Managing medications MH Flashcards
What are anxiolytics?
Used primarily in MH settings for relieving acute panic and anxiety, insomnia, OCD, post-traumatic stress disorder and alcohol withdrawal.
How to anxiolytics work?
Enhancing the effects of the neurotransmitter GABA
What are some commonly used anxiolytics?
Diazepam Alprazolam (Xanax) Bromazepam Clonazepam Flunitrazepam Lorazepam Temazepam
What are the side effects of anxiolytics?
Headache Nausea Hypotension Unsteadiness Drug dependency Impaired memory and concentration Sedation Feelings of being "cut" off from one's own feelings Low mood Poor motor coordination Mood swings, irritability, anger
What are the four main groups of antidepressants?
Tricyclics
Monoamine Oxidase Inhibitors (MAOIS)- older
SSRIs
SNRIs
What can antidepressants be prescribed to treat?
Moderate to severe depression Sever anxiety and panic attacks The depressed phase of bipolar episode OCD Chronic pain Eating disorders PTSD
How to SSRIs work?
Prevent the re-uptake of serotonin in the CNS.
What are the side effects of SSRIs?
Nausea
Diarrhoea
Agitation
Headaches
SEROTONIN SYNDROME: a potentially life-threatening emergency resulting from excessive serotonin activity- can results from other antidepressants being combined with SSRIS or being administered while the person is taking St John’s wort. Can lead to hyperthermia, kidney failure and death if untreated. Emergency interventions include ceasing administration of SSRIs and administering anticonvulsants and clonazepam to reduce agitation and induce calm.
Symptoms are: Confusion, mania, agitation/restlessness, sweating, urgent need to urinate and frequently, tremor, nausea, diarrhoea, headache.
How do SNRIs?
Newer type- block reuptake of both noradrenaline and 5-HT neurotransmitters.
What are the side effects of SNRIs?
Similar to SSRIs: Diarrhoea, nausea, headaches, agitation. Sexual side effects also common-loss of libido, failure to reach orgasm and erectile dysfunction
What is serotonin discontinuation syndrome?
If people stop taking antidepressants suddenly, they may experience the following non-life threatening symptoms:
Flu-like reaction
Physical symptoms- headache, GI distress, faintness and strange sensations of touch or vision.
Anxiety and depression
The following medications appear to be associated with this syndrome: Citalopram (celexa), escitalopram (lexapro), fluoxetine (prozac), Fluvoxamine (luvox), paroxetine (paxil) and sertraline (zoloft).
What are some examples of SSRIs?
Citalopram (celexa), escitalopram (lexapro), fluoxetine (prozac), Fluvoxamine (luvox), paroxetine (paxil) and sertraline (zoloft).
What are some examples of SNRIS?
Venlafaxine (Efexor); Reboxetine (Edronax)
What is the mode of action of TCAs?
Block the reuptake of the neurotransmitters noradrenaline and serotonin in the CNS.
What are the side-effects of TCAs?
Increased HR, drowsiness, dry mouth, constipation, urinary retention, blurred vision, dizziness, seizures, confusion.
What are the signs of tricyclic overdose?
Agitation Confusion Drowsiness Bowel and bladder paralysis Dysregulation of body temperature and bp Dilated pupils
Why are MAOIs less commonly prescribed now?
They induce life-threatening high blood pressure if foods containing tyramine (eg aged cheeses, certain types of fish, red wine, broad beans) are eaten when taking MAOIs
What is the mode of action of MAOis?
Block the enzyme monoamine oxidase, which breaks down the neurotransmitter dopamine, serotonin and noradrenaline.
What are commonly used MAOIs?
Phenelzine (Nadril)
Tranylcypromine (Parnate)
What are the side effects of MAOIs?
Dry mouth Sedation Constipation Hypotension Seizures Urinary retention
What are examples of typical/first-generation antipsychotics?
Chlorpromazine Flupenthixol Fluphenazine Haloperidol Pericyazine Trifluoperazine
What are examples of atypical or second-generation antipsychotics?
Aripiprazole Amisulpride Clozapine Olanzapine Quetiapine Risperidone
How do antipsychotics work?
Reduce or eliminate delusions, hallucinations, abnormal mood and thought disorders. They also reduce the likelihood of further episodes of psychosis. Their MOA is to block dopamine and 5-HT receptors within the CNS.
What are the extrapyramidal side effects of antipsychotics?
Dystonia- muscular spasm in any part of the body, head and neck twisted etc
Parkinsonism- tremor and/or rigidity, bradykinesia (decrease facial expression, flat monotone voice, slow body movements, inability to initiate movements), bradyphrenia (slowed thinking), salivation.
Akathesisa- inner restlessness, foot tapping when seated, rocking, pacing up and down etc
Tardive dyskinesia- A wide range of movements can occur such as lip smacking or chewing, tongue protrusion, choreiform movements and pelvic thrusting etc
What are anticholinergic drugs?
Used to reduce the distressing and unwanted side effects of antipsychotic medication. They block the neurotransmitter acetylcholine at the muscarinic receptor site. eg Benzhexol (Artane) and Benztropine (Cogentin).
What are the side effects of anticholinergic drugs?
Dry mouth, constipation and dizziness
What are the side effects of antipsychotics?
Increased appetites, weight gain Nausea Constipation Postural hypotension Drowsiness Dry mouth Sensitivity to sunburn
What is neuroleptic malignant syndrome?
Neuroleptic malignant syndrome is a life-threatening, neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs. Symptoms include high fever, sweating, unstable blood pressure, stupor, muscular rigidity, and autonomic dysfunction.
What are mood stabilisers?
Prescribed to maintain a balanced mood for people with intense or shifting moods. Lithium, a naturally occurring ring salt is the drug of choice for treating acute mania and for the ongoing maintenance of those with a history of mania. Anticonvulsants such as sodium valporate (Epilim), carbamazepine (tegretol) and lamotrigine (Lamictal) are also used as mood stabilisers.
What is the therapeutic range for lithium?
0.6-1.2 for acute mania
0.6-0.8 for maintenance.
If the level exceeds 1.5 the next dose should be withheld and doctor notified
What are side effects of mood stabilisers?
Sleepiness, diziness, a metallic taste in the mouth, increased appetite and weight gain, a feeling of sickness, nausea, skin rashes, changes in blood count, irregular menstrual periods in females.
Rare: pancreatitis, abdo pain, liver failure, weakness, loss of appetite, lethargy, drowsiness
What are the signs of lithium toxicity?
Anorexia, nausea, vomiting, diarrhoea, coarse hand tremor, twitching, lethargy, slurred speech, hyperactive deep tendon reflexes, ataxia, tinnitus, vertigo, weakness, drowsiness.
Signs in later stage- fever, decrease urine output, decreased blood pressure, irregular pulse, ECG changes, impaired consciousness, seizures, coma.
What are drugs used to manage dementia?
Cholinesterase inhibitors include: donepezil (Aricept), rivastigmine (Exelon), galantamine (Reminyl)
What are common side effects of anticonvulsants?
Carbamazepine: blood dyscrasias, drowsiness, nausea, vomiting, constipation, diarrhoea, hives or skin rashes, hepatitis.
Valporate: Prolonged bleeding time, GI upset, tremor, ataxia, somnolence, dizziness, hepatic failure,
Topiramate: Cog impairment, sedation, nausea, weight loss, dizziness, vomiting, rash, agitation, paraesthesia.
