Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Toni's Psych > Pharmacological Therapy > Flashcards

Pharmacological Therapy Flashcards

You may prefer our related Brainscape-certified flashcards:
Psychology 101 flashcards GRE® Psychology flashcards
1
Q

What are the TCAs?

A 
Amitriptyline - most tox, sed
Imipramine - less sed
Lofepramine - least tox in OD, less sed 
Clomipramine - sed
Dosulepin - most tox, sed 
Trazodone - sed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

SSNRIs

Selective serotonin and noradrenaline reuptake inhibitor

A

Venlafaxine

Duloxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are Mirtazapine’s SEs?

A

Increased appetite/weight gain
Sedation
Oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the SSRIs?

A 
Sertraline
Paroxetine
Citalopram
Fluoxetine
Fluvoxamine
Escitalopram
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the atypical antipsychotics?

A 
Dopamine D2 receptor blockade
Olanzapine +ve sx
Risperidone
Clozapine
Aripiprazole red EPSE
Quetiapine
Amisulpride
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the typical antipsychotics?

A

Dopamine D2 receptor blockade
Haloperidol
Chlorpromazine
Flupentixol decanoate - depot assoc with v severe EPSEs
Tend to cause distressing EPSEs at normal treatment doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are SEs of typical antipsychotics?

A 
EPSE: extra pyramidal side effects
Hyperprolactinaemia
Weight gain, dyslipidaemia + increased risk diabetes
Sedation
Anticholinergic SE
Arrhythmias
Seizures
Neuroleptic malignant syndrome
Hypotension
Tachycardia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Clozapine

A

Most common side effect= hypersalivation
1-2% Agranulocytosis rate
Myocarditis
Arrhythmia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Quetiapine

A

Diabetes
Weight gain
Lipid abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Risperidone

A

Increased prolactin levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Olanzapine

A

Diabetes
Weight gain
Lipid abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the benzodiazepines?

A

Incr Cl channel freq = enhance GABA

Diazepam
Clonazepam
Alprazolam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the MAOIs?

A

Irreversible MAO inhibition
Phenelzine
Moclobemide: reversible inhibition
Trancypromine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How would you counsel patients regarding SSRIs?

A

Avoid drinking alcohol whilst in antidepressants due to increased sedation
Never drive if feeling drowsy on antidepressants
Onset of action is delayed
Outline side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are common side effects of SSRIs?

A 
Nausea, vomiting
Appetite, weight change
Blurred vision
Anxiety + agitation
Insomnia, tremor, dizziness
Headache
Sweating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are common side effects for SSNRIs

A

Same as SSRIs plus
Constipation
Hypertension
Raised cholesterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

NASSAs

Noradrenergic and Specific Serotonin Antidepressant

A

Mirtazapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the SEs of TCAs?

A 
Tachycardia, arrhythmia
Dry mouth, blurred vision, 
Constipation, urinary retention
Postural hypotension
Sedation
Nausea, weight gain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the common side effects of MAOIs?

A 
Hypertensive crisis "cheese reaction"
Postural hypotension, dizziness
Drowsiness, insomnia
Headache, blurred vision
Nausea, vomiting
Constipation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the side effects of St John’s Wort?

A

As effective as TCAs for mild-mod depression
Photosensitivity
Anxiety dizziness
GI symptoms
Fatigue, headache
Induces P52 risks drug interactions: reduces warfarin, ciclosporin, COCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are discontinuation symptoms?

A

Occur when antidepressant stopped suddenly:
Flu like sx, electric shock sensations, headaches, vertigo, irritability
To avoid withdraw over a few weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What should you be careful of when swapping antidepressants?

A

If of different classes they might interact dangerously: check!
SSRI-> TCA: cross-taper
Drug free washout period: fluoxetine 1 wk
Start venlafaxine v slowly 37.5mg each day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is serotonin syndrome?

A

Excess serotonin
Potentially life-threatening
Sx: restlessness, sweating, myoclonus, confusion, fits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Buspirone

A

Acts on 5HT1a receptor
Anxiolytic
No antidepressant action alone
May synergistic effect in combination with SSRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the mood stabilisers?

A

Lithium
Sodium valproate
Carbamazepine
?action on Na channels / GABA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Lithium

A

Unknown mech of action ? cAMP inhibition
Therapeutic range: 0.6-1mmol/L
>1.2 mmol/L = toxic
Monitored weekly after start/ dose change until a steady therapeutic level achieved
U+Es & TFTs every 3-6 months
Can cause renal impairment + hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Valproate

A

Active drug= valproic acid
An anticonvulsant
Plasma levels don’t require monitoring
Dose related toxicity not an issue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Carbamazepine

A 
2nd line, less effective than lithium
Anticonvulsant
Can cause toxicity at high doses
Induces liver enzymes
Levels must be carefully monitored
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Lithium SEs

A 
Mild tremor
Nausea + vomiting
Polyuria, polydipsia
Arrhythmia
Hypothyroidism
Weight gain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Valproate SEs

A 
Nausea, vomiting, diarrhoea
Liver failure
Thrombocytopenia 
Hair loss
Weight gain
31
Q

Carbamazepine SEs

A 
Rash
Leukopenia
Dizziness, ataxia
Drowsiness, fatigue
Nausea, vomiting
Oedema, weight gain, hyponatraenia
32
Q

Lithium toxicity

A

Presents: GI disturbance, sluggishness, giddiness, ataxia, gross tremor, fits, renal failure
Triggers: salt balance changes, drugs affecting lithium excretion (NSAIDs, diuretics, ACEi), OD
Management: stop lithium, medics: rehydration, osmotic diuresis

33
Q

Mood stabilisers and pregnancy, what are the risks and how are they mitigated?

A

Lithium: Ebstein’s anomaly
Valproate + Carbamazepine: spina bifida
Teratogenic risk must be weighed against harm of a manic relapse!
Women of childbearing age: contraceptive advice + folate supplement
If medications are used during pregnancy close monitoring of fetus req

34
Q

What are the EPSEs associated with antipsychotics?

A

Dystonia: involuntary painful sustained muscle spasm - within hours - torticolis, oculogyric spasms
Akathisia: unpleasant feeling of restlessness -> pacing/jiggling - hours to weeks
Parkinsonism: resting tremor, rigidity, bradykinesia - days to weeks
Tardive dyskinesia: rhythmic involuntary movements, often grimacing, sucking or chewing movements - months to years

35
Q

How are EPSEs of antipsychotics treated?

A 
Dystonia = anticholinergics e.g. Procyclidine
Akathisia = decr dose/change antipsychotic, add propanolol or benzos
Parkinsonism = decr dose/change antipsychotic, anticholinergic
Tardive dyskinesia (oft irreversible) = stop antipsychotic/decr dose avoid anticholinergics, switch to atypical / clozapine
36
Q

What factors are associated with increased risk of violence in schizophrenics?

A 
Past Hx violence
Substance misuse
Acute psychotic symptoms
Non-concordance with treatment
Access to weapons
Specific threats to a victim
Comorbid personality disorder
37
Q

What risk is a schizophrenic to themself?

A

Lifetime suicide risk= 10%
Self neglect
Social decline
Risk highest in early years after diagnosis, following 1st admission or where there are depressive symptoms

38
Q

What is the prognosis in schizophrenia?

A

25% experience no further issues after one episode
66% remain liable to relapse
10% seriously and continuously disabled

39
Q

What SSRI is preferred post MI?

A

Sertraline

40
Q

What SSRI is preferred in children + young adults?

A

Fluoxetine

41
Q

Which SSRI should be avoided in those with known long QT or taking other drugs which could prolong QT

A

Citalopram

Also assoc with sexual dysfunction

42
Q

If prescribing SSRI to a patient on NSAIDs what must you also prescribe?

A

PPI!

43
Q

If prescribing SSRIs what might give you cause to reconsider?

A

Warfarin/heparin - avoid SSRIs -> mirtazapine
NSAIDS - avoid/ coprescribe PPI!
Triptans - avoid SSRIs
Renal impairment -> incr risk SIADH: monitor renal function + U + Es

44
Q

When should SSRI use be reviewed?

A

In

45
Q

How do you avoid discontinuation symptoms following SSRI use?

A

Gradually reduce dose over 4 wks when stopping

Except fluoxetine which can be stopped straight away

Incr risk of sx with paroxetine

46
Q

What are the discontinuation sx seen following abrupt end to SSRI use?

A 
Mood changes
Restlessness
Difficulty sleeping
Unsteadiness
Sweating
GI sx
Paraesthesia
47
Q

When would clozapine be offered?

A

With treatment resistant schizophrenia
Only after:
2 other antipsychotics, one being an atypical
Which were trialled for 6-8 wks without effect

48
Q

What increased risks are associated with antipsychotic use on the elderly?

A

Incr stroke risk

Incr VTE risk

49
Q

What are the non EPSEs of antipsychotics?

A

Anti muscarinic sx
Sedation
Weight gain
Incr prolactin: galactorrhoea, red glucose tolerance
Neuroleptic malignant syndrome: pyrexia muscle stiffness
Red seizure threshold
Prolonged QT

50
Q

Causes of long QT syndrome

A

Normal=

51
Q

How do you treat TCA overdoses presenting with widened QRS complexes

A

IV bicarbonate

52
Q

How do you treat lithium OD?

A

Mild/mod: fluid resus with IV normal saline

Severe: haemodialysis

53
Q

How do you treat benzo OD?

A

Flumazenil

54
Q

How do you treat opiate OD?

A

Naloxone

55
Q

How do you treat paracetamol OD?

A

Ingestion

56
Q

How do you treat salicylate OD

A

Haemodialysis

(Urine alkalinisation if mild but CI in cerebral + pulm oedema

57
Q

How do you treat warfarin OD?

A

Vit K

Prothrombin complex

58
Q

How do you treat heparin OD?

A

Protamine sulphate

59
Q

How do you treat beta blocker OD?

A

If bradycardic give atropine

If resistant give glucagon

60
Q

How do you treat ethylene glycol OD?

A

Fomepizole

61
Q

How do you treat methanol poisoning

A

Fomepizole or ethanol

Haemodialysis

62
Q

How do you treat organophosphate poisoning?

A

Atropine

63
Q

How do you treat digoxin OD

A

Digoxin specific antibody fragments

Aka digibind

64
Q

How do you treat iron overload?

A

Desferrioxamine

65
Q

How do you treat lead poisoning?

A

Dimercaptol

Calcium edatate

66
Q

How do you treat cyanide poisoning?

A

Hydroxycobalamin

Amylnitrite, sodium nitrite + sodium thiosulphate

67
Q

What is neuroleptic malignant syndrome?

A

Oft just commenced antipsychotics ATN + renal failure

10% mortality

68
Q

How do you manage neuroleptic malignant syndrome?

A

Stop antipsychotics
IV fluids to prevent renal failure
Dantrolene
Bromocriptine

69
Q

TCA CIs

A

Recent MI
Prostatic hypertrophy
Narrow angle glaucoma

70
Q

How do you withdraw benzodiazepines?

A

1/8 of daily dose reduction every fortnight
Difficulty:
Or switch to equivalent dose diazepam and reduce 2-2.5 mg fortnightly
May take 4 wks to a year to withdraw

71
Q

Sx of benzo withdrawal

A 
Up to 3 wks after stopping:
Insomnia
Irritability
Anxiety
Tremor
Loss of appetite
Tinnitus
Perspiration
Perceptual disturbances
Seizures
72
Q

Barbituates

A

Enhance GABA by incr duration of Cl channel opening

73
Q

Rapid tranquilisation

A

Only after failure of non pharm methods and refusal of oral meds
With sufficient risk to themselves / others
With sufficient flumazenil on site
2mg IM lorazepam
10mg IM haloperidol

74
Q

Medication which can cause priapism

A

Trazodone

Chlorpromazine

Toni's Psych (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions