Mental Health Flashcards
Antipsychotic agents can cause dry mouth, blurred vision, constipation and urinary retention. These are due to their ______ effectd
The adverse effects described are due to their anticholinergic effects, blockade of muscarinic receptors by antipsychotic agents.
Benzodiazepines facilitate the action of which of the following neurotransmitters?
Benzodiazepines facilitate the action of the inhibitory CNS neurotransmitter, GABA.
Compared to other neuroleptics, clozapine has less affinity for which type of dopamine receptors?
Clozapine has less affinity for D2 compared to the conventional neuroleptics, so it is less likely to induce extrapyramidal effects.
Schizophrenia is thought to be due to the:
due to the overactivity of dopaminergic pathways.
Which of the following benzodiazepines has the longest duration of action?
Diazepam
Which of the following benzodiazepines has the shortest duration of action?
Alprazolam
Which drugs can evoke depression?
beta-blockers, corticosteroids and oral contraceptives
Hyperprolactinaemia, resulting in swelling of the breast and milk secretion, is one adverse effect of antidepressive agents. t/f?
false. Hyperprolactinaemia is due to the antagonism of dopamine receptors.
Lithium may increase the bone density or bone formation in children. t/f?
true - Lithium may decrease bone density or bone formation in children.
Regular and nightly use of a hypnotic agent is effective in preventing insomnia in the elderly.
false. When possible, prescribers often suggest that the elderly limit their intake of hypnotic drugs to three or four times a week to decrease the potential for inducing drug tolerance.
How antipsychotics work?
theories focus on neurotransmitter doapmine (DA) and blokcing the D2 receptor.
seotonin also thought to modulate activity of dopamine.
Antipsychotic benefits
effective in reducing symptoms of psychosis.
more relapses the pt has the less likely they will respond
2-4 weeks for full effect except clozapine which is 12 months
reduces risk of suicide
What part of brain controles release of prolaction?
Hypothalamus
Atypical antipsychotics were made to
reduce the level of EPSEs (extra-pyramidal side effects), especially tardive dyskinesia
Name some extra-pyramidal side effects
Parkinsonian symptoms - tremor, rigidity
Dystonia - abnormal postures, difficultry swallowing
Akathisia - rocking from foot to foot, walking on the spot
Tardive dyskinesia - late onset, involuntary movements of limbs
Which drugs have higher propensity to cause extra-pyramidal side effects ?
Typical antipsychotics
Atypical Antipsychotics less likely to cause EPSE’s however more likely to cause
metabolic syndrome.
Examples of Atypical Antipsychotics
Olanzapine, colazpine, quetiapine [PINES]
Metabolic syndrome symptoms include
Weight gain, elevated Hba1c, hypertension, decreased cholestrol
Metabolic syndrome is a serious health risk especially when people with _____ and ______ already have a genetic predisposition to developing diabetes
schizophrenia and BPAD
Rare but life threatening - clozapine:
Agranulocytosis or Neutropenia:
low white blood cell or neutrophil count
Weekly blood tests for first 18 weeks of treatment, then 4 weekly thereafter
Symptoms of concern - fever, rigor, sore throat, any signs of infection and cognitive changes.
Neuroleptic Malignant Syndrome (NMS) (antipsychotic medication)
- describe how this forms and signs and symptoms?
Dopamine receptor block in the corpus striatum, resulting in spasticity of skeletal muscles (leading to excessive heat generation) and impaired hypothalamic thermoregulation.
Signs and symptoms: F - fever E - encephalopathy V - vitals unstable E - elevated enzymes (elevated CPK) R - rigidity of muscles
Antidepressants
The biomedical explanation suggests that depression is related to deficiencies of serotonin, noradrenaline and possibly dopamine, or serotonin
Antidepressant medications have been developed to address these deficiencies, they do this in three ways.
Inhibiting the effects of monoamine oxidase, thus increasing the levels ofserotonin and norepinephrinein the synaptic cleft.
By blocking the reuptake ofspecific neurotransmitters leading to increased neurotransmitter levelsin the synaptic cleft.
Are involved in the regulation of receptor sites and breakdown of neurotransmitters, leading to an accumulation of neurotransmitter in the synaptic cleft
3 categories of antidepressants - name.
SSRI’s, TCA’s and MAOI’s
Example of SSRI’s and actions
prams and ine’s.
Citalopram, fluoxetine, sertraline
Action - SSRI’s block reuptake of serotonin.
Side effects of SSRI’s
Insomnia, sexual dysfunction, nausea and vomiting.
Rare - serotinin syndrome. increased HR, fever, sweating.
TCA’s examples and actions and side effects
INE’s. Amitriptyline, Nortiptyline. Block reuptake of norepinephrne and serotonin.
Dry mouth, blurred vision, constipation, weight gain.
MAOI’s example and action
Tranylycpromine. Inhibit MAO, an enzyme in the nerves that breaks down norepinephrine, dopamine and serotonin.
Anxiolytic (Anti-anxiety) Benzo’s - short treatment only. examples of anxiolytics and hypnotics
Anxiolytics
diazepam, clonazepam, lorazepam
Hypnotics
Temazepam, Triazolam, Zoplicone
What is the one thing to look out for when it comes to anxiolytics?
They are metabolised extensively in the liver, therefore need to be used very cautiously with people with liver disease
Benzodiazepines are ______ and _______ develops quickly
Benzodiazepines are addictive and tolerance develops quickly
Benzodiazepines are sometimes used for their:
muscle relaxant effects
In addition to its use in schizophrenia, chlorpromazine is also used to treat:
Chlorpromazine is useful in the treatment of intractable hiccup.
Overdose of which of the following antidepressants is most likely to result in cardiac arrhythmias?
Overdose of TCAs can be life-threatening, resulting in serious adverse reactions such as cardiac arrhythmias.
Tricyclic antidepressants act mainly by inhibiting the reuptake of:
TCAs act by inhibiting the reuptake of noradrenaline or 5-HT (serotonin).
Which antipsychotic agents has the potential for causing agranulocytosis?
clozapine
Which of the following drugs is used to manage benzodiazepine overdose?
flumazenil - This is a specific benzodiazepine-receptor antagonist.
Which class of drugs increases the risk of falls in the elderly?
Psychotropics, antidepressants and benzodiazepine dosage are associated with increased risk of falls in the elderly.
Antihistamines may be used as a sedative in young children.
This is preferred to benzodiazepines in children. However, antihistamines may sometimes cause paradoxical reactions, which include increased excitability, hostility and increased body temperature.
Antipsychotics are particularly effective against the positive symptoms of schizophrenia, which are disordered thinking or hyper-behaviours commonly associated with schizophrenia. T/F
True
Electroconvulsive therapy (ECT) is a safe and highly effective treatment for schizophrenia. T/F
False Although ECT was originally introduced to treat schizophrenia, it is now used to treat severe depression. ECT is thought to act by causing consistent readjustment in monoamine levels in the brain.
Anixolytics/benzodiazepines(diazepam-longest duration of action) MOA EFFECT INDIC AR
MOA inc GABA to inhibit nerve trans in CNS
Effect drowsiness, confusion, dizziness, slurred speech
Indic acute stress, anxiety
AR addictive
Antipsychotic MOA EFFECT INDIC AR
MOA block dopamiergic receptor sites which reduce + symptoms that we observe w psychosis
SEffect constipation, weight gain, sexual dys
Indic mgmt of shizoph, mania, reduces risk of suicide, psychosis
AR NMS[neuroleptic malignant syndrome]-FEVER mnemonic S+S
Antidepressant (SSRI’s, TCA’s, MAOI’s) MOA EFFECT INDIC AR
MOA inhibit effects of monoamine oxidase,
SEffect anxiety, GI upset, diarrhoea, n+v
Indic depression, anxiety disorders
AR Serotonin syndrome
Antimania/Lithium MOA effect indic pt ed, S+S toxicity
MOA mimics the effects of sodium, absorbed from GI tract. excreted from kidneys although 80% absorped, if low Na2+ levels is dehydr
SEffect tremor, gi upset, polyuria/in children can inc bone density and formation
Indic bipolar affective and schizo affective, and manic episodes.
Pt ed take with food, increase fluids, 3m tests to determine lithium levels
S+S of toxicity - blurred vision, confusion, slurred speech, n+v
