Mental Health Flashcards
Typical Antipsychotic - Example
- haloperidol
- chlorpromazine
- prochlorperazine
Typical antipsychotics - Indications
Schizophrenia
Bipolar disorder
nausea and vomiting
Typical antipsychotics - MOA
They act by blocking post-synaptic dopamine D2 receptors in the dopaminergic pathways in the brain. blockade increases levels of dopamine in the synaptic cleft and produces antipsychotic effects.
Typical antipsychotics - Side Effects
Extrapyramidal effects = acute dystonic reaction, akathisia, neuroleptic malignant syndrome.
can also cause drowsiness, hypotensions and prolongation of QT
Typical antipsychotics - Caution
elderly,
dementia
parkinson’s disease
avoid giving with drug that prolong the QT
Atypical Antipsychotic - Example
- quetiapine
- olanzapine
- risperidone
- clozapine
Atypical antipsychotics - Indications
severe psychomotor agitation = violent/aggressive behaviour
Schizophrenia
Bipolar disorder
Atypical antipsychotics - MOA
They act by blocking postsynaptic dopamine D2 receptors in the dopaminergic pathways within the brain. The blockade increases levels of dopamine in the synaptic cleft producing antipsychotic effects.
Atypical antipsychotics - Side Effects
Sedation, extrapyramidal effects, weight gain
can also cause QT prolongation and arrhythmias
agranulocytosis and myocarditis (clozapine)
Atypical antipsychotics - Contraindications
Do not give in severe heart disease or neutropenia
Atypical antipsychotics - Caution
Cardiovascular disease
SSRI - Example
- citalopram
- fluoxetine
- sertraline
- escitalopram
SSRIs - Indications
moderate to severe depression
panic disorder/anxiety
OCD
SSRIs - MOA
Act by inhibiting neuronal reuptake channels for 5-HT/serotonin. This results in more serotonin in the synaptic cleft available for neurotransmission. This allows improvement in the mood and physical symptoms of depression, panic disorder and OCD
SSRIs - Side Effects
GI upset, changes to appetite and weight and hypersensitivity (skin rash)
it can also cause suicidal thoughts/behaviours,
lower seizure threshold
may prolong QT interval
increased bleeding risk
SSRIs - Caution
avoid in epilepsy, peptic ulcer and young people
avoid prescribing with MOA-B inhibitors and drugs which prolong QT
Lithium - Indication
Bipolar disorder
psychomotor agitation
recurrent depression
Lithium - MOA
It acts to increase GABA which downregulates the NMDA receptor. This in turn reduces pre-synaptic dopaminergic activity. Lithium also reduces glutamate levels. Collectively this all helps to reduce symptoms and stabilise mood.
Lithium - Side Effects
abdo discomfort, N&V and dry mouth commonly.
more serious effects include lithium toxicity and neuropathy
Lithium - Contraindication
Do no give lithium to someone with addison’s disease, Brugada syndrome, cardiac insufficiency/arrhythmia
untreated hypothyroidism
Lithium - Caution
cardiac disease,
elderly
epileptic
diuretic treatment and MG
avoid prescribing with diuretics, K+sparing drugs , ACEi/NSAIDs and theophylline
Tricyclic Antidepressant - Example
- amitriptyline
- lofepramine
Indications for tricyclic antidepressants
second line for moderate to severe depression
neuropathic pain
Tricyclic antidepressants - MOA
They inhibit the neuronal reuptake of 5-HT/serotonin and noradrenaline (SNRI) from the synaptic cleft which means there is increasing availability for neurotransmission. this improves mood and the physical symptoms of depression
Tricyclic antidepressants - Side effects
dry mouth, urinary retention and blurred vision
can also cause arrhythmias and hallucinations/mania
Tricyclic antidepressants - Caution
elderly
epilepsy
CVD, glaucoma
avoid prescribing with monoamine-oxidase inhibitors
