Medications Flashcards
Chlorpromazine
Typical (traditional) anti-psychotic
Thioridazine
Typical (traditional) anti-psychotic
Haloperidol
Typical (traditional) anti-psychotic (tablet, liquid, or depot)
Trifluoperazine
Typical (traditional) anti-psychotic
Thiothixene
Typical (traditional) anti-psychotic
Zuclopenthixol
Typical (traditional) anti-psychotic
Flupentixol decanoate
Typical (traditional) anti-psychotic
Fluphenazine decanoate
Typical (traditional) anti-psychotic
Fluanxol
Depot typical (traditional) anti-psychotic
Olanzapine
Atypical (newer) anti-psychotic. Significant weight gain, diabetes and lipid abnormalities risks.
Risperidone
Atypical (newer) anti-psychotic. Also available in depot.
Quetiapine
Atypical (newer) anti-psychotic with low EPS risk. Often used as sedating agent or anxiolytic.
Ziprasidone
Atypical (newer) anti-psychotic with low diabetes risk. Must be taken with fat-containing meal/snack.
Aripiprazole
“Third generation” anti-psychotic: unique complex action, dopamine system stabilizer.
Clozapine (use and regime)
Gold standard atypical, last resort antipsychotic, for treatment resistant schizophrenia. Standard: 300-600mg/day, any more can cause epilepsy, max. is 900mg/day. “Clozapine workup” before commencing treatment. If 2 days are missed during treatment, doses have to be retitrated. Bloods weekly for 18 weeks, then monthly. WBC and ANC (absolute neutrophil count) monitored due to agranulocytosis risk.
Agranulocytosis
Decreased neutrophil WBCs - develops suddenly, characterised by sore throat, fever, malaise and leukopenia. High risk of cold/flu.
Sulpiride
Typical (traditional) anti-psychotic
Paliperidone
Depot atypical (newer) anti-psychotic
Clozapine side effects
Constipation, sedation, hypersalivation, acid reflux, urinary incontinence, postural hypotension, myocarditis (arrhythmia, ECG abnormalities), tachycardia, paralytic ileus (obstruction in ileum), epilepsy (high doses), agranulocytosis.
Anticholinergics
Given oral or IM. Treats EPS. Causes dry mouth, constipation, blurred vision. E.g. Benztropine, procylidine
Benztropine
Anticholinergic
Procylidine
Anticholinergic
Diazepam
Benzodiazepine, anxiolytic. Also used for alcohol withdrawals.
Clonazepam
Benzodiazepine anxiolytic
Alprazolam
Benzodiazepine anxiolytic
Lorazepam
Benzodiazepine, anxiolytic
Temazepam
Benzodiazepine anxiolytic
Zopiclone
Sedative/sleeping pill (anxiolytic)
Propanolol
Beta blocker used to treat symptoms that lead to anxiety i.e. tachycardia
Buspirone
Potent anxiolytic, takes several weeks to work. No muscle relaxant or sedative effect.
Anxiolytic side effects.
Sedation, dependance, CNS depression, withdrawal syndrome, respiratory depression - sleep apneoa
Lithium
Mood stabilizer: gold standard for mania. Can be used as prophylaxis, or in conjunction for better antidepressant therapy. Bloods needs to be checked (0.6-1.2mmol/L for adult, 0.5-1.0mmol/L for older persons). Onset of 5-14 days.
Sodium valporate
Mood stabilizer and anticonvulsant, also used for mania, can be used as prophylactic. Blood levels to be monitored.
Carbemazepine
Mood stabilizer and anticonvulsant, also used as prophylaxis.
Lamotrigine
Rarely used mood stabilizer
Side effects of lithium
Short term: polyuria, polydipsia, weight gain, nausea and vomiting, fine tremor, headache, metallic taste, somnolence, lethargy, acne.
Long term: hypothyroidism, hyperthyroidism, impaired renal function, mild cognitive impairment, memory deficits
Adverse effects of sodium valporate
GI: nausea, vomiting, GI irritation
CNS (dose related): drowsiness, ataxia
Alopecia
Endocrine and metabolic: pancreatitis, hepatic failure
Adverse effects of carbamazepine
(dose related): sedation, dizziness, blurred vision, diplopia, nystagmus. GI: dry mouth, nausea, diarrhoea, constipation Sensitivity reactions (rashes) - 3%
Asenapine
Rarely used mood stabilizer
TCAs
Tricyclic antidepressants
SSRIs
Selective serotonin reuptake inhibitors
SNRIs
Serotonin and noradrenaline reuptake inhibitors
MAOIs
Monoamine oxidase inhibitors, for treatment resistance/atypical depression.
Mirtazapine
Anti-depressant that does not fit under category (not SSRI, SNRI, TCA or MAOI)
Tricyclic antidepressants
Works with norepinephrine, serotonin and histamine. Blood levels monitored to check dose effectiveness.
Tricyclic antidepressants side effects
anticholinergic side effects (dry mouth, contipation, blured vision, urinary retention)
cardiac arrhythmias and conduction effects
postural drop, sedation
Imipramine
Tricyclic antidepressant
Nortryptyline
Tricyclic antidepressant
Amitriptyline
Tricyclic antidepressant
Selective serotonin reuptake inhibitors
Takes weeks to come into effect. Inhibits reuptake, leaving more serotonin in in the synapse.
Paroxetine
SSRI
Citalopram
SSRI
Sertraline
SSRI
Fluoxetine
SSRI
SSRI side effects
Decreased sexual drive, impaired sexual function. With higher does: nausea, diarrhoea, anorexia, and vomiting. Headache, dizziness, anxiety (esp fluoxetine), rash, sedation, vivid dreams, dry mouth (esp paroxetine).
SSRI adverse effects
Increased suicidal ideation, esp in children and in early treatment.
Serotonin syndrome: from taking SSRI and MAOI at same time
Symptoms of serotonin syndrome
Agitation, sweating, fever, tachycardia, hypotension, rigidity, hyperreflexia, and in extreme cases, death.
Phenelzine
MAOI
Tranylcypromine
MAOI
Monoamine oxidase inhibitors
For treatment resistance/atypical depression. Increase serotonin and noradrenaline by inhibiting enzyme that breaks down neurotransmitters. Works quicker than other anti-Ds.
The enzyme MAO controls tyramine levels, related to raised BP and headaches. So taking MAOIs will increase BP.
Risk for MAOIs
Interaction with foods: chianti, liver, marmite, yeast extracts, aged cheese, aged wine. Can cause hypertensive crisis.
Side effects of MAOIs
blurred vision, dizziness, headache, sexual dysfunction, increased appetite, weight gain, increased sweating
Length of treatment for affective disorder / depression
Standard: 6-12 months after full recovery to avoid relapse.
Maintenance treatment could be 1-5yrs.
Chronic course of treatment is recommended for 3 or more episode.
Medications for dementia
Cholinesterase inhibitors: temporarily slows the progress of dementia. Treats behavioural issues of Alzheimers. Not suitable for vascular dementia.
Donepezil
Cholinesterase inhibitor (dementia)
Rivastigmine
Cholinesterase inhibitor (dementia)
Galantamine
Cholinesterase inhibitor (dementia)
Memantine
Cognitive enhancer: protects NMDA receptors form high levels of glutamate.
Naltrexone
Used for treating opioid dependence
Buproprion
Used for treating nicotine dependence