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Phsyciatry > Medications > Flashcards

Medications Flashcards

1
Q

In what conditions are antipsychotics used?

A

Schiophernia
Psychosis
Mania
Schizoaffective disorder
Severedepression
Agitation (usually in dementia)

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2
Q

How are antipsychotics differentiated?

A

Either 1st generation (typical) or 2nd generation (atypical) antipshcotics

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3
Q

What is the mechanism of action of typical antipsychotics?

A

Dopamine D2 receptor antagonists

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4
Q

What are the adverse effects of typical antipsychotics?

A

EPSE’s
Hyperprolactinaemia

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5
Q

What are some examples of typical antipsychotics?

A

Haloperidol
Chlopromazine

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6
Q

What are EPSE’s

A

Extrapyramidal side effects

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7
Q

What are the common EPSEs with antipsychotic use?

A

Dystonia
Akathisia
Tardive dyskinesia
Acute dystonia

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8
Q

What is dystonia?

A

Painful muscular spasms

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9
Q

What is parkinsonism?

A

Rigidity
Bradykinesia (slow movement)
Tremor
Masked facies (lack of facial expression)
Shuffling gait
Sialorrhea (hypersalivation)

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10
Q

What is akathisia?

A

Severe restlessness

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11
Q

What is tardive dyskinesia?

A

Irregular jerky movements in face and distal extremities

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12
Q

What are the most common symptoms of tardive dyskinisia?

A

Lip smacking, chewing, pouting

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13
Q

Which atypical antipsychotic has the most tolerable side effect profile (particularly for prolactin elevation)?

A

Aripiprazole

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14
Q

What is the mechanism of action of atypical antipsychotics?

A

Act on a variety of receptors

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15
Q

What are the main side effects of aytipcal antipsychotics?

A

Metabolic side effects (weight gain, hyperglycaemia, dyslipidaemia)

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16
Q

What are some examples of aytipical antipsychotics?

A

Clozapine
Riperidone
Olanzapine

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17
Q

What is Clozapine used for?

A

Treatment resistant schizophrenia (must have tried two other antipsychotics)

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18
Q

What are the main risks associated with Clozapine use?

A

SCAM:
Seizures
Constipation
Agranulocytosis (fucks up immune system)
Myocarditis)
Hypersalivation

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19
Q

When might the dose of Clozapine need to be adjusted during treatment?

A

If the patient starts/ stops smoking

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20
Q

If Clozapine doses are missed for more than 48 hours, what needs to happen?

A

The dose needs to be re-titrated slowly

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21
Q

What is Lithium used for?

A

The treatment of bipolar disorder

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22
Q

What type of drug is lithium?

A

Mood stabiliser

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23
Q

What conditions are mood stabilisers used in?

A

Bipolar
Mania/Hypomania
Recurrent, severe depression

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24
Q

What are the three main types of mood stabilisers?

A

Lithium
Anticonvulsants
Antipsychotics

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25
Q

What is the main anticonvulsant used as a mood stabiliser?

A

Valproate

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26
Q

What the are risks of using valproate?

A

High risk of birth defects and learning disabilities so should not be prescribed to females unless there is no chance they’re pregnant.

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27
Q

What are the issues with using lithium?

A

It has a very narrow therapeutic range and long plasma half life.

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28
Q

What are the adverse effects of lithium?

A

Nausea/ vomiting/ diarrhoea
Fine tremor
Nephrotoxicity
Weight gain/ oedema
Hypothyroidism
Leucocytosis
ect

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29
Q

How should patients on lithium therapy be monitored?

A

Check lithium levels weekly and after each dose change until they are stable
Then check every 3 months
Check thyroid and renal function every 6 months

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30
Q

How long post-dose should lithium levels be checked?

A

12 hours

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31
Q

What is the first line treatment for alcohol withdrawal?

A

Long-acting Benzodiazepines (usually reducing dose)

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32
Q

What are examples of long-acting benzodiazepines?

A

Chlordiazepoxide
Diazepam

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33
Q

What medication is also given in alcohol withdrawal and what is this?

A

Pabrinex (B vitamins including Thiamine)

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34
Q

What medication should be given to those in alcohol withdrawal with hepatic failure?

A

Lorazepam

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35
Q

What are antidepressants used in the treatment of?

A

Depression
Anxiety disorders
Phobias
Bulimia
PTSD
Managing long term pain

36
Q

What are the different types of antidpressants?

A

SSRIs
SNRIs
Tricyclics
Tricyclic-related
MAOIs
Others

37
Q

What is the first line treatment for patients with depression?

A

SSRIs

38
Q

What are the two main SSRIs used?

A

Citalopram and Fluoxetine

39
Q

When is Sertraline preferably used?

A

Post MI

40
Q

What does SSRI stand for?

A

Selective Serotonin Reuptake Inhibitors

41
Q

What are the side effects of SSRIs?

A

GI symptoms
Increased anxiety/ agitation after starting
Drug interactions

42
Q

What should be done if a patient is taking an SSRI and NSAID?

A

Give PPI to prevent risk of GI bleed

43
Q

What medication should not be used with an SSRI and why?

A

Sumatriptan due to risk of serotonin syndrome

44
Q

What is Citalopram associated with and therefore when should it not be used?

A

Dose dependent QT interval prolongation. Should not be used in those with congenital long QT syndrome or with other medications that prolong QT interval.

45
Q

What is the maximum dose of Citalopram?

A

40mg in adults
20mg in those >65 or with hepatic impairment

46
Q

What other drugs do SSRI’s interact with?

A

NSAIDs
Warfarin/ Heparin
Triptans
MAOIs

47
Q

What is the usual management of pateitns after they have started antidepressants?

A

Review with doctor 2 weeks after starting (or 1 week if <25 or at risk of suicide).

48
Q

How long should patients continue with antidepressants after remission?

A

At least 6 months

49
Q

How should SSRIs be stopped?

A

Reduce the dose gradually over 4 weeks

50
Q

Which SSRI does not require gradually reduced dose to stop?

A

Fluoxetine

51
Q

What are symptoms of SSRI discontinuation?

A

Increased mood change
Restlessness
Difficulty sleeping
Unsteadiness
Sweating
Gi symptoms
Paraesthesia

52
Q

Should SSRI’s be used during pregnancy?

A

Weigh up risks and benefits

53
Q

What are the risks of SSRIs during the first trimester?

A

Small increased risk of congenital heart defects

54
Q

What are the risks of using SSRIs during the third trimester?

A

Persistent pulmonary hypertension

55
Q

Which antidepressant is useful for treating people with low appetite and sleep problems?

A

Mirtazapine

56
Q
A
57
Q

What is the mechanism of tricyclics?

A

Affect reuptake of noradrenaline and serotonin

58
Q

What is an example of a tricyclic?

A

Amitriptyline Hydrochloride
Nortriptyline

59
Q

What are the main side effects of using TCA’s?

A

Drowsiness (anti-histamine)
Dry mouth
Blurred vision
Constipation
Urinary retention
Postural hypotension

60
Q

What are TCA’s mainly used for now instead of as antidepressants?

A

Neuropathic pain

61
Q

What are SNRIs?

A

Serotonin and noradrenaline reuptake inhibitors

62
Q

Examples of SNRIs?

A

Duloxetine
Venlafaxine

63
Q

What should be monitored when starting SNRIs?

A

Blood pressure

64
Q

What are MAOIs?

A

Monoamine Oxidase Inhibitors

65
Q

How long should SSRIs be continues to prevent relapse in OCD?

A

At least 12 months

66
Q

How long does it take to respond to SSRI treatment in OCD?

A

At least 12 weeks

67
Q

What alternative medication should be used in OCD if an SSRI is not appropriate?

A

Clompramine

68
Q

If CBT or EMDR are ineffective in PTSD, what are the first line drug treatments?

A

SSRI or Venlafaxine (SNRI)

69
Q

How is acute dystonia secondary to antipsychotics managed?

A

With procyclidine (anti-cholinergic)

70
Q

What kind of drug may be used to treat insomnia?

A

Hypnotics

71
Q

What hypnotics are recommended for treating insomnia?

A

Short-acting benzodiazepnies or non-benzodiazepines

72
Q

What is the recommendation for using hypnotics for insomnia?

A

Use the lowest effective dose for the shortest period possible
Do not prescribe another if the first has failed

73
Q

What is a life-threatening side effect of antipshycotics?

A

Neuroleptic Malignant Syndrome

74
Q

What are the symptoms of NMS?

A

Severe muscle rigidity
Fever (>40)
Autonomic changes (fluctuating blood pressure, pulse rate and breath rate)
Altered consciousness

75
Q

What is the management of NMS?

A

Review
Fluids
Send to A&E
Bromocriptine/Dantrolene/Amantadine

76
Q

How long is the typical onset of NMS?

A

days to weeks

77
Q

What is serotonin syndrome?

A

Serotonin toxicity

78
Q

What causes serotonin syndrome?

A

Taking multiple serotonergic drugs or high doses of a single agent

79
Q

What are the symptoms of mild serotonin syndrome?

A

Mydriasis (pupil dilation)
Shivering
Sweating
Tachycardia

80
Q

What are the symptoms of moderate serotonin syndrome?

A

Altered mental status (agitation, confusion)
Autonomic hyperactivity (rigidity, tachycardia, fever)
Neuromuscular abnormalities (tremor, clonus)

81
Q

What are the symptoms of life threatening serotonin syndrome?

A

Delirium
Hypertension
Hyperthermia
Muscle rigidity
Tachycardia

82
Q

What is the management of mild serotonin syndrome?

A

Discontinue serotonergic meds
Observation for at least 6 hours
Benzodiazepines

83
Q

What is the management of moderate serotonin syndrome?

A

Cyproheptadine
Cardiac monitoring
Admit to hospital

84
Q

What is the management of severe serotonin syndrome?

A

ICU
Esmolol/Nitroprusside
Cooling measures
Sedation
Ventilation

85
Q
A

Phsyciatry (3 decks)

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