitis.

Pregnancy – potent teratogen causing neural tube defects. Now contraindicated in women of childbearing age unless exceptional circumstances. Patients must be using reliable form of contraception.

29
Q

Sodium valproate monitoring

A

Weight, FBC, LFTs at baseline and then every 6-12/12

30
Q

ANTIPSYCHOTICS e.g.

A

ANTIPSYCHOTICS e.g. Olanzapine, Haloperidol, Risperidone

31
Q

Antipsychotics MOA

A

dopamine receptors, particularly D2 receptors. Also act on other receptors (serotinergic, histaminic etc.) but degree varies from drug to drug.

Typical (first generation) and atypical (second generation).

Some available in long-acting injection form (depot) given 2-4/52ly.

32
Q

Clinical indications ANTIPSYCHOTICS

A
  • Used to treat acute psychotic illness by reducing delusions, hallucinations, thought disorder and agitation.
  • Also used prophylactically to prevent relapse of psychosis.
  • Olanzapine and Quetiapine can be used as mood stabilisers for patients with bipolar.
  • Risperidone can be used short term for management of BPSD in dementia. Can also be used to augment other treatments for non-psychotic disorders e.g. anxiety, depression.
33
Q

Antipsychotics SE

A
34
Q

SIDE EFFECTS COMPARISON TABLE antipsychotics

A
35
Q

Monitoring antipsychotics

A
  • BMI and waist circumference at baseline then repeated at 3/12, 12/12
  • BP + pulse baseline then repeated at 3/12, 12/12
  • HbA1c, Lipids, baseline, 3/12 then annually
  • LFTs FBC, U&Es baseline then annually
  • Prolactin 6/12 then annually (if required depending on medication)
  • ECG at baseline then after dose changes, annually or more frequent if risk factors e.g. hx of cardiac disease.
36
Q

CLOZAPINE indication

A

Used as third line treatment for schizophrenia.
if already been on 2 antispychotics and they weren’t effective

37
Q

clozapine SE

A
  • Side-effects agranulocytosis – hypersalivation, sedation, postural hypotension, weight gain, constipation (can lead to paralytic ileus). Myocarditis and cardiomyopathy.
38
Q

clozapine monitoring

A

Weekly FBC for first 18/52, then fortnightly until 1 year. Thereafter monthly.

39
Q

Benzodiazapines MOA

A

Enhance GABA neurotransmission (Act on GABAA receptors).

40
Q

Benzodiazapines clinical indications

A

Short-term use (<4 weeks) for the management of acute anxiety.
Management of acute behavioural disturbance.

41
Q

Benzodiazapines SE

A
  • Sedation, slurred speech, incoordination, ataxia, impaired attention, respiratory depression.
  • Short-acting BZDs more likely to be associated with dependence and withdrawal.
  • Withdrawal syndrome – anxiety, insomnia, tremor, nausea, perceptual disturbances. Occurs within 2-3/7 of stopping short-acting, or 7/7 long-acting BZD.
  • Flumazenil – BZD receptor antagonist, for acute toxicity.
42
Q

Z-drugs (Zopiclone, Zolpidem, Zaleplon) MOA

A

Act at or close to the BZD receptor site.

43
Q

Z-drugs (Zopiclone, Zolpidem, Zaleplon) clinical indiacation

A

Short-term management of insomnia

44
Q

Z-drugs (Zopiclone, Zolpidem, Zaleplon) SE

A

Bitter aftertaste. Residual drowsiness the following day. Can develop tolerance with rebound insomnia on withdrawal.

45
Q

Acetylcholinesterase Inhibitors e.g.

A

Donepezil, Galantamine, Rivastigmine

46
Q

Acetylcholinesterase Inhibitors MOA

A

Block action of acetylcholinesterase which breaks down acetylcholine.

47
Q

Acetylcholinesterase Inhibitors clinical indications

A

Used for mild-moderate Alzheimer’s disease.

Rivastigmine used for Lewy Body dementia.

Slows progression of disease

48
Q

Acetylcholinesterase Inhibitors SE

A

Nausea, vomiting, diarrhoea, muscle cramps, insomnia, bradycardia

49
Q

Acetylcholinesterase Inhibitors monitoring

A

Check pulse

50
Q

memantine MOA

A

NMDA- type glutamate receptor antagonist

51
Q

memantine clinical indications

A

Moderate –severe Alzheimer’s disease. Slows progression.

52
Q

memantine SE

A

Sedation, dizziness, constipation

53
Q

Anticholinergic side effects

A

dry mouth/eyes
blurred vision
constipation
urinary retention
postural hypotension
confusion
drowsiness

54
Q

SSRIs discontinuation syndrome presetation

A
  • flulike symptoms
  • dizziness
  • insomnia
  • vivid dreams
  • irritability
  • crying spells
  • sensory symptoms (“electric shocks” in the arms, legs or head)
55
Q

has the most tolerable side effect profile of the atypical antispsychotics, particularly for prolactin elevation

A

Aripripizole

56
Q

which group of commonly prescribed medications can induce psychosis?

A

Sudden onset psychosis following course of corticosteroids - consider steroid-induced psychosis

57
Q

how long after changing the dose of lithium should you check levels? what time after taking the dose?

A

When checking lithium levels, the sample should be taken 12 hours post-dose, 7 days after dose change

Year 4 Psych- A (20 decks)

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