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Mental health Flashcards

1
Q

What are the indications of SSRI’s and provide examples?

A

1) Depression (1st line)
2) GAD/Panic disorders
3) OCD

-Citalopram, Sertraline, Fluoxetine

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2
Q

What is the mechanism of action of SSRI’s?

A

Selective serotonin reuptake inhibitors inhibit serotonin reuptake.

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3
Q

Why use SSRI’s over TCA’s?

A

SSRI’s are generally preferred as they have fewer adverse effects and less dangerous in overdose than TCA’s.

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4
Q

What are the important side effects of prescribing SSRI’s and SNRI’s?

A
  • Weight disturbance (loss or gain)
  • Insomnia
  • Sexual dysfunction
  • Hyponatraemia in the elderly
  • Citalopram specifically can prolong QT interval, predisposing to arrhythmias
  • Suicidal thoughts and behaviour increased, just use with caution
  • GI upset (nausea, vomiting, pain, diarrhoea)
  • At high doses can cause serotonin syndrome (triad of altered consciousness level, neuromuscular abnormalities and autonomic hyperactivity), but this usually responds to treatment withdrawal.
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5
Q

What is serotonin syndrome? What other medication can increase the risk of it?

A

At high doses of SSRI’s can cause serotonin syndrome (triad of altered consciousness level, neuromuscular abnormalities and autonomic hyperactivity), but this usually responds to treatment withdrawal of SSRI’s.
-Other antidepressants such as MAOI, have the same effect, so when used simultaneously with SSRI’s can increase risk of serotonin syndrome.

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6
Q

What happens when antidepressants are stopped?

A

-Discontinuation syndrome occurs with symptoms such as GI upset, diarrhoea, dizziness, headache, insomnia, tremor. So antidepressants need to be gradually tapered down before being withdrawn completely

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7
Q

What are interactions of SSRI’s?

A
  • Do not combine with MAOI/triptans as can increase chance of serotonin syndrome
  • Do not combine with Antipsychotics as can prolong QT interval, predisposing to arrhythmias
  • If using with NSAIDS co-prescribe PPI as NSAID and SSRI can cause GI bleeding.
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8
Q

What are MAOI’s and action?

A

Monoamine oxidase inhibitors inhibit monoamine oxidase A. These are typically used for atypical depression.

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9
Q

What are CI of SSRI’s and SNRI’s?

A
  • prolonged QT interval
  • young people.
  • mania, may actually worsen symptoms of bipolar or uncover a manic episode
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10
Q

What are SNRI’s?

A

Serotonin-noradrenaline reuptake inhibitors inhibit uptake of serotonin and noradrenaline.

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11
Q

What are indications of TCA’s and examples?

A

1) Depression (2nd line)
2) Anxiety/panic disorders
3) OCD
4) Neuropathic pain in MS

Examples: Amitriptyline

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12
Q

What is the mechanism of action of TCA’s?

A

-Tricyclic antidepressants inhibit reuptake of serotonin and noradrenaline. Also blocks wide array of receptors e.g. muscarinics, histamine, adrenergic, dopamine

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13
Q

What are adverse effects of TCA’s?

A
  • Blockage of histamine and adrenergic receptors can cause sedation and hypotension
  • Cardiac effects can cause ST elevation and QT interval prolongation
  • cause sexual dysfunction
  • DANGEROUS in overdose causing convulsions, arrhythmias
  • Sudden withdrawal can cause GI upset, insomnia
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14
Q

What are CI of TCA’s?

A
  • Arrhythmias
  • Recent MI
  • Pts with high risk of overdose
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15
Q

What are indications of Mirtazapine?

A

1)Antidepressant for major depression, can be given to patients with depression whereby sedation or increased oral intake is needed

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16
Q

What are side effects of mirtazapine?

A

-Associated with increased appetite, weight gain
-sedation
So can be given to patients with depression whereby sedation or increased oral intake is needed.

17
Q

What are indications of Benzodiazepines?

A

1) Seizures (1st line) - lorazepam
2) Alcohol withdrawal (1st line) - chlordiazepoxide/diazepam
3) Short treatment for insomnia - temazepam
4) Short term treatment for anxiety disorders - temazepam
5) Sedation for acute mania or psychosis

18
Q

What is the mechanism of action of Benzodiazepines?

A

Benzodiazepines facilitate and enhance binding of GABA to the GABAA receptor.

19
Q

What are the side effects of Benzodiazepines?

A
  • Can cause dose-dependent drowsiness, coma and sedation. Important to warn pts about potential dangers of drowsiness when driving.
  • Risk of substance dependence with prolonged use
  • Sudden withdrawal can cause withdrawal symptoms
20
Q

What are the warnings of Benzodiazepines?

A
  • Use with caution in pts with chronic respiratory disease (COPD, sleep apnoea) as may depress respiration.
  • Use lower doses for elderly, their more susceptible to side effects leading to falls
21
Q

What is the antagonist for Benzodiazepines?

A

-Flumazenil can reverse effects of benzodiazepines

22
Q

What is the mechanism of action and types of antipsychotics?

A
  • First generation (typical) are D2 (dopamine) receptor antagonist
  • Second generation atypical antipsychotics act on a variety of receptors.
23
Q

What are the indications of antipsychotics?

A

1) Schizophrenia - Haloperidol (first generation antipsychotic)
2) Bipolar disorder
3) Severe psychomotor agitation that is causing dangerous, impulsive, violent behaviour (calms patients)
4) Depression or mania with psychotic features

24
Q

What are extrapyramidal side effects and which drug associated with?

A

Commonly in first generation typical antipsychotics e.g. haloperidol, blocking dopamine pathway can cause extrapyramidal effects (movement abnormalities e.g.

  • parkinsonism (bradykinesia which is slowing of movements)
  • dystonia (muscle spasms)
  • akathisia (severe restlessness)
  • tardive dyskinesia (involuntary movements of head, limbs, trunk)

Other side effects are include impaired glucose tolerance, prolonged qt intervals, hyperprolactinaemia.

25
Q

What are warnings of antipsychotics?

A
  • Elderly start at lower doses, as more susceptible to the side effects
  • Avoid in pts with dementia, can cause stroke or death
  • Avoid in pts with Parkinson’s disease due to extrapyramidal effects.
26
Q

What are examples of mood stabilizers and what do they do?

A
  • Lithium
  • Anti-epileptics e.g. Valproate, Carbamazepine, Lamotrigine

Mood stabilizers help reduce mood swings and prevent manic and depressive episodes

27
Q

What are indications of Lithium?

A

1) Acute mania

2) Prophylaxis of bipolar disorders (prevents relapse), if lithium CI give carbamazepine

28
Q

What are important drug interactions for lithium?

A

-Avoid use of diuretics (thiazides), NSAIDSs and ACE inhibitors as these can increase lithium levels.

29
Q

Investigations needed prior to initiating treatment with mood stabilisers?

A

Mood stabilizers e.g., lithium

Prior to initiating therapy

  • FBC
  • U + E
  • Calcium - check for hypercalcaemia
  • Thyroid function
  • Pregnancy test (women of childbearing age)
  • ECG (cardiac disease)
30
Q

What are adverse effects of Lithium?

A
  • Teratogenicity
  • Cardiac: T wave flattening or inversion
  • Polydipsia, polyuria, weight gain, oedema
  • Fine tremor
  • Impaired renal function
  • Hypernatraemia
  • Hyperparathyroidism can result in hypercalcaemia (kidney stones)
  • FBC
  • U + E
  • Calcium
  • Thyroid function
  • Pregnancy test (women of childbearing age)
  • ECG (cardiac disease)
31
Q

How is lithium monitored?

A

Weekly after starting treatment until stable for 2 consecutive weeks. Then monitor every 3 months. Monitor renal function.

32
Q

What is the warning of Valproate?

A

-Avoid in women of childbearing age due to teratogenicity.

33
Q

Which of these is not a contraindication of SSRI use?

  • mania
  • suicidal thoughts
  • epilepsy
  • prolonged QT interval
A

Can be used with caution if pt with depression has suicidal thoughts, regular monitoring.

34
Q

What are side effects of atypical antipsychotics?

A

Examples: olanzapine and clozapine

  • Polyuria and polydipsia leads to diabetes
  • Weight gain
  • Clozapine causes agranulocytosis (reduced number of WBC called neutrophils)
35
Q

What is the antidepressant of choice for young adults and children?

A

Fluoxetine

36
Q

What are the adverse effects of atypical antipsychotics e.g. clozapine, olanzapine?

A

Commonly in second generation antipsychotics e.g. clozapine, metabolic disturbances

  • obesity
  • diabetes mellitus
  • hypercholesterolaemia
  • dyslipidaemia

Other side effects are prolongation of QT intervals causing arrhythmias, sexual dysfunction.

37
Q

Why is lithium monitoring required?

A

Can cause lithium toxicity.

  • Can cause thyroid dysfunction.
  • Nephrotoxicity. Lithium is excreted by kidneys, so clearance of lithium decreased in pts with renal impairment and sodium depletion so requires lithium monitoring.
38
Q

What are the CI for lithium use?

A
  • Addisons disease - lithium block action of fludrocortisone (drug used to replace aldosterone)
  • Cardiac disease associated with rhythm disorders
  • Significant renal impairment
  • Untreated hypothyroidism
  • Pregnant
39
Q

What length of time to withdraw SSRI to prevent discontinuation syndrome?

A

Over 1 month, antidepressants need to be gradually tapered down before being withdrawn completely

Drugs (10 decks)

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