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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
What is the main anticonvulsant used as a mood stabiliser?
Valproate
26
What the are risks of using valproate?
High risk of birth defects and learning disabilities so should not be prescribed to females unless there is no chance they're pregnant.
27
What are the issues with using lithium?
It has a very narrow therapeutic range and long plasma half life.
28
What are the adverse effects of lithium?
Nausea/ vomiting/ diarrhoea Fine tremor Nephrotoxicity Weight gain/ oedema Hypothyroidism Leucocytosis ect
29
How should patients on lithium therapy be monitored?
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
30
How long post-dose should lithium levels be checked?
12 hours
31
What is the first line treatment for alcohol withdrawal?
Long-acting Benzodiazepines (usually reducing dose)
32
What are examples of long-acting benzodiazepines?
Chlordiazepoxide Diazepam
33
What medication is also given in alcohol withdrawal and what is this?
Pabrinex (B vitamins including Thiamine)
34
What medication should be given to those in alcohol withdrawal with hepatic failure?
Lorazepam
35
What are antidepressants used in the treatment of?
Depression Anxiety disorders Phobias Bulimia PTSD Managing long term pain
36
What are the different types of antidpressants?
SSRIs SNRIs Tricyclics Tricyclic-related MAOIs Others
37
What is the first line treatment for patients with depression?
SSRIs
38
What are the two main SSRIs used?
Citalopram and Fluoxetine
39
When is Sertraline preferably used?
Post MI
40
What does SSRI stand for?
Selective Serotonin Reuptake Inhibitors
41
What are the side effects of SSRIs?
GI symptoms Increased anxiety/ agitation after starting Drug interactions
42
What should be done if a patient is taking an SSRI and NSAID?
Give PPI to prevent risk of GI bleed
43
What medication should not be used with an SSRI and why?
Sumatriptan due to risk of serotonin syndrome
44
What is Citalopram associated with and therefore when should it not be used?
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
What is the maximum dose of Citalopram?
40mg in adults 20mg in those >65 or with hepatic impairment
46
What other drugs do SSRI's interact with?
NSAIDs Warfarin/ Heparin Triptans MAOIs
47
What is the usual management of pateitns after they have started antidepressants?
Review with doctor 2 weeks after starting (or 1 week if <25 or at risk of suicide).
48
How long should patients continue with antidepressants after remission?
At least 6 months
49
How should SSRIs be stopped?
Reduce the dose gradually over 4 weeks
50
Which SSRI does not require gradually reduced dose to stop?
Fluoxetine
51
What are symptoms of SSRI discontinuation?
Increased mood change Restlessness Difficulty sleeping Unsteadiness Sweating Gi symptoms Paraesthesia
52
Should SSRI's be used during pregnancy?
Weigh up risks and benefits
53
What are the risks of SSRIs during the first trimester?
Small increased risk of congenital heart defects
54
What are the risks of using SSRIs during the third trimester?
Persistent pulmonary hypertension
55
Which antidepressant is useful for treating people with low appetite and sleep problems?
Mirtazapine
56
57
What is the mechanism of tricyclics?
Affect reuptake of noradrenaline and serotonin
58
What is an example of a tricyclic?
Amitriptyline Hydrochloride Nortriptyline
59
What are the main side effects of using TCA's?
Drowsiness (anti-histamine) Dry mouth Blurred vision Constipation Urinary retention Postural hypotension
60
What are TCA's mainly used for now instead of as antidepressants?
Neuropathic pain
61
What are SNRIs?
Serotonin and noradrenaline reuptake inhibitors
62
Examples of SNRIs?
Duloxetine Venlafaxine
63
What should be monitored when starting SNRIs?
Blood pressure
64
What are MAOIs?
Monoamine Oxidase Inhibitors
65
How long should SSRIs be continues to prevent relapse in OCD?
At least 12 months
66
How long does it take to respond to SSRI treatment in OCD?
At least 12 weeks
67
What alternative medication should be used in OCD if an SSRI is not appropriate?
Clompramine
68
If CBT or EMDR are ineffective in PTSD, what are the first line drug treatments?
SSRI or Venlafaxine (SNRI)
69
How is acute dystonia secondary to antipsychotics managed?
With procyclidine (anti-cholinergic)
70
What kind of drug may be used to treat insomnia?
Hypnotics
71
What hypnotics are recommended for treating insomnia?
Short-acting benzodiazepnies or non-benzodiazepines
72
What is the recommendation for using hypnotics for insomnia?
Use the lowest effective dose for the shortest period possible Do not prescribe another if the first has failed
73
What is a life-threatening side effect of antipshycotics?
Neuroleptic Malignant Syndrome
74
What are the symptoms of NMS?
Severe muscle rigidity Fever (>40) Autonomic changes (fluctuating blood pressure, pulse rate and breath rate) Altered consciousness
75
What is the management of NMS?
Review Fluids Send to A&E Bromocriptine/Dantrolene/Amantadine
76
How long is the typical onset of NMS?
days to weeks
77
What is serotonin syndrome?
Serotonin toxicity
78
What causes serotonin syndrome?
Taking multiple serotonergic drugs or high doses of a single agent
79
What are the symptoms of mild serotonin syndrome?
Mydriasis (pupil dilation) Shivering Sweating Tachycardia
80
What are the symptoms of moderate serotonin syndrome?
Altered mental status (agitation, confusion) Autonomic hyperactivity (rigidity, tachycardia, fever) Neuromuscular abnormalities (tremor, clonus)
81
What are the symptoms of life threatening serotonin syndrome?
Delirium Hypertension Hyperthermia Muscle rigidity Tachycardia
82
What is the management of mild serotonin syndrome?
Discontinue serotonergic meds Observation for at least 6 hours Benzodiazepines
83
What is the management of moderate serotonin syndrome?
Cyproheptadine Cardiac monitoring Admit to hospital
84
What is the management of severe serotonin syndrome?
ICU Esmolol/Nitroprusside Cooling measures Sedation Ventilation
85

Phsyciatry (3 decks)

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