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YR3 Therapeutics > Mental Health > Flashcards

Mental Health Flashcards

1
Q

4 examples of TCAs

A

Amitriptyline
Lofepramine
Imipramine
Clomipramine

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2
Q

Mechanism of TCAs

A

Inhibit neuronal reuptake of serotonin and adrenaline from the synaptic cleft

Block receptors including alpha 1/2, muscuranic, histamine, dopamine

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3
Q

Indications for use of TCAs

A

Second line treatment for moderate to severe depression

Neuropathic pain

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4
Q

CIs of TCAs

A 
Elderly
CVD
Constipated
Prostatic hyperplasia
Epileptic
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5
Q

Side effects of TCAs

A

TCAs

Tremor
Cardiovascular (arrhythmia)
Antimuscuranic (dry mouth, constipation, blurred vision, urinary retention)
Sedation and seizures

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6
Q

Which drugs should TCAs not be prescribed with

A

Monoamine oxidase inhibitors

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7
Q

What should a patient be told to avoid doing whilst taking TCAs

A

Not to stop suddenly

Not to take more than the stated dose

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8
Q

Citalopram, fluoxetine and sertraline are examples of which drug class?

A

SSRIs

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9
Q

Mechanism of SSRIs

A

Similar to TCAs but they DO NOT INHIBIT ADRENALINE REUPTAKE, only serotonin

Do not block as many other receptors unlike TCAs

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10
Q

Indications for use of SSRIs

A

Moderate to severe Depression
Panic disorder
OCD

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11
Q

CI of SSRIs

A

Prescribed with caution in those with with epilepsy or PUD

SSRIs have poor efficacy in young people and cause thoughts of self harm so should only be prescribed by a specialist

Dose reduction in hepatic impariment

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12
Q

Side effects of SSRIs

A 
GI upset
Appetite change + weight change 
Suicidal thoughts
Hyponatremia
Lowered seizure threshold
Syndrome of inappropriate ADH secretion
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13
Q

What is serotonin syndrome?

A

A triad of autonomic hyperactivity, altered mental state and neuromuscular excitation

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14
Q

What happens if SSRIs are suddenly withdrawn?

A

GI disturbance
Neurological and influenza like symptoms
Sleep disturbance

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15
Q

Which drug should SSRIs not be prescribed with and why?

A

Monoxidase inhibitors. They both result in increased levels of serotonin in the synaptic cleft which can lead to serotonin syndrome (much like TCAs)

Any drug which prolongs the QT interval ie antipyschotics

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16
Q

How long should patients be told to take SSRIs for after they start to feel better

A

6 months

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17
Q

Examples of benzodiazepines include

A 
Diazepam
Temazepam
Lorazepam
Midazolam
Chlordiazepoxide (the weird one that doesn't fit the -am rule)
18
Q

Mechanism of action of benzodiazepines

A

Facilitate the binding of GABA to GABA1 receptors which allows more chloride to flow into the cell, making it more resistant to depolarization

19
Q

Indications for use of benzodiazepines

A
  1. Seizures and status epillepticus
  2. Alcohol withdrawal reactions
  3. Sedation for interventional procedures
  4. SHORT TERM mx of anxiety
  5. SHORT TERM mx of insomnia
20
Q

Contraindications of benzodiazepines

A 
Caution in the elderly
AVOID in:
-resp. impairment
-neuromuscular disease
-liver failure (they precipitate hepatic encephalopathy)
21
Q

Side effects of benzodiazepines

A

Dose dependant drowsiness, sedation and coma
Loss of airway reflexes due to overdose can lead to death
Dependance can develop if used rptdly over weeks
Abrupt cessation = withdrawal symptoms

22
Q

Cytochrome p450 inhibitors may increase the effect of this class of mental health drug

A

Benzodiazpines

23
Q

Donepezil, galantamine and rivastigimine are examples of what type of drug?

A

ACh-esterase inhibitors

24
Q

How do ACh-esterase inhibitors work?

A

Reversible inhibition of ACh esterases which prevents the hydrolsysis of ACh and an increase of ACh in the cleft

25
Q

This drug type is used for mild-moderate dementia in Alzheimers

A

ACh-esterase inhibtor

26
Q

Side effects of ACh-esterase inhibitors

A

Basically every common side effect imaginable

27
Q

Mechanism of action of SNRI

A

interferes with uptake of neurotransmitters from the synaptic cleft

28
Q

Examples of SNRIs

A

Venlaflaxine, Reboxetine, duloxetine

29
Q

What can sudden withdrawal of an SNRI or NaSSA cause?

A

GI upset
Neuro and flu like symptoms
Sleep disturbance

30
Q

What are the side effects of SNRI and NaSSAs?

A 
GI upset
Dry mouth
Nausea
Change in wt
Headache
Abnormal dreams
Insomnia
Confusion
Convulsions
Serotonin syndrome
Hyponatraemia
Suicidal thoughts and behaviour
31
Q

Venlaflaxine has other side effects which are

A

Prolonged QT

Greater risk of withdrawal affects than others

32
Q

Contraindications to the use of SNRI and NaSSAs

A

Elderly

Hepatic/renal impairment

33
Q

What is carbamazepine used for?

A

Epilepsy: 1st choice
Trigeminal neuralgia: 1st choice
Bipolar disorder: prophylaxis in patients intolerant of other meds

34
Q

Anti epileptic hypersensitivity syndrome is contraindicated with what key mental health drug?

A

Carbamezapine

35
Q

Which kind of patients should be prescribed carbamazepine with caution

A

Hepatic disease
Renal disease
Cardiac disease

36
Q

What does carbamazepine do to p450 enzymes?

A

Induces them

37
Q

What can increase the serum level of carbamazepine?

A

CP450 inhibitors

38
Q

Side effects of carbamazepine

A

GI upset
Neurological defects
Oedema
Hyponatraemia

39
Q

A patient diagnosed with bipolar disorder has presented with a milky maculopapular skin rash. What is causing this?

A

Carbamezapine hypersensitivity

40
Q

Can carbamezapine be prescribed in pregnancy?

A

Yes but it should be avoided as it is associated with NTDs, cardiac and urinary abnorms., and cleft palate

41
Q

MoA of carbamezapine

A

Inhibit neuronal sodium channels, stabilising resting membrane potentials and reducing neuronal excitability

42
Q

What are the types of mood stabilisers?

A

Sodium valproate
Carbamazepaine
Lithium

YR3 Therapeutics (8 decks)

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