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Psychiatry > Pharmacological therapies > Flashcards

Pharmacological therapies Flashcards

1
Q

What drugs are used to treat bipolar?

A

Lithium

Anti-convulsants: s. valproate, carbamazepine

Anti-psychotics (in acute mania)

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2
Q

Patients on lithium need to be monitored, what for and why?

A
  1. renal function: Li is excreted by kidneys so they need to be working well, monitor U+E, creatinine
  2. Thyroid function: Li can lead to hypothyroid
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3
Q

What are some side effects of lithium?

A

LITHIUM

Leukocytosis
Insipidus
Tremors
Hypothyroidism
Increased Urine
Mums beware (teratogenic)
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4
Q

What are some features of lithium toxicity?

A 
Blurred vision
Coarse tremor
Muscle weakness
Ataxia
Hyper-reflexia
Circulatory failure
Seizures
Coma
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5
Q

List some tricyclic antidepressants?

How do they work?

A

Amitriptyline
Imipramine

Blocks reuptake of noradrenaline and serotonin (so there’s more around!)Affects muscarinic and histamine receptors

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6
Q

Side effects of TCAs? What causes them?

A

Anti-cholinergic (blockage of muscarinic receptors)

  • dry eyes, mouth
  • blurred vision
  • constipation
  • urinary retention

Others:

  • drowsiness
  • arrhythmia
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7
Q

List some SSRIs?

How do they work? Where in brain?

A

Citalopram
Sertraline
Fluoxetine

Downregulate number of serotonin receptors in pre-frontal cortex

More seratonin floating around in synapse, so more effect

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8
Q

Side effects of SSRIs?

A

Is a stimulant so can mean that patient now has motivation to take own life

GI: nausea, anorexia, diarrhoea

Insomnia, restlessness

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9
Q

List some SNRIs?

How do they work?

A

Duloxetine
Venlafaxine

Inhibit reuptake of serotonin and noradrenaline

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10
Q

What does MAO stand for?

List some MAOs?

How do they work?

A

Monoamine oxidase inhibitors

Isocarboxazid

Inhibit monoamine oxidase enzyme, so there’s less breakdown of things like serotonin and noradrenaline

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11
Q

What’s a serious problem that’s caused by some anti-depressants?

A

Serotonin syndrome

Caused by MAOs, SSRIs, SNRIs. If taken at high doses

Increased serotenergic activity in the CNS

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12
Q

Features of serotonin syndrome?

A

Triad: CAN

  1. Cognitive impairment: agitation, confusion, delirium
  2. Autonomic: shivering, sweating
  3. Neuromuscular dysfunction: akathasia, clonus, tremor
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13
Q

Management of serotonin syndrome?

A

Stop drug

Supportive

Benzos

5HT (serotonin) block, called chlorpormazine

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14
Q

List some typical and atypical anti-psychotics?

A

Typical:

  • Chlorpromazine
  • Haloperidol

Atypical:

  • olanzapine
  • aripiprazole
  • risperidone
  • clozapine
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15
Q

How do the typical anti-psychotics work?

A

They block the action of dopamine (at differing strengths)

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16
Q

What are the side effects of the typical anti-psychotics?

A

Parkinsonism (due to dopamine being blocked)
- stiffness, tremor, stooped

Drowsiness, apathy

Extrapyramidal:

  • akathasia
  • tardive dyskinesia
  • dystonia
  • torticollis
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17
Q

Which typical anti-psychotic is good for psychiatric emergencies?

A

Haloperidol

18
Q

What is:

  • akathasia
  • tardive dyskinesia
  • dystonia
  • torticollis
A

Akathasia: restlessness

T. dyskinesia: rhythmic involuntary movements of face, tongue, etc.

Dystonia: spasms of neck, jaw, extremities

Torticollis: holding neck in abnormal position

19
Q

How do the atypical anti-psychotics work?

A

Block dopamine, but to a lesser extent

Also block serotonin and others

Clozapine works on different brain receptors

20
Q

Side effects of the atypical anti-psychotics?

A

Similar to typical, but less so.
And no parkinsonism

Can still get akathasia and tardive dyskinesia

Weight gain
Hyperglycaemia + diabetes
Palpitations (long QT, arrythmias)
Gynaecomastia
Drowsy, n+v, constipation
21
Q

Which atypical anti-psychotic is good for:

  1. younger patients
  2. older patients
  3. patients who also have mood problems
  4. aggressive patients
  5. treatment resistant schiz.
A
  1. Aripiprazole
  2. Risperidone
  3. Olanzapine
  4. Risperidone
  5. Clozapine
22
Q

What do you need to look out for in a patient taking clozapine?

A

Agranulocytosis

Severe leukopenia, most commonly neutropenia
They’re at high risk of severe infection

23
Q

Which anti-psychotic has hypersalivation as a side effect?

A

Clozapine

24
Q

What is neuroleptic malignant syndrome?

A

A condition that develops after starting an antipsychotic or increasing the dose of one

Very serious and can be life threatening

Caused by dopamine blockade

25
Q

Clinical features and investigative findings of neuroleptic malignant syndrome?

A

CAN CAN

Cognitive: confusion, disorientation

Autonomic: hyperpyrexia, sweating,

Neuro: seizures, coma, stiffness (lead pipe)

Cardiac: long QT

Acidosis: metabolic (due to raised CK)

Neutrophils raised (leukocytosis)

26
Q

Management of neuroleptic malignant syndrome?

A

Supportive

Benzos

Muscle relaxants

27
Q

List some benzodiazepines?

How do they work?

A

Diazepam
Lorazepam
Midazolam

Enhance effect of GABA, sedating effect

28
Q

What is a common side effect of anti-psychotics seen in young men? When does it occur?

A

Acute dystonic reaction
Spasms in neck, jaw etc

Happens really soon after giving drug

29
Q

What is used to treat extra-pyramidal symptoms caused by anti-psychotics?

What about akathasia?

A

Anti-cholinergics
- Benztropine

Sometimes will require B blockers or benzodiazepines

30
Q

Another name for serotonin receptor?

A

5HT

31
Q

How long should a patient keep using SSRI for even if they feel better?

A

6 months

32
Q

OD of tricyclic anti-depressants, symptoms?

A

Tachycardia
Dilated pupils
Enlarged bladder due to retention

33
Q

Inheritance of Alzheimer’s?

Percentage chance a child of a patient will get it?

A

Aut dominant

15%

34
Q

What is the name for when eyes roll back into head?

A

Oculogyric crisis

35
Q

Which drug classes can cause delirium?

A 
Benzodiazepines
Narcotic analgesics
Furosemide
Steroids
Warfarin
36
Q

Management of Paracetamol OD?

A 
Activated charcoal (within 8 hrs of OD)
Acetylcistiene if after
37
Q

Whats the treatment for acute dystonia?

A

Procyclidine (a anti-cholinergic)

IM or PO

38
Q

Which neurotransmitter do atypical anti-psychotics work on primarily

A

Serotonin 5HT 2a

39
Q

Complications of neuroleptic malignant syndrome?

A

Renal failure
Hyperkalaemia
Rhabdomyolysis

Pulmonary embolus
Pneumonia
Prolonged QT
Death

40
Q

Features of TCA overdose?

A 
Elevated body temperature
Blurred vision
Dilated pupils
Sleepiness, confusion
Seizures
Tachycardia: prolonged QT, wide QRS
Cardiac arrest.

Psychiatry (17 decks)

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