HNN222 Mental Health Medications Flashcards
TYPCIAL (1st Gen) ANTIPSYCHOTICS
Haloperidol, Chlorpromazine, Thioridazine, Flupentixol.
Indication: Acute psychosis and psychotic disorders (e.g. schizophrenia)
MOA: Antagonise post synaptic D2 receptor sites, blocking dopamine transmission and decreasing the amount of DOPAMINE in the brain.
Effective for treating the positive symptoms of schizophrenia but not the negative symptoms.
ATYPICAL (2nd Gen) ANTIPSYCHOTICS
Olanzapine, Risperidone, Quetiapine, Ziprasidone, Clozapine.
Indication: Acute psychosis, acute mania, maintenance therapy in bipolar disorder, and schizophrenia.
MOA: Antagonise D2 receptors, reducing the amount of DOPAMINE. Block sub-type 2 serotonin receptors effecting SEROTONIN levels.
Effective for treating the positive symptoms of schizophrenia and can also alleviate some of the negative symptoms.
Adverse Effects
TYPCIAL (1st Gen) ANTIPSYCHOTICS
Extrapyramidal effects (EPS) causing movement disorders such as:
* Tardive dyskinesia: involuntary muscle movements
* Akathisia: restlessness and agitation
* Acute dystonia: muscle spasms of the head, neck and toros
* Parkinsonism
Neuroleptic malignant syndrome (NMS)
* Life threatening
* Hyperthermia
* Mental status changes
* Muscle rigidity
* Autonomic instability
Other
* Sedation
* Photosensitivity
* Weight gain
* Anticholinergic effects
* Sexual dysfunction
Adverse Effects
ATYPICAL (2nd Gen) ANTIPSYCHOTICS
Less likely to cause EPS and NMS.
Common effects:
* Metabolic syndrome
* Sedation - can reduce occupational and social function
* Sexual dysfunction
* Increased appetite > weight gain
Anticholinergic effects
○ Dry mouth
○ Orthostatic hypotension
○ Blurred vision
○ Tachycardia
○ Constipation
Cardiac effects
○ Arrythmias
○ ECG changes
○ Myocarditis
Clozapine Considerations
Agranulocytosis
* Treatment refractory drug (must have tried at least 2 different anti-psychotics)
* Depletion of WBC
* Increased risk of serious or life threatening infection
* Regular blood tests (weekly for first 18 weeks)
* Go to Dr if cold or flu like symptoms e.g. sore throat.
* Don’t quit smoking without consulting Dr.
SSRIs
Indication: Depression
MOA: Selectively inhibit the reuptake of serotonin forcing the serotonin to have a longer lasting effect. Most common.
Adverse Effects: Target specific receptors so have less side effects and are safer.
Should not be stopped abruptly as it will cause withdrawal syndrome causing dizziness, sleep disturbance, paraesthesia, anxiety and tremors.
Tricyclic Antidepressants
Indication: Depression
MOA: Stop re-uptake of serotonin and noradrenaline at the synapse, promoting increased transmission. Have broad synaptic effects.
Adverse Effects: Hypotension, arrythmias, heart blocks. Can be toxic and life threatening.
Monoamine Oxide Inhibitors
Indication: Depression
MOA: Prevent breakdown of serotonin and noradrenaline. Increased in the synapse.
Adverse Effects:
* Interact with tyramine rich foods e.g. cheese, cured meats, liver, broad beans, avocado, bananas.
* Interact with stimulants, hay fever and asthma medication, narcotics, vasoactive substances.
* Interactions can lead to hypertensive crisis.
Atypical Anitdepressants
SNRIs - more targeted, less side effects
Noradrenaline Reuptake Inhibitors
Noradrenaline-Dopamine Reuptake Inhibitors
Serotonin Syndrome
- Headaches
- Altered conscious state
- Dilated pupils
- Hyperthermia
- Diaphoresis
- Tachycardia
- Unstable BP
- N+V
- Tremors and seizures
Bipolar Disorder Medications
- Lithium
- Sodium valproate
- Anticonvulsants (carbamazepine and eoxcarbazepine)
- Benzodiazepienes (lorazepam and clonazepam)
- 2nd gen antiepileptic (topiramate)
- Lamotrigine
Lithium
Indication: Bipolar, acute mania
MOA: Unknown; its actions include inhibition of dopamine release, enhancement of serotonin release and decreased formation of intracellular second messengers.
PRACTICE POINTS
Toxicity: extreme thirst and frequent urination, nausea and vomiting
Take blood for lithium concentration regularly
Check weight, serum calcium (including ionised calcium) and parathyroid hormone concentrations, and renal and thyroid function at baseline, then every 3–6 months
Avoid sodium bicarbonate > reduces effectiveness
High risk of dehydration: need to drink 2-3L of water a day, report GI issues.
Sodium Valproate
Indication: Epilepsy, migraine, bipolar disorder
MOA: Prevents repetitive neuronal discharge by enhancement of GABA, inhibition of glutamate and blockade of T-type calcium channels.
PRACTICE POINTS
Drowsiness
May also increase the effects of alcohol.
Appetite increase and weight gain.
Appears to reduce BMD and may increase fracture risk. Ensure vitamin D status and calcium intake are adequate
Monitoring: Baseline FBE. Routine LFTs (rare occurrence of liver failure). Only require trough levels if non-adherence or toxicity.
Anticonvulsants
Carbamazepine and Oxcarbazepine
Indication: Epilepsy, BPAD
MOA: Prevents repetitive neuronal discharges by blocking sodium channels.
PRACTICE POINTS
Carbamazepine
* Interacts with grapefruit juice and many other drugs.
* Check baseline FBE and periodically thereafter.
* Stop carbamazepine if significant bone marrow depression occurs.
* Monitor for skin reactions; most are transient but some may be serious and life-threatening.
Oxcarbazepine
* Monitor sodium concentration after 2 weeks and then each month for 3 months.
* Oxcarbazepine may be an alternative in patients unable to take carbamazepine.
Benzodiazepines
(Lorazepam and Clonazepam)
Indications: Anxiety
MOA: Increase the effects of the neurotransmitter gamma aminobutyric acid (GABA), the universal inhibitory neurotransmitter, decreasing neurotransmission, thus calming neuronal activity.
Adverse Effects:
Risk of dependence. Only use short term (2 weeks).
Reduced mental activity and alertness.
Avoid alcohol and drugs as these also depress the nervous system.
Risk of withdrawal symptoms: agitation, dizziness, anorexia, anxiety, autonomic arousal, hallucinations, insomnia, nausea and vomiting, seizures, and tinnitus.
