Mental Health Disorders Flashcards

1
Q

What are the psychological symptoms of anxiety?

A
Restlessness
Worry
Fear
Difficulty concentrating
Irritability
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2
Q

What are the physical symptoms of anxiety?

A
Palpitations
Muscle aches and tension
Trembling or shaking 
Excessive sweating
Shortness of breath 
Insomnia
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3
Q

What class are benzodiazepines?

A

CD4 part 1

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4
Q

What are the benzodiazepines?

A
Alprazolam
Clobazam
Chlordiazepoxide
Diazepam
Lorazepam
Oxazepam
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5
Q

What benzodiazepines are better for use in elderly?

A

Short acting

Lorazepam
Oxazepam

Greater risk of withdrawal symptoms

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6
Q

What beta blockers are used for palpitations in anxiety?

A

Propranolol

Oxprenolol

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7
Q

What is buspirone?

A

5HT1a agonist

Low potential for abuse and dependence
Takes two weeks to work

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8
Q

What is the mechanism of action of benzodiazepines?

A

Facilitates and enhances the binding of GABA to the GABAa receptor to cause widespread depressant effect on synaptic neurotransmission

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9
Q

What are benzodiazepines used for?

A

Short term (2-4 weeks) relief of anxiety that is severe, disabling or causing patient unacceptable distress

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10
Q

What are the side effects of benzodiazepines?

A

Paradoxical increase in hostility aggression

Overdose - ataxia, drowsiness, dysarthria, nystagmus, respiratory depression, coma

Sedation

Dependence

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11
Q

How do you withdraw benzodiazepines?

A

Gradually convert to equivalent diazepam dose ON

Reduce diazepam dose by 1-2mg every 2-4 weeks

Reduce further

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12
Q

What are the diazepam drug interactions that increase sedation and CNS depressant effects?

A
Alcohol
Opioids
Antihistamines 
Antidepressants
Barbiturates 
Antipsychotics 
Z-drugs
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13
Q

What are the diazepam interactions that increase plasma concentrations?

A

Amiodarone
Diltiazem
Macrolides
Fluconazole

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14
Q

What are the symptoms of ADHD?

A

Hyperactivity
Impulsivity
Inattention

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15
Q

What is the treatment for ADHD in children 5 years + and young people?

A

Methylphenidate first line

Lisdexamfetamine second line

Atomoxetine/guanfacine alternative

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16
Q

What is the ADHD treatment in adults?

A

First line methylphenidate/lisdexamfetamine

Alternative atomoxetine

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17
Q

What is the mechanism of action of methylphenidate?

A

Potent CNS stimulant

Increases dopamine and noradrenaline levels in the brain

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18
Q

What are the side effects of methylphenidate?

A
Appetite loss
Insomnia
Weight loss
Increased heart rate and blood pressure
Tics and Tourette’s 
Growth restriction
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19
Q

What needs to be monitored with methylphenidate?

A

Pulse
BP
Appetite
Weight and height

Psychiatric symptoms

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20
Q

What are the contraindications of methylphenidate?

A
Cardiovascular disease
Hyperthyroidism
Hypertension
Uncontrolled bipolar
Severe depression

Prescribe by brand for MR

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21
Q

What is the mechanism of action of dexamfetamine and lisdexamfetamine?

A

Potent central nervous system stimulant

Increases dopamine and noradrenaline levels in the brain

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22
Q

What are the side effects of lisdexamfetamine and dexamfetamine?

A
Appetite loss
Anorexia
Increased heart rate and blood pressure
Tics and Tourette’s 
Growth restriction in children
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23
Q

What are the signs of lisdexamfetamine overdose?

A
Wakefulness
Hyperactivity 
Paranoia
Exhaustion 
Convulsions
Hyperthermia
Coma
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24
Q

What is the monitoring needed for lisdexamfetamine and dexamfetamine?

A
Pulse
BP
Appetite
Weight and height
Psychiatric symptoms
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25
Q

What are the contraindications of lisdexamfetamine and dexamfetamine?

A

CVD
Hyperthyroidism
Hypertension
Agitated states

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26
Q

What is the mechanism of action of atomoxetine?

A

Noradrenaline reuptake inhibitor causes increased levels of noradrenaline at synaptic cleft

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27
Q

What are the side effects of atomoxetine?

A

Suicidal ideation
Hepatotoxicity
QT prolongation

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28
Q

What are the side effect counselling points of atomoxetine?

A

Report suicidal thoughts, self harming behaviour

Report signs of liver toxicity

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29
Q

What is the monitoring needed for atomoxetine?

A
Pulse
BP
Psychiatric symptoms
Appetite
Weight
Height
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30
Q

What is bipolar disorder?

A

Characterised by extreme mood swings

Bipolar episode can last several weeks or months

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31
Q

What are the two types of bipolar episodes?

A

Mania

Depression

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32
Q

What do you give for acute mania and hypo mania?

A

Benzodiazepines - short term use, risk of dependence

Antipsychotics - quetiapine, olanzapine, risperidone

Lithium or valorous acid added if inadequate
Asenapine in moderate-severe manic episodes

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33
Q

What do you use for prophylaxis of bipolar disorder?

A

Lithium salts
Valproate
Olanzapine
Carbamazepine

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34
Q

What are the contraindications in bipolar disorder?

A

Do not give antidepressants in - rapid cycling bipolar disorder, recent history of hypo mania, manic episode, rapid mood fluctuations

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35
Q

What are the lithium salts used for?

A

Prophylaxis and treatment of mania, hypo mania and depression in bipolar disorder, resistant depression and aggressive or self harming behaviour

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36
Q

What is the therapeutic range for lithium?

A
  1. 4 - 1 mmol/L - lower end for prophylactic/elderly

0. 8 - 1 mmol/L - acute manic episodes

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37
Q

What is the monitoring needed for lithium?

A

12 hours post dose

Monitored every 3 months

Additional monitoring if significant inter current illness or significant changes to diet or water intake

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38
Q

Why should you avoid abrupt withdrawal of lithium?

A

Warn patients of higher risk of relapse

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39
Q

What are the signs and symptoms of lithium toxicity?

A

Revenge

Renal disturbances
Extra pyramidal symptoms 
Visual disturbances 
Nervous system disturbances
GI effects

> 2 mmol/L - renal failure, arrhythmias, seizures, BP changes, circulatory failure, coma, death

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40
Q

What are the side effects of lithium?

A
Thyroid disorders
Renal impairment 
Benign intracranial hypertension 
QT prolongation 
Lowers seizure threshold
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41
Q

What are the counselling points for the side effects of lithium?

A

Report hypothyroidism symptoms
Report renal dysfunction
Report persistent headaches, visual disturbance

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42
Q

Does hyper or hyponatraemia predispose lithium toxicity?

A

Hyponatraemia

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43
Q

What are the counselling points for lithium?

A

Report signs and symptoms of lithium toxicity
Maintain salt and water intake
Lithium treatment pack
Can cause drowsiness avoid alcohol
OTC interactions - ibuprofen, soluble analgesics, antacids

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44
Q

Is lithium teratogenic?

A

Yes

Need effective contraception
Toxicity can occur in breast fed infants

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45
Q

What are the lithium interactions that increase risk of seizures?

A

Ciprofloxacin
SSRIs
Epilepsy

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46
Q

What are the lithium interactions that increase risk of arrhythmias due to QT prolongation?

A
Quinolones
Citalopram
Clarithromycin 
Amiodarone 
Antipsychotics 
Imipramine 
Theophylline 
Corticosteroids 
B2 agonists 
Loop/thiazide
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47
Q

What are the lithium interactions that increase risk of lithium toxicity due to reduced renal excretion?

A

ACEi
ARB
NSAIDs

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48
Q

What are the lithium interactions that increase risk of hyponatraemia and so predispose lithium toxicity?

A

Diuretics

Antidepressants

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49
Q

What are the lithium interactions that increase risk of extrapyramidal symptoms?

A
Haloperidol
Clozapine
Phenothiazines 
Parkinson’s disease
Metoclopramide
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50
Q

What drugs used with lithium affect the salt balance?

A

Soluble analgesics

Sodium containing antacids

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51
Q

What are the lithium interactions that increase risk of neurotoxicity?

A

Phenytoin
Carbamazepine
Antipsychotics
Amitriptyline

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52
Q

What are the lithium interactions that increase risk of serotonin syndrome?

A
Sumatriptan
Citalopram
Granisetron
MAOIs
Amfetamines
St Johns Wort
Tramadol
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53
Q

What are the psychological symptoms of depression?

A

Low self esteem
Worry and anxiety
Suicidal thoughts

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54
Q

What are the physical symptoms of depression?

A

Lack of energy
Changes in weight/appetite
Insomnia

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55
Q

How do antidepressants work?

A

Depression is thought to be caused by under activity of monoamine neurotransmitters

Antidepressants increase monoamine levels at synapse

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56
Q

What are the tricyclic antidepressants?

A

Raises 5HT, NA

Amitriptyline 
Clomipramine
Dosulepin
Imipramine
Nortriptyline
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57
Q

What are the tricyclic related antidepressants?

A

Mianserin

Trazodone

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58
Q

What are the selective serotonin reuptake inhibitors?

A

Raises 5HT

Citalopram (QT prolongation)
Escitalopram (QT prolongation)
Fluoxetine (only antidepressant given in children)
Fluvoxamine 
Paroxetine 
Sertraline - safe to use after MI
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59
Q

What are the irreversible monoamine oxidase inhibitors?

A

Raise 5HT, NA, DA

Phenelzine
Isocarboxazid
Tranylcypromine

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60
Q

What are the reversible monoamine oxidase inhibitors?

A

Moclobemide

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61
Q

What are antidepressants used for?

A

Moderate to severe depression

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62
Q

What are the first line antidepressants?

A

SSRIs

Better tolerated and safer in overdose
Less sedating, antimuscarinic, epileptogenic, cardiotoxicity than TCAs

MAOIs rarely used

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63
Q

How long does it take for antidepressants to work?

A

At least two weeks

Initially feel worse, increased agitation, anxiety, suicidal ideation

Review every 1-2 weeks
Wait at least 4 weeks

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64
Q

How long should you take antidepressants for?

A

At least six months after remission

12 months in generalised anxiety
2 years in recurrent depression

65
Q

What is the second line depression treatment?

A

Increase SSRI dose
Different SSRI
Mirtazapine

66
Q

What are the alternative antidepressant treatments?

A

Lofepramine
Reboxetine
Moclobemide

Other TCAs
Venlafaxine
Irreversible MAOIs

67
Q

What are the side effects of antidepressants?

A

Hyponatraemia - drowsiness, confusion, convulsion

Suicidal ideation and behaviour

Serotonin syndrome

68
Q

What are the symptoms of serotonin syndrome?

A

Neuromuscular hyperactivity - tremors, myoclonus, muscle rigidity

Altered mental state - agitation, confusion, mania

Autonomic dysfunction - labile blood pressure, urination, diarrhoea, hyperthermia, tachycardia, pallor, sweating, shivering

69
Q

How do you switch between different antidepressants?

A

Washout period required when antidepressant is stopped before switching to different antidepressant class, avoid serotonin syndrome

70
Q

What is the washout period for MAOIs?

A

Wait 2 weeks before switching

Except meclobomide which doesn’t need a washout period

71
Q

What is the washout period for SSRIs?

A

Wait 1 week before switching

2 weeks if sertraline
5 weeks if fluoxetine

72
Q

What is the washout period for TCAs?

A

Wait 1-2 weeks before switching

3 weeks if imipramine or clomipramine

73
Q

Why do you need to avoid abrupt withdrawal for antidepressants?

A

Withdrawal reactions occur within 5 days of stopping

Risk of withdrawal reactions is increased if antidepressant stopped suddenly after taking for 8 weeks or more

Reduce dose gradually over 4 weeks

74
Q

What antidepressants have a higher risk of withdrawal reaction?

A

Paroxetine

Venlafaxine

75
Q

What is the mechanism of action of SSRIs?

A

Selectively inhibit the reuptake of 5HT from synaptic cleft

76
Q

What are the side effects of the SSRIs?

A

GASH

GI
Appetite or weight disturbances
Serotonin syndrome
Hypersensitivity reactions

Bleeding risk increased
QT interval prolongation with citalopram/escitalopram
Seizure threshold lowered
Movement disorders and dyskinesia

77
Q

Which SSRI is used in children?

A

Fluoxetine

78
Q

Which SSRI is used in MI/unstable angina?

A

Sertraline

79
Q

Which SSRIs cause QT prolongation?

A

Citalopram

Escitalopram

80
Q

What are the symptoms of SSRI overdose?

A
Nausea
Vomiting
Agitation
Tremors
Nystagmus
Drowsiness
Sinus tachycardia 
Convulsions
81
Q

What drugs cause an increased plasma concentration when used with SSRIs?

A

Grapefruit juice

82
Q

What drugs cause an increased risk of bleeding when used with SSRIs?

A

NSAIDs/aspirin
Anticoagulants
Antiplatelets

83
Q

What drugs cause an increased risk of QT prolongation when used with SSRIs?

A
Erythromycin 
TCAs
Sotalol
Amiodarone
Chloroquine
Mefloquine
Lithium
Quinine
Antipsychotics 
Theophylline
Beta 2 agonists
Loop/thiazide diuretics 
Corticosteroids 

Hypokalaemia increases risk of torsade de pointes

84
Q

What drugs cause an increased risk of hyponatraemia?

A

Diuretics
Desmopressin
Carbamazepine
NSAIDs

85
Q

What drugs cause an increased risk of serotonergic effects/serotonin syndrome when used with SSRIs?

A
St Johns Wort
Amfetamines
Sumatriptan
Selegiline
Tramadol
TCA
MAOI
Ondansetron
86
Q

What is the mechanism of action of TCAs?

A

Inhibits reuptake of 5HT and NA

Also blocks a wide array of receptors M, H1, a1/2, D2

87
Q

What is the dose of TCAs?

A

Once daily at night

88
Q

Which TCAs are sedating?

A
Amitriptyline 
Clomipramine 
Dosulepin
Doxepin
Trimipramine

Mianserin
Trazodone

89
Q

What TCAs are less sedating?

A

Imipramine
Lofepramine
Nortriptyline

90
Q

What are the side effects of TCAs?

A

More sedating, more epileptogenic, more cardiotoxicity, more antimuscarinic than SSRIs

Toxic
Cardiac effects
Antimuscarinics
Seizures

Hallucinations
Mania
Hypotension
Sexual dysfunction 
Breast changes
EPS
91
Q

What are the drugs that reduce plasma concentrations when used with TCAs?

A

Carbamazepine

92
Q

What are the drugs that increase plasma concentrations when used with TCAs?

A

Cimetidine

93
Q

What are the drugs that increase the risk of hyponatraemia when used with TCAs?

A

Diuretics
Desmopressin
Carbamazepine

94
Q

What are the drugs that increase risk of QT interval prolongation when used with TCAs?

A
Amiodarone
Sotalol
Antipsychotics
Citalopram
Escitalopram 
Loop diuretics
B2 agonists
Corticosteroids 
Theophylline
95
Q

What are the drugs that increase the risk of hypotension when used with TCAs?

A
Alpha blockers 
Beta blockers
ACEi
CCBs
Antipsychotics
Levodopa/dopaminergic as
NSAIDs
SGLT2 inhibitor
Diuretics
Phosphodiesterase type 5 inhibitor
96
Q

What are the drugs that increase antimuscarinic effects when used with TCAs?

A

Antimuscarinics
Antihistamines
Atropine
Antipsychotics

97
Q

What are the drugs that increase the risk of serotonin syndrome when used with TCAs?

A
MAOIs/selegiline
Tramadol
Amfetamines
5HT1a agonists (sumatriptan)
Ondansetron
Lithium
98
Q

What is the mechanism of action of the MAOIs?

A

Blocks monoamine oxidase enzymes which leads to accumulation of monoamines - DA, NA, 5HT

99
Q

What are the MAOIs used for?

A

Rarely used due to significant food/drug interactions

100
Q

What are the irreversible MAO-A and MAO-B inhibitors?

A

Phenelzine
Isocarboxazid
Tranylcypromine

101
Q

Which MAOIs have a high risk of hepatotoxicity?

A

Phenelzine

Isocarboxazid

102
Q

Which MAOI has the greatest stimulant action?

A

Tranylcypromine

103
Q

What are the reversible MAO-A inhibitors?

A

Moclobemide

104
Q

What are the side effects of MAOIs?

A

Hepatotoxicity
Postural hypotension/hypertensive responses
Hypertensive crises

105
Q

What are the interactions with MAOIs that cause hypertensive crises?

A
Pseudoephedrine
Adrenaline
Noradrenaline 
Levodopa
DRAs
MAO-B inhibitors 
TCAs
106
Q

What are the counselling points for MAOIs?

A

Avoid food containing tyramine - cheese, marmite, cured meat

Eat only fresh food

Avoid alcohol

Interactions 2 weeks after stopping an irreversible MAOIs

107
Q

What are the negative symptoms of schizophrenia?

A

Under activity in mesocorticol pathway

Social withdrawal
Poor hygiene
Apathy
Catatonia

108
Q

What are the positive symptoms of schizophrenia?

A

Overactivity of mesolimbic pathway

Hallucinations
Delusions
Disorganised speech/thoughts

109
Q

What are the extrapyrimidal symptoms of schizophrenia?

A

D2 antagonism in nigrostriatal pathway

Parkinsonism
Tardive dyskinesia
Akathisia 
Dystonia
Dyskinesia
110
Q

What are the hyperprolactinaemia symptoms of schizophrenia?

A

D2 antagonism in tuberofundibular pathway

Menstrual disturbances
Galactorrhoea
Breast enlargement
Sexual dysfunction

111
Q

Is the dose of antipsychotics higher or lower in the BNF compared to the Royal college of psychiatrists?

A

Lower

112
Q

What needs to be considered in antipsychotic prescribing?

A

Consider alternatives
Be aware of risk factors
Drug interactions
ECG
Increase dose slowly and once weekly
Regular pulse, blood pressure and temperature checks
High dose for limited period, stop if no improvement after 3 months

113
Q

How do you administer antipsychotics in an emergency?

A

Via IM

IM dose lower than oral dose

Prescription should specify dose for each route
Review dose of antipsychotic at least daily

114
Q

What needs to be considered when prescribing antipsychotics in the elderly?

A

In elderly patients with dementia there’s an increased risk of death and stroke

Susceptible to postural hypotension and hyper/hypothermia

Do not treat mild-moderate psychotic symptoms
Initial dose is half adult dose
Review regularly

115
Q

What needs to be considered for prescribing antipsychotics in patients with learning disabilities?

A

If patient is not experiencing psychotic symptoms
Reduce dose or stop long term treatment
Review condition
Refer to psychiatrist
Annual documentation of reasons for continuing antipsychotic

116
Q

What is the mechanism of action of 1st generation antipsychotics?

A

Blocks post synaptic dopamine D2 receptors in the brain

117
Q

What are the phenothiazines?

A

Group 1
Chlorpromazine
Levomepromazine
Promazine

Group 2
Pericyazine

Group 3
Fluphenazine
Perphenazine
Prochlorperazine
Trifluoperazine
118
Q

Which phenothiazines are the most sedative?

A

Group 1

119
Q

Which phenothiazines have the least extrapyramidal symptoms?

A

Group 2

120
Q

Which phenothiazines have the most extrapyramidal symptoms?

A

Group 3

121
Q

What are the butyrophenones?

A

Haloperidol - high extrapyramidal symptoms and QT interval prolongation

122
Q

What are the thioxanthenes?

A

Flupentixol - not in evening

Zuclopenthixol

123
Q

What are the other 1st generation antipsychotics?

A

Pimozide
Sulpiride
Loxapine

124
Q

What is the mechanism of action of the second generation antipsychotics?

A

Blocks post synaptic dopamine D1-D4 receptors and act on wide range of other receptors

125
Q

What are the second generation antipsychotics?

A
Amisulpride
Aripiprazole
Clozapine
Lurasidone
Olanzapine
Paliperidone
Quetiapine
Risperidone
126
Q

Which second generation antipsychotics cause the most hyperprolactinaemia?

A

Amisulpride

Risperidone

127
Q

Which second generation antipsychotics cause weight gain and diabetes?

A

Clozapine

Olanzapine

128
Q

What is clozapine?

A

Second generation antipsychotic and is the most effective

129
Q

What is clozapine used for?

A

Licensed for resistant schizophrenia

Try for at least 8-10 weeks, if symptoms don’t respond to optimised dose measure plasma levels before augmenting with second antipsychotic

130
Q

What do you do for a missed dose of clozapine?

A

> 2 missed doses re-initiate by specialist

131
Q

What are the interactions of clozapine that cause an increased risk of agranulocytosis (blood dyscrasias)?

A

Aminosalicylates

Immunosuppressants

132
Q

What are the side effects of clozapine?

A

MAG

Myocarditis and cardiomyopathy- stop permanently
Agranulocytosis and neutropenia - report flu like illness
GI obstruction - constipation can be fatal

133
Q

How often is clozapine monitored?

A

Leukocyte and differential blood count

Every 18 weeks, then every 2 weeks for a year, then monthly onwards

134
Q

What is the MHRA warning for clozapine?

A

Reminder of potential,y fatal risk of intestinal, obstruction, faecal impaction, paralytic ileus

Report constipation before taking next dose

135
Q

How often are antipsychotic depot preparations administered?

A

Every 1-4 weeks by IM injection

Test dose
Oral antipsychotic whilst stabilising

136
Q

What is the safety information needed for antipsychotic depot preparations?

A

Do not confused with other preparations

IM haloperidol decanoate for maintenance
IM haloperidol rapid control

137
Q

In patients with schizophrenia what needs to be monitored?

A

Physical health annually

138
Q

What are the extrapyramidal symptoms associated with antipsychotics?

A
Parkinsonism
Dystonia
Dyskinesia
Akathisia
Tardive dyskinesia  - stop at first sign of fine vermicular movements of tongue

Occurs most frequently with group 3 phenothiazines, butyrophenones, 1st generation depot preparations

139
Q

What are the hyperprolactinaemia symptoms associated with risperidone, amisulpride and 1st generation antipsychotics?

A

Breast symptoms
Reduced bone mineral density
Menstrual irregularities
Sexual dysfunction

Aripirazole is the only antipsychotic without this side effect as it is a partial dopamine agonist

140
Q

What monitoring is needed for hyperprolactinaemia in antipsychotics?

A

Prolactin levels at start, 6 months and then yearly

Endocrine function in children - weight, height, sexual maturation, menstrual function

141
Q

What are the metabolic side effects more commonly associated with second generation antipsychotics?

A

Hyperglycaemia and sometimes diabetes - ciroq (clozapine, risperidone, olanzapine, quetiapine)

Weight gain

Lipid changes

142
Q

What are the antipsychotics that most commonly cause sexual dysfunction?

A

Haloperidol

Risperidone

143
Q

What is the mechanism of action of antipsychotics that cause hyperprolactinaemia and low libido?

A

Block D receptors

144
Q

What is the mechanism of action of antipsychotics that cause arousal disorders?

A

Block M receptors

145
Q

What is the mechanism of action of antipsychotics that cause erectile dysfunction and ejaculatory problems?

A

Block a1 receptors

146
Q

What are the cardiovascular effects of antipsychotics?

A

Tachycardia
Arrhythmias
Hypotension
QT interval prolongation - pimozide, haloperidol

147
Q

What antipsychotics are most likely to cause hypotension and interference with temperature regulation?

A

Elderly especially at risk of falls, hypothermia, hyperthermia

Clozapine
Chlorpromazine
Lurasidone
Quetiapine

148
Q

Is neuroleptic malignant syndrome fatal?

A

Yes

Discontinue antipsychotic drug immediately
Bromocriptine or dantrolene
Lasts 5-7 days after stopping but longer with depot preparation

149
Q

What are the other side effects of antipsychotics?

A
Antimuscarinic side effects
Blood dyscrasias 
Photosensitivity 
Jaundice
Sedation
150
Q

What is the warning with chlorpromazine?

A

Contact sensitisation, avoid direct contact

151
Q

What are the warnings for pimozide?

A

Prolongs QT interval, cases of sudden death

If QT interval prolonged stop or reduce dose
Do not give concomitant drugs that prolong QT interval
Do not give concomitant drugs that cause electrolyte imbalance

152
Q

What are the side effects of phenothiazines?

A

Hepatotoxicity

Acute dystonic reactions

153
Q

What is the monitoring needed for antipsychotics?

A
FBC
Urea
Electrolytes 
LFT
Blood lipids
Weight
Fasting blood glucose
ECG
Blood pressure before starting and frequently during dose titration
154
Q

What are the antipsychotic interactions that cause QT interval prolongation?

A

Amiodarone
Ciprofloxacin
Macrolides
Quinine SSRIs

155
Q

What are the antipsychotic interactions that increase the risk of extrapyramidal symptoms?

A

Metoclopramide

Parkinson’s disease

156
Q

What are the interactions with antipsychotics that increase the risk of sedation and CNS depressant effects?

A

Hypnotics
Benzodiazepines
Opioids
Antiepileptics

157
Q

What are the interactions with antipsychotics that increase the risk of hypotension?

A

Antihypertensives
Diuretics
Nitrates

158
Q

What are the interactions with antipsychotics that increase the risk of antimuscarinic effects?

A

TCA
Antihistamines
Antimuscarinics