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3a psychiatry > Medication > Flashcards

Medication Flashcards

1
Q

Examples of SSRIs

A

sertraline
citaloparm
fluoxetine
paroxetine

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2
Q

How long should SSRIs be continued?

A

for at least 6 months to reduce the risk of relapse

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3
Q

Which anti depressant is recommended in children?

A

fluoxetine

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4
Q

Outline the mechanism of SSRIs

A

inhibit the reuptake of serotonin so there is more serotonin at the synaptic cleft

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5
Q

List the side effects of SSRIs

A

usually well tolerated…

GI upset** (take PPI if NSAID + SSRI to reduce risk of GI bleed)
initial anxiety and agitation
hyponatraemia
sexual dysfunction

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6
Q

What is contraindicated with SSRIs?

A

NSAIDS (unless with PPI)
warfarin and heparin
triptans

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7
Q

which SSRI is contraindicated in pregnancy and why?

A

PAROXETINE

causes congenital heart defects and pulmonary hypertension

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8
Q

List the symptoms after discontinuing SSRIs (should be done over 4 weeks)

A 
restlessness
GI- vomiting, pain, diarrhoea
sweating
mood change
unsteadiness
difficulty sleeping
paraesthesia
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9
Q

Examples of TCAs

A

amitriptyline

clomipramine

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10
Q

What are TCAs used to treat?

A

2nd line depression
neuropathic pain
migraine prophylaxis

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11
Q

Outline the mechanism of action of TCAs

A

serotonin and noradrenaline reuptake inhibited so increase serotonin and noradrenaline at synaptic cleft

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12
Q

Outline the side effects of TCAs

A

(worse side effects than SSRI and bad in overdose)
anti muscarinic e.g. dry mouth, blurred vision
urinary retention, constipation
drowsiness
prolong QT interval / arrhythmias

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13
Q

Examples of SNRIs

A

venlafaxine

duloxetine

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14
Q

When are SNRIs used?

A

major depressive disorders
GAD
social anxiety
menopausal symptoms

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15
Q

List the side effects of SNRIs

A 
dry mouth
constipation
tiredness
sweating
anxiety/ agitation
dizziness
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16
Q

Who is mirtazapine recommended for?

A

elderly!
side effects of sedation and weight gain can be beneficial
2nd line anti depressant after SSRI

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17
Q

Outline the mechanism of mirtazapine

A

alpha 2 adrenergic recetor blocker so increase release of neurotransmitter

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18
Q

What are the side effects of mirtazapine?

A

increased appetite - WEIGHT GAIN

sedation

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19
Q

Examples of monoamine oxidase inhibitors

A

phenelzine
isocarboxazid
trancylpromine

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20
Q

When are MAOIs used?

A

atypical depression

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21
Q

Outline the mechanism of action of MAOIs

A

MAO metabolises NA and 5-HT pre synaptically

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22
Q

What are the side effects of MAOIs

A

anti cholinergic- dry mouth, visual disturbance, urinary retention

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23
Q

What should be avoided with MAOIs?

A

avoid tyramine containing foods e.g. cheese, broad beans, marmite, pickles, bovril , red wine

causes hypertensive crisis !

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24
Q

What is serotonin syndrome?

A

excess serotonin in the CNS from use of SSRIs, SNRIs, TCAs, MAOIs, tramadol, cocaine, MDMA

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25
Q

How does serotonin syndrome present?

A
  1. cognitive - altered mental state, headache, agitation, hallucinations
  2. somatic- myoclonus, tremor, hyperreflexia
  3. autonomic - sweating, tachycardia, hypertension. nausea, hyperthermia
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26
Q

How is serotonin syndrome treated?

A
  1. remove cause
  2. IV fluids and benzodiazepines
  3. cyproheptadine = serotonin antagonist
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27
Q

Examples of benzodiazepines

A

chlordiazepoxide
diazepam
lorazepam

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28
Q

When are benzos used?

A

sedation
anxiolytic
anti convulsant

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29
Q

Describe the mechanism of benzodiazepines

A

enhance effect of GABA by increasing frequency of chloride channels

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30
Q

What are the side effects of benzodiazepines?

A 
high risk of dependence 
confusion
drowsiness
hypotension/ dizziness
nausea
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31
Q

List the withdrawal side effects from benzodiazepines?

A 
anxiety
insomnia 
tremor
loss of appetite 
seizures
32
Q

examples of 2nd generation anti-psychotics “atypical”

A

olanzapine
clozapine
risperidone
quetiapine

(worse metabolic syndrome SE)

33
Q

What should be used if resistant to treatment in schizophrenia?

A

clozapine

34
Q

examples of 1st generation anti-psychotics “typical”

A

haloperidol
laxapine
pimozide

(worse EPS symptoms)

35
Q

Describe the mechanism of typical anti-psychotics

A

block D2 dopamine receptors in the brain

36
Q

List the side effects of anti-psychotics

A 
extra pyramidal
anti muscarinic e.g. dry mouth, blurred vision, urinary retention, constipation
raised prolactin
hypercholesterolaemia
reduced seizure threshold 
impaired glucose tolerance (diabetes) 
prolonged QT interval
weight gain
adrenergic - sedation, postural hypotension, inhibition of ejaculation
37
Q

List the extra pyramidal symptoms

A

Acute dystonia = first few days
akathisia (restlessness, muscle pains)= first month
parkinsonism = few months
tardive dyskinesia = years

38
Q

What is included in the monitoring of anti psychotics

A 
FBC
UandE
LFTs
blood lipids
weight
ECG
39
Q

When does tardive dyskinesia occur?

A

occurs after taking anti psychotics for a long period of time

40
Q

What are the symptoms of tardive dyskinesia?

A 
chewing
jaw movements
chorea
irreversible
lip smacking
41
Q

How is tardive dyskinesia treated?

A

tetrabenazine = treatment for hyperkinetic movement disorders (e.g. Huntington’s also)

42
Q

Examples of anti psychotics depot injections

A

zuclopenthixol

flupentixol decanoate

43
Q

What can be used if patients not compliant with anti psychotic medication?

A

anti psychotic monthly depot injections!

44
Q

How is neuroleptic syndrome caused?

A

occurs most commonly in first 10 days of starting anti psychotic treatment (commonly in males)

OR

when anti psychotic medication stopped/ reduced

45
Q

List the symptoms of neuroleptic malignant syndrome

A 
rigidity
hyperthermia/ fever
sweating
tachycardia
raised CK
confusion
46
Q

How is neuroleptic malignant syndrome treated?

A
  1. stop anti psychotic
  2. IV fluids
  3. bromocriptine or dantrolene (dopamine agonist)
47
Q

List the symptoms of acute dystonic reaction

A 
facial grimacing
oculogyric crisis 
torticollis
dystonia of laryngeal muscles
opisthotonus
48
Q

How is acute dystonic reaction treated?

A
  1. stop anti psychotic

2. anti cholinergic drugs e.g. procyclidine IM/IV , IM benzotopine

49
Q

When is lithium used?

A

lithium is a mood stabiliser

1st line for bipolar disorder, cyclothymia

reduces suicidal ideation

50
Q

What is the therapeutic index of lithium?

A

NARROW= 0.4-1.0 mmol/L

51
Q

How often are lithium levels monitored?

A

checked weekly when starting lithium until stable

then checked every 3 months (12 hours post dose)

52
Q

What is included in the monitoring of lithium?

A 
weight
TFTs
renal function (creatinine and eGFR)
ECG
FBC
53
Q

List the adverse effects of lithium

A 
L - leucocytosis
I - impaired renal function
T- tremor (fine)
H - hypothyroidism
I - increased weight gain
U - urine increase (oliguria)
M - metallic taste

+ nausea/ vomiting. diabetes insipidus, idiopathic intracranial hypertension

54
Q

List the levels of lithium toxicity and severity

A
  1. 6-2.0 = mild
  2. 1-2.5 = moderate

> 2.5 = severe

55
Q

What are the symptoms of mild lithium toxicity?

A

fine tremor
nausea and vomiting
poor concentration

56
Q

What are the symptoms of moderate lithium toxicity?

A 
coarse tremor
slurred speech
disorientation
nystagmus 
hyperreflexia
57
Q

Describe the ECG changes in lithium treatment

A

inverted T wave/ flat T wave

58
Q

What are the symptoms of severe lithium toxicity?

A 
muscle twitches
parkinsonism
incontinence
renal failure
seizures 
confusion
59
Q

What are the symptoms of a TCA overdose?

A 
severe hypotension
convulsions
arrythymias 
coma 
anti cholinergic - dry mouth, dilated pupils
60
Q

Which drugs are contraindicated with lithium?

A

ACE-I
pregnancy
diuretics
NSAIDs

61
Q

What are the adverse effects of clozapine?

A

agranulocytosis
neutropenia
constipation

NEED 1 MONTHLY FBC
used if fail to respond to 2 other drugs and good for comorbid movement disorders

62
Q

What can raised prolactin cause?

A

sexual dysfunction
breast enlargement
gallactorhoea

63
Q

What is a side effect of citalopram?

A

prolonged QT interval

64
Q

How is TCA overdose treated?

A
  1. IV bicarbonate

2. IV lipid emulsion

65
Q

what is the mechanism of 2nd gen atypical anti psychotics

A

serotonin dopamine D2 receptor antagonist

66
Q

List the dopamine pathways in schizophrenia

A
  1. mesolimbic: +VE symptoms
  2. mesocortical: -ve symptoms
  3. nigrostriatal: extra pyramidal symptoms
  4. tuberoinfundibular: Hyperprolactinaemia

in schizophrenia, there is overactivity of mesolimbic pathway and under activity of mesocortical so drugs block these and help +ve symptoms but worsen -ve symptoms

67
Q

What are the examples of hypnotics?

A
  1. benzodiazepines e.g. diazepam
  2. Z drugs e.g. zopiclone
  3. melatonin - only used over >55 y/o
68
Q

What are the examples of mood stabilisers?

A

lithium
anti convulsants e.g. valproate, lamotrigine
anti psychotic e.g. olanzapine

69
Q

List the types of psychological interventions?

A

PRIMARY CARE/ VOLUNTARY SECTOR:
counselling
psychoeducation
CBT

SECONDARY CARE / SPECIALIST:
DBT
psychoanalytic psychotherapy
group therapy 
family therapy
70
Q

explain section 2

A

detention in hospital for assessment of your mental health and potentially get treatment

71
Q

explain section 5: 4

A

nurses holding power, 6 hours, needs to be followed by MHA

72
Q

Explain section 136

A

police removal from public place to designated place of safety for MHA assessment

73
Q

Explain section 135

A

police removal from home to designated place of safety for MHA assessment

74
Q

who do you need for section 3?

A

2 doctors (one must be section 12 approved, other must be registered doctor) + approved mental health professional

75
Q

which conditions must be met regarding his mental health condition to detain him?

A

mental health disorder
nature or degree to warrant detention in hospital
risk to self others or health

76
Q

who could release him from the section?

A

RMO - registered mental officer

family - nearer relative

3a psychiatry (9 decks)

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