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Psych Year 4 > Neuropharmacology > Flashcards

Neuropharmacology Flashcards

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1
Q

drug used for MDD that causes confusion on a hot day (?)

A

escitalopram (SSRI)

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2
Q

what are some serious side effects of ecitalopram?

A

increased suicidal risk for first few weeks of therapy
birth defect for pregnant mothers
serotonin syndrome
discontinuation syndrome

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3
Q

sedative drug that causes visual hallucinations?

A

diazepam

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4
Q

MDD drug that causes weight gain and sedation

A

mirtazepine

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5
Q

mood stabilizer that causes confusion and unsteadiness when used in cojunction with a diuretic

A

lithium d/t changes in body concentration

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6
Q

what medication do you use for dystonia for antipsychotics?

A

benztropine

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7
Q

what medication can be offered IM for an acute agitated psychiatric patient?

A

midazolam

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8
Q

what are the clinical manifestations of hyperprolactinemia from anti-psychotics?

A

gynecomastia, galatorrhea, menstrual cycle disturbance, anovulation, decreased libido, impaired sexual arousal, impotence

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9
Q

what are common drugs that cause hyperprolactinemia?

A

amisulporide, paliperidone, risperidone, first-generation anti-psychotics

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10
Q

what is the treamtent to hyperprolactenmia?

A

reduce dosage of medication
switch to medication w/ low risk = ariprazole and clozapine
if not able to switch medicatins = add low dose 5mg ariprazole
prevention: regular prolactin monitoring, actively ask for symptoms of prolactinemia (menstrual changes, sexual changes)

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11
Q

what are the common anti-psychotics drugs that causes weight gain and other cardiometabolic changes?

A

clozapine and olazapaine

chlorpromazine

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12
Q

what si the treatment to cardiometabolic changes and weight gain?

A

monitoring: weight, bmi, waist circumference, BP, fasting blood glucose, full lipid profile (done at baseline, then 3 monthly, 6 monthly for the duration of therapy)
management of metabolic symptoms:
ongoing lifestyle interventions: education on healthy eating, weight reduction programmes
review of concurrent drugs that contribute to weight gain
phramcothreapy for: bp, dyslipidemia, t2dm (consider metformin)

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13
Q

what is the antipsychotic medication that causes lengthening of QT intervla

A

sertindole - has serotonin and dopamine receptors effect

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14
Q

what is the management of QT interval lengthening?

A 
assess and manage risk factors: 
female
congenital disposition
hypocalcemia
hypokalemia
hypomagnesemia
other medications that lengthen QT interval

mostly prevention: do ECG before starting treatment
ECG monitoring during treatment with sertindole

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15
Q

what is the management of medium-long term sedation in anti-psychotic drugs?

A

start low and go slow
reassurance that sedation wil go away in 2 weeks
avoid driving/machinery driving
if sedation remains - lower dose, change to less sedating anti-psychotics (such as aripiprazole)

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16
Q

orthostatic hypotension culprit anti-psychotic drugs?

A

risperidone, paliperidone

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17
Q

what culprit anti-psychotic drugs for anticholinergic effects?

A

clozapine
chlorpromazine
pericyazine

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18
Q

what are the symptoms of EPS - antipsychotics?

A

dystonia (sustained/brief muscle contraction that results in twisting movements or abnormal postures)
Parkinsonism
tardive dyskinesia (chronic repetitive involuntary choreiform movements - tongue, lips, mouth)
akathisia (abnormal/uncomfortable sensation of restlessness that is relieved upon movement)

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19
Q

what are medications more likely to cause EPS?

A

first generation anti-psychotics (chlorpromazine, haloperidol, flupenthixol)

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20
Q

what anti psychotic medications are less likely to cause EPS

A

clozapine, sertindole, olanzapine

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21
Q

what is the management of EPS?

A

acute dystonia = benztropine (IM/IV acute) and oral for maintenance for weeks
akathisia = lower dosage, start altnerative anti-psychotics, give propanolol short term OR diazepam short term
tardive dyskinesia = change to a second gen antipsychotic
Parkinsonism = use benztropine 0.5 - 2mg oral

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22
Q

what is neuroleptic malignant syndrome?

A

severe muscle rigidity, dystonia, akinesia, high fever, autonomic instability, raised creatine kinase (rhabdomyolysis), delirium

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23
Q

what is managemnet of neuroleptic malignant syndrome?

A 
discontinue anti-psychotics, if need to continue, wait at least 5 days before anti-psychotic rechallenge and use a different anti-psychotic, start low go slow, 
measure and monitor vitals 
ensure adequate hydrations w/ IV fluids 
give DVT prophylaxis 
consider the use of diazepam
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24
Q

what is the management of akathesia in a patient on anti-psychotics?

A

first line BDZ long acting (ie lorezapam)
OR
second line B-blocker (propanolol) or benztropine

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25
Q

what is the shortest acting benzodiazepines?

A

midazolam (because you give it for acute psychiatric agitations!)

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26
Q

what is the management of parkinsonism in a patient on anti-psychotics?

A

(first line) benztropine.

if already on anti-cholinergic OR unable to tolerate (dementia/glaucoma), give amantidine

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27
Q

what is the management of acute dystonia in a patient on anti-psychotics?

A

benztropine

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28
Q

what second gen anti-psychotic is most assoc. w/ weight gain?

A

olly the elephant olanzapine

and clozapine

29
Q

what second gen anti-psychotic is most assoc w/ EPS?

A

risperidone

30
Q

what medication should not be given together with SSRI?

A

MAO-Inhibitor - causes serotonin syndrome

31
Q

what are some side effects of SSRI

A

sexual dysfunction
GI adverse effects: n/v, diarhoea, anorexia, dyspepsia, weight gain, headaches
anxiety
insomnia and sedation/vivid dreams and nightmares
EPS is rare
serotonin syndrome (especially when mixed with a MAO-Inhibitor)

32
Q

what are some of the symptoms of serotonin syndrome?

A

(in the following order)
diarrhoea
restlessness
extreme agitation/hyperreflexia/autonomic instability w/ possible fluctuations in vitals (tachycarida, elevated bp)
myoclonus, seizures, hyperthermia, uncontrollable shakes, rigidity
delirium, coma, status epilepticus, cardiovascular collapse, death

33
Q

what are the symptoms of SSRI withdrawal?

A

dizziness, weakness, nausea, headache, rebound depression, anxiety, imsomnia, poor concentration

34
Q

good drugs for hyperprolactanemia?

A

quietiapine and clozapine

aripripazole

35
Q

good drugs for EPS?

A

clozapine and quietiapine

36
Q

good drugs against weight gain and cardiometabolic?

A

ziprasidone (excellent)

haloperidol/aripripazole (not bad)

37
Q

half life of SNRI vs SSRI

A

SNRI generally has a shorter half life than SSRI. fluoxetine (SSRI) in particular has a long half life

38
Q

what are some s.e of SNRI?

A 
venlafaxine: 
GI upset: n/v, constipation 
somnolence
dry mouth 
dizziness
nervousness 
weakness
erectile disturbances and impotency 
increase in b.p

duloxetine similar except less GI upset

39
Q

what are the indications for TCA?

A

second line depression
second line depression in bipolar I
headaches: preventive for migraine and preventive for frequent tension headaches

40
Q

what are some of the common side effects of TCA?

A

anti cholinergic symptoms: dry mouth, dry eyes, constipation, blurred vision, urinary retention, if severe (cause delirium and confusion)
sedation
orthostatic hypotension
cardiac effects: tachycardia, prolonged QT intervals, depressed ST segments
neurological: psychomotor agitation, myoclonic twitches. tremor of the tongue and upper extremities
weight gain

41
Q

what are medications that can be used for neuroleptic malignant syndrome (NMS)?

A

bromocriptine

dantrolene

42
Q

what are the main risks of clozapine?

A

agranulocyotsis
lowers seizures threshold
orthostatic hypotension

43
Q

what are the drug interactions between SSRI and NSAIDS/warfarin?

A

bleeding tendency

44
Q

what are the main indications for clozapine?

A

patients w/ parkinson’s
patinets suffering w/ severe tardive dyskinesia or EPS symptoms
patients refractory to prev treatmnet

45
Q

what antipsychotics are effective for negative symptoms of schizophrenia?

A

olanzapine and clozapine

46
Q

what are the drug interactions between SSRI and NSAIDS/warfarin?

A

bleeding tendency

47
Q

what are good anti-depressants for the elderly?

A

SSRIs (fluoxetine, paroxetine, setraline, citalopram, fluvoxamine), venlfaxafine, bupropion, mirtazapine
do not cause anti cholinergic effects, do not cause cardiotoxic s.e, do not cuase orthostatic hypotension

48
Q

what is the definition of akathisia?

A

feeling of restlessness, inability to stay still.
patient will pace, shift positions, constant leg movements.
arises in the first few days of treatment

49
Q

what are some anti-depressants that do not affect erectile function?

A

bupropion, mirtazapine

50
Q

what are second line (not ideal) anti-depressants for the elderly and why?

A

TCA (amitriptyline, imipramine, desipramine) - anticholinergic, sedation
MAO-Inhibitors (phenelzine, tranylcypromine) causes hypotension

51
Q

what is the treatment of lithium toxicity?

A

mild to moderate (serum level

52
Q

what is the fatal dose of TCA

A

around 2 - 3mg. makes it unsuitable for highly suicidal patients

53
Q

what are the relative contraindications of ECT?

A

recent MI, raised intracranial pressure, bleeding disorder, cerebral aneurysms, recent cerebrovascular events, medical disorder that can disrupt the blood-brain barrier

54
Q

medications that can interact w/ lithium levels

A

NSAID, AT2, ACEI, diuretics

55
Q

what do high potency neuroleptics vs low potency neuroleptics presidpose patients to?

A

high potency: EPS, hyperprolactinemia

low potency: sedating, hypotension, anti cholinergics

56
Q

what are some high potency neuroleptics?

A

haloperidol, fluphenazine

57
Q

what are some low potency neuroleptics?

A

chlropromazine, thioridazine

58
Q

what are some rare, serious complicaitons of carbamazepine?

A

aplastic anemia

steven-johnson syndrome

59
Q

what are the preferred treatment for acute mania in a pregnant patient?

A

neuroleptics (olanzapine, risperidone)
not carbamazepine/valproate as they cause an increased risk of neural tube defects and spina bifida that occur in the first trimester of pregnancy

60
Q

what are the pharmacotherapy for narcolepsy?

A

CNS sitmulants for day time sleepiness: methylphenidate, amphetamine
to reduce REM sleep and cataplexy: TCA/SSRI

61
Q

how long does lithium take to reach steady state?

A

5 - 7 days

62
Q

what are the lithium congenital anomalies?

A

Ebstein’s anomaly (cardiovascular - distorted tricuspid valve into the RV)

63
Q

what are the SSRIs that has to be slowly weaned off, and what are the SSRIs that does not require any weaning?

A

paroxetine, setraline (shorter half life - require to wean)

fluoxetine (long half life - can be stopped abruptly)

64
Q

what dietary requirement for MAO-I?

A

avoid tyramine rich food such as aged cheese, salami, pepperoni, red wine, overripe fruits

65
Q

what are the features of neuroleptic malignant syndrome/

A

hyperthermia, severe muscular rigidity, autonomic instability, changes in mental status
show increased CPK, ALT, leukocytes and myglobunuria

66
Q

what level of lithium represents where costs may outweigh the potential benefits/

A

1.5meq/L

67
Q

what is the most common cardiovacscular s.e of using a TCA?

A

slowing of cardiac conduction, prolonging QT

68
Q

what is the treatment of lithium induced tremor?

A

supportive: dose reduction, elimination of caffeine, slow release lithium preparations
give Beta blocker s

69
Q

what are the symptoms of dystonia?

A

intermittent, sustained muscle spasms - usually affecting the head and neck
such as torticollis (neck spasms), tongue spasms, oculogyric crises (eye forced in upward and lateral gaze)

Psych Year 4 (10 decks)

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