Pharmacology Flashcards
1
Q
Name the 3 groups of mood stabilizers and examples.
A
- Classic mood stabilizer: lithium
- Anticonvulsants (glutamate channel blockers): valproate , carbamazepine, lamotrigine,
- Atypical antipsychotics: olanzapine (dopamine + serotonin agonist), quetiapine, aripiprazole (dopamine/serotonin/NA multimodal)
2
Q
Name 3 indications of lithium
A
1 first line treatment bipolar and maintenance
2 prevent and treat manic episodes (most effective but take long )
3. Consider for treatment mixed features and rapid cycling-not first line
3
Q
Discuss Dose of lithium for mood stabilisation? (5) considerations, starting dose, maintenance bipolar, manic episode.
A
- According to trough level in blood : start low, go slow
- Starting dose 500mg po mane
- very narrow therapeutic index
- 0,5-0,9 blood level for maintenance phase bipolar
- up to 1,5 for manic episode
4
Q
How often are lithium levels checked after prescription?
A
- 4 days after starting or changing dose
- then 6-monthly
Normal levels: 0,6 - 1,2 mmol/l
5
Q
Name 8 common side effects of lithium
A
LITHIUM
- Lithium toxicity emergency
- increased urine output: Renal effects!: polyuria with secondary polydypsia, hypokalaemia, rarely nonspecific interstitial fibrosis with more than 10 years lithium dose
- thyroid Benign, reversible: hypothyroidism most commonly ; tremor (postural)
- Heart: Cardiac effects secondary to hypokalaemia: t wave flattering or inversion on ECG, sinus dysrhythmias, heart block, syncope episodes
- Increased Weight gain and fluid retention
- upset stomach : Nausea, vomiting, diarrhea
- Malformation: Teratogenesis: Ebstein’s anomaly (new research show risk is = to those not on lithium);
6
Q
Name 6 symptoms of lithium toxicity
A
LITHUM
- Loc impaired/coma/seizure.
- increased urination: Renal dysfunction
- Tremor, dysarthria, ataxia
- Heart: Cardiovascular change
- Upset stomach: Nausea, vomit, diarrhea,
- Myoclonus, muscular fasciculations
7
Q
What is the treatment of lithium toxicity?
A
- Stop lithium
* push iv fluids to dilute lithium and promote renal secretion
8
Q
Which special investigations must be checked before starting patient on lithium and monitored thereafter? (6)
A
- UKE: potassium and kidney function ! First month then 6 monthly
- Creatinine clearance: kidney function !. First month then 6 monthly
- fbc: leucocytosis
- TSH ! First month then 6 monthly
- B- HCG ! Cause cardiac defects teratogenesis
- ECG; First month then 12 monthly
- Lithium levels - 4 days then 3-6 monthly. Normal = 0,6 - 1,2 mmol/l
9
Q
Indications of valproate? (3)
A
- first line treatment and maintenance bipolar (can titrate up quick)
- Effective for manic episodes (advantage: can titrate up dose rapidly if aggressive patient)
- Best for mixed features and rapid cycling!
NOT depressive episode
10
Q
Dosage valproate as mood stabiliser?
A
250-1250 mg po bd
Able to titrate dose up rapidly unlike lithium
11
Q
Name 7 common side effects of valproate
A
- Weight gain!
- pcos! In females (pelvic us)
- Teratogenic: neural tube defects, (supplement with folate) ( bhcg)
- Sedation
- Thrombocytopenia
- Hair loss at high doses
- Tremor
- Hepatotoxic (lft before tx + 6 monthly)
12
Q
Indications of carbamazepine as mood stabiliser?
A
Same as valproate (manic episode) but much less effective. Not routinely used
13
Q
Name 5 common side effects carbamazepine
A
HAMLET
- Hyponatraemia! And syndrome of inappropriate ADH secretion (siadh) (do uke)
- agranulocytosis / aplastic anaemia: Bone marrow suppression rarely (do FBC )
- metabolism other drugs interfere: inhibit cyp450!
- Liver: Hepatitis (do LFT)
- exfoliate dermatitis rash
- teratogenesis (ntd) (do bhcg )
Also git,
14
Q
Indications of lamotrigine for mood stabilisation? (4)
A
- first line for prominent bipolar depression!
- Effective in treating depressive episodes! And prevent!
- Effective to prevent! Manic episodes. Not treat
- Bipolar maintenance
15
Q
Starting Dosage lamotrigine and titration considerations?
A
25 mg po nocte. Titrate slowly by 25 mg every 2 weeks to prevent Steven’s Johnsons syndrome! To final dose of about 100-200 for eg maintenance of bipolar with depressive episodes
16
Q
Maintenance dose of lamotrigine as mood stabiliser?
A
100 - 200 mg po nocte
17
Q
Name 5 most common side effects of lamotrigine
A
- Steven’s - Johnson syndrome! (If rash, stop immediately)
- Sedation
- Nausea and vomiting
- dizzy and ataxia!
- Blurred vision and diplopia
Side effects rare.
18
Q
Indications of atypical antipsychotic in mood stabilisation? (4)
A
Ie olanzapine (dopamine and serotonin antagonist), quetiapine + aripiprazole (dopamine, serotonin + NA multimodal)
- Effective treat manic episodes
- Prevent manic
- Treat depressive episodes
- Can consider to treat mixed features and rapid cycling but not first line
19
Q
Most common side effect of atypical antipsychotics?
A
Metabolic syndrome
Also: cardiac conduction abnormalities
20
Q
3 common side effects of olanzapine
A
- Severe ms! (Metabolic syndrome)
- Dry mouth
- Constipation
- Akathisia, dyspepsia
Atypical antipsychotic
21
Q
3 common side effects of quetiapine
A
- Metabolic syndrome
- Severe sedation
- Dizzy and postural hypotension
22
Q
3 common side effects of aripiprazole
A
1 akathisia!
2 agitation, anxiety
3 nausea, dyspepsia
4 headache
Only atypical antipsychotic that does not cause metabolic syndrome!
23
Q
Mechanism of action of SSRI?
A
Selectively prevent binding of serotonin to transport molecule to inhibit reuptake from synaptic cleft into presynaptic neuron. Therefore more serotonin to synapse and cause effect
24
Q
Indication of ssri in depression?
A
First line for MDD
25
Name 6 examples of SSRIs
1. Fluoxetine
2. Paroxetine
3. Sertraline
4. Fluvoxamine (bd)
5. citalopram
6. Escitalopram
26
Name 3 most common side effects ssri
1. Sexual dysfunction: decreased libido, anorgasmia
2. Insomnia
3. Nausea, vomiting, diarrhea
4. Headache
5. Suicidal ideation - black box warning
6. Lack energy, irritable
27
Moa snri?
Serotonin noradrenaline reuptake inhibitor (same as ssri )
28
Indication serotonin- noradrenaline reuptake inhibitors in depression? (3)
* Second line MDD
* treatment augmentation:
* treatment resistant MDD
* MDD with prominent pain symptoms
29
3 examples of snri?
1. Venlafaxine
2. Desvenlafaxine
3. Duloxetine
30
3 most common side effects duloxetine
Snri
1. Sedation
2. Sexual dysfunction
3. Hypotension or hypertension and tachycardia
4. Git discomfort but subside as gain tolerance
Mood derailments in bipolar?
31
Moa nri?
Noradrenaline reuptake inhibitor (as for ssri)
32
Indication of noradrenaline reuptake inhibitor in depression?
Ineffective. Use only for augmentation
33
Example of nri drug
Reboxetine
| Atomoxetine
34
Moa NDRI?
Noradrenaline - dopamine reuptake inhibitor. As for ssri
35
Indications of ndri in depression? (3)
• 2nd line antidepressant
Augmentation:
• MDD with prominent hyperSomnia and fatigue
• patients with sexual dysfunction on other antidepressants
36
Example of noradrenaline-dopamine reuptake inhibitor
Bupropion
37
3 most common side effects bupropion
```
(Ndri)
1. Increase seizure threshold-careful in epilepsy
2. Headache
3. Insomnia
Not sexual dysfunction!
```
38
Mechanism of action TAD and TTAD? (2)
* Not selective for specific neurotransmitter:act on dopamine, serotonin, noradrenaline, muscarinic, alpha, histominergic, cholinergic etc receptors so more adverse effects
* Similar moa to ssri but not selective.
39
Name indications for tad and TTAD in depression
Second line (although effective) in depression because more side effects and risk lethal arrhythmias with overdose
40
Name 5 examples of tricyclic antidepressants
1.amitriptylline
2. Clomipramine
3. Imipramine
4 trimipramine
5. Lofepramine
41
Name 1 examples of tetracyclic antidepressants
Maprotiline
42
Name 3 common side effects tad and TTAD
1. Lethal cardiac arrhythmia! In overdose. Especially tad
2. Severe anticholinergic side effects: constipation, urinary retention, dry mouth, blurred vision
3. Sedation
43
Moa MAOI and RIMA? (4)
Inhibit mono amine oxidase, which is responsible for breakdown of neurotransmitters. Therefore increased binding to postsynaptic neuron.
Selective for serotonin, na, dopamine.
Maoi= irreversibly bind to mono amine oxidase
Rima= reversible.
44
Indication MAOI and RIMA in depression
- Powerful antidepressants but not for first line treatment. Prescribed by specialists
- refractory MDD
- depression/phobias with atypical/ hysterical/ hypochondriac features
45
Example of mono amine oxidase inhibitor
Tranylcipromine
46
Example of reversible inhibitors of monoamine oxidase
Moclobemide
47
3 most common side effects of MAOI and RIMA
1 sexual dysfunction
2 insomnia
3 weight gain
48
NB side effect of mono-amine oxidase inhibitors? (and to lesser extent rima)
Tyramine induced hypertensive crisis caused by intake of tyramine containing foods eg aged cheese, fish, biltong, marmite, sauerkraut, beer, Chiati wine, liqueur
Due to massive release of noradrenaline. Bind to alpha 1 receptor + cause vasoconstriction
49
Moa NASSA? (3)
Noradrenaline and specific serotonin antagonist.
1. Block Presynaeptic alpha 2 receptor which normally causes inhibition of secretion of neurotransmitter into synaptic left
2. 5ht2c receptor antag on postsynaptic neuron, which normally cause inhibition of the postsynaptic effect by inhibiting protein synthesis.
3. Minimal effect on increasing posysynaptic secretion of neurotransmitter into synaptic cleft
50
Indications NASSA in depression? (2)
* First or second line
| * augment MDD treatment with prominent insomnia.
51
Example of noradrenaline and specific serotonin antagonist?
Mirtazapine
52
3 most common side effects mirtazapine
NASSA
1. Sedation!
2. Weight gain!
3. Increased appetite
53
Moa sari? (2)
Serotonin antagonist and reuptake inhibitor
1. Inhibit reuptake presynaptically
2. 5ht2c r antagonist
54
Indication of sari for depression?
Mdd with prominent insomnia (mostly prescribed for insomnia, not so good for mdd)
55
Example of serotonin antagonist/reuptake inhibitor
Trazodone
56
3 most common side effects trazodone
Sari
1. Sedation
2. Orthostatic hypotension
3. Nausea
57
Moa ma?
Melatonin agonist on postsynaptic neuron to produce same effect as melanin.
58
Indication of ma in depression?
MDD with prominent insomnia
59
Example of melanin agonist?
Agomelatine
60
2 most common side effects agomelatine?
Melanin agonist.
1. Dizzy
2. Nausea
61
Vortioxetine moa? (3)
Serotonin specific
1. Reuptake inhibitor
2. 5ht2c r antag
3. Other.
62
Indication for vortioxetine in depression?
MDD, especially if secondary cognitive problems
63
3 common side effects vortioxetine?
1. Serotonin syndrome!
2. Abnormal bleeding
3. hyponatraemia
64
Cause of serotonin syndrome?
Raised plasma serotonin secondary to co -admin antidepressants. Especially ssri plus lithium/maoi
65
Symptoms of serotonin syndrome in order (5)
1. Diarrhea !
2. Restlessness
3. Extreme agitation, hyperreflexia !, autonomic instability
4. Myoclonus !, seizures, hyperthermia , uncontrollable shivering and rigidity
5. Delirium, coma, status epilepticus, CV collapse and death
DRE MD
66
Treatment serotonin syndrome (5)
Medical emergency!
1. Transfer to ICU
2. Stop antidepressants
3. Supportive and cooling
4 nitroglycerin, cyproheptadine (antihistamine), chlorpromazine (antipsychotic), dantrolene (muscle relaxant), benzos, anticonvulsants
5. Muscle relaxant, mechanical ventilation
67
Cause of antidepressant discontinuation syndrome?
Abrupt discontinuance antidepressant, especially ssri with short half life eg paroxetine.
68
4 symptoms antidepressant discontinuation syndrome and onset
6 weeks after discontinue
FINISH
1. Flu - like symptoms: Upper resp symptoms
2. insomnia, poor conc
3. nausea, "needles" (paraesthesias )
4. Imbalance: Dizzy, weak
5. Six weeks after stopping, spontaneous resolution > 3 weeks
6. Headache, migraine symptoms; hyperarousal (Rebound depression, anxiety )
69
Treat antidepressant discontinuation syndrome?
Usually resolve spontaneously after 3 weeks
Restart medication and taper slowly (fluoxetine bestbecause long half life )
Symptomatic rx
70
Pharmacology for acute management of aggressive psychosis? (5)
1. Lorazepam (benzo) 2-4 mg IMI ! and
2. Intramuscular acute onset antipsychotic
• haloperidol 5-10 mg / 2-4h (max 40 mg/day) !
• olanzepine (don't give with benzo)
• ziprasidone
• zuclopenthixol acetate (don't give if have never had antipsychotic)
71
Name the 2 classes of antipsychotics and examples
1. Typical or first gen
• d2 antagonism ( also M1, H1, alpha 1 antag)
• eg haloperidol, chlorpromazine
2. Atypical
• 5ht2a - d 2 antag , 5ht1a agonist (also M1, H1, 2HT2c, alpha 1 antag)
• Eg risperidone, clozapine, olanzapine
72
Which 2 SSRIS have been approved for use in childhood depression?
Fluoxetine (best) and escitalopram
73
Treatment for acute dystonia?
Anticholinergics eg biperidine 5 mg iv stat
( caused by antipsychotics and antidepressants )
74
Which antidepressant does not cause sexual dysfunction?
Ndri : bupropion
75
Which antipsychotic should never be given with benzo?
Olanzepine
76
Intermediate-term treatment of aggression?
Zuclopenthixol acetate 50-100mg im 72hrly
| Never give to antipsychotic naive person
77
Which antipsychotic should never be given to an antipsychotic naive patient?
Zuclopenthixol
78
Which drugs cause paradoxical disinhibition in children and elderly?
Benzodiazepines
79
Treat respiratory depression caused by benzodiazepines?
Flumazenil
80
Name 5 common side effects of methylphenidate
```
(Ritalin)
• appetite and weight loss
• headache
• delay sleep onset
• new onset tics, motor and vocal
• abdominal pain
```
81
Cautions for using stimulants in adhd treatment? (5)
* drug dependence and alcoholism
* sudden death, stroke, mi or vfib associated with pre-existing cardiac abnormalities
* pre-existing psychotic or bipolar disorders: psychosis (tactile and visual hallucinations)
* slow growth rates children
* Lower seizure threshold
82
Name 4 adverse effects associated with discont of stimulants eg ritalin
* Twitching - motor or vocal tics
* Anorexic/growth retard/stunted growth
* insomnia
* tachycardia
83
Name 5 contraindications to stimulant treatment
```
• Anxiety disorder
• tourette's
• eating disorders
• structural cardiac lesions and hypertensive states
• mania or concurrent substance abuse
Florid psychosis
```
84
Which antipsychotic is reserved for treatment resistant patients?
Clozapine (atypical)
85
First line treatment of akathisia
Propanalol: beta blocker
Can add benzo.
If possible, change to low potency typical or decrease dose
86
Name 5 side effects of clozapine
1. Agranulocytosis!
2. Cardiomyopathy and myocarditis
3. Toxic megacolon
4. Seizures
5. Metabolic syndrome and weight gain
Sedation
87
Which antipsychotic does not cause weight gain?
Aripiprazole (atypical)
| Also no effect on prolactin.
88
Name 4 drugs that lower seizure threshold
* tricyclic antidepressants
* buproprion (ndri)
* low potency antipsychotics eg chlorpromazine, thioridazine
* lithium
89
Which condition describes painful prolonged contraction of muscles resulting in abnormal movements or posture?
Acute dystonia
90
What causes acute dystonia?
High potency antipsychotics , first 4-7 days of commence treatment or increase dose.
91
Name 5 symptoms acute dystonia
* Oculogyric crisis (upward deviation)
* Torticollis
* trismus
* protrude tongue
* Laryngo-pharyngeal spasm
* Dysphagia
92
Which condition is described by tremors, rigidity and bradykinesia caused by antipsychotic use?
Parkinsonism
93
Treatment of parkinsonism caused by antipsychotic use?
Anticholinergics: biperidine, orphenadrine
| Lower dose antipsych.
94
Which condition is described by irreversable abnormal involuntary movements eg oral movements, protrude tongue, grimaces, choreoatesosis of extremeties, abnormal postures after more than 4 years of antipsychotic use?
Tardive dyskinesia
95
Which condition is described by muscle rigidity ! and fever with increased ck !, diaphoresis, autonomic instability, tremor, dysphagia, mutism, incontinence, leukocytosis ! and delirium caused by antipsychotic use in first week?
Neuroleptic malignant syndrome
96
Name 5 symptoms neuroleptic malignant syndrome
FALTER
• fever - diaphoresis, delirium
• autonomic instability; tachycardia and ht, incontinence
• leukocytosis : increased white cell count!
• tremor
• elevated: increased ck !, transaminases
• Muscle rigidity!, rigours, dysphagia; mutism
First week
97
Cause and onset neuroleptic malignant syndrome?
Antipsychotics first week
98
Treatment neuroleptic malignant syndrome (5)
* Stop antipsychotic!
* diazepam or lorazepam for rigidity
* avoid anticholinergics
* if all else fails: dantrolene (mm relax) or bromocriptice
* still no response: ect
Monitor ck to rule out renal failure, give DVT prophylaxis
99
In which conditions caused by antipsychotics should anticholinergics be avoided? (2)
Neuroleptic malignant syndrome and tardine dyskinesia
100
Mechanism of action antipsychotics? (6)
* Block d2 receptors in mesolimbic pathway (motivation and desire. high dopamine cause positive symptoms)
* action at mesocortical pathway (emotions, cognition, socialisation. Low levels cause negative symptoms) . Typicals block dopamine r, worsening negative symptoms. Atypicals block serotonin 5-ht2a , alleviating negative symptoms
* block dopamine receptors in nigrostriatal path (involuntary moves and coordination)
* tuberoinfundibular path (dopamine limit secretion prolactin)
* chemoreceptor trigger zone
* Medullary periventricular ( appetite )
101
Difference between typical and atypical antipsychotics for negative symptoms?
* Typicals, eg haloperidol, zuclopenthixol, chlorpromazine, worsen negative symptoms
* Atypicals, eg clozapine, olanzapine, risperidone, ariprazole, alleviate negative symptoms
102
Difference between typical and atypical antipsychotics for side effects?
* typicals more likely to cause as bind tightly to receptors. More likely to cause extrapyramidal + sexual dysfunction, less metabolic syndrome.
* atypicals less side effects. More metabolic syndrome + anticholinergic + seizures, less extrapyramidal
103
Which antipsychotic safest for epilepsy?
Haloperidol
104
Which antipsychotic best for psychomotor agitation?
Haloperidol
105
First line treatment schizophrenia?
Olanzapine (atypical)
106
Which antipsych should never be given with benzo
Olanzapine (respiratory depression)
107
Main Side effect olanzapine?
Weight gain
| No risk agranulocytosis, less sedation
108
Which antipsychotic favoured for elderly?
Thioridazine (typical) (low potency phenothiazine)
- bc less motor side effects
109
Side effect Thioridazine
( Typical)
| Retinal deposits
110
Which 3 antipsychotics are strong sedatives?
Chlorpromazine (typical)
Paliperidone (atypical)
Quetiapine (atypical) at a LOW dose (high dose = antipsychotic effects, less antihistamine sedative effect)
111
Risperidone side effects? (3)
(Atypical)
• hyperprolatinemia!
• sedation
• extrapyramidal at high doses
112
Which antipsychotic indicated for restless and agitation elderly?
Risperidone (atypical)
113
Where is lithium excreted?
Kidneys
114
Which mood stabiliser is best for bipolar depression?
Lamotrigine (anticonvulsant) . > lithium
Can also use olanzapine, quetiapine, aripiprazole
115
Which 3 atypical antipsychotics have mood stabilising propenties and can be used in management bipolar?
* Olanzapine
* quetiapine
* aripiprazole
116
Which condition is described by tremor, dysarthria, ataxia, git upsets , cardiovas changes and renal dysfunction, myoclonus and fasciculations, seizures, impaired loc and coma?
Lithium toxicity. Clue in renal disfunction.
117
Which mood stabilisers can treat mania?
• Lithium
• valproate
(Carbamazepine)
• olanzapine, quetiapine, aripiprazole
118
Which mood stabiliser is best for mixed features and rapid cycling?
Valproate
119
What type of drug is reboxetine?
Selective noradrenaline reuptake inhibitor
120
Which antidepressant is also registered to aid smoking cessation?
Bupropion (ndri)
121
What type of drug is mirtazapine?
Nassa
122
What type of drug is tranylcypromine?
Maoi
123
Which drug, when combined with tyramine containing goods, can cause tyramine induced hypertensive crisis?
Tranylcypromine (maoi)
| Moclobemide (rima)
124
What drug type is moclobemide?
Rima
125
Which condition is described by diarrhoea, restless, extreme agitation , hyperreflexia, autonomic instability, myoclonus, seizures, hyperthermia, uncontrollable shivering and rigidity, delirium, coma, status epilepticus, cardiovascular collapse and death
Serotonin syndrome
126
Which condition characterised by dizzy, weak, nausea, rebound depression, anxiety, insomnia, poor conc, headache, migraine symptoms, paraesthesias and upper resp symptoms?
Antidepressant discontinuation syndrome
127
Which drugs high risk antidepressant discontinuation syndrome?
Ssris , especially short half life eg paroxetine
128
Which drug most likely to cause serotonin syndrome
Vortioxetine, because agonist 5- hta
129
Which antidepressant for mdd with hypersomnia and fatigue?
Bupropion (ndri)
130
Which antidepressants have risk of lethal arrythmia?
Tad: amitryptilline, clomipramide etc
Ttad: maprotiline
131
Which antidepressants reserved for refractory mdd?
Maoi: tranylcypromine
Rima: moclobemide
132
Which antidepressants can be prescribed for mdd with prominent insomnia? (3)
* Agomelatine (melatonin agonist)
* mirtazapine (nassa)
* trazadone (sari)
133
Which antidepressant best for patient that doesn't want to gain weight?
Nri: reboxetine, atomoxetine
134
Name drug interaction with ssri
MAOI
Potentially fatal serotonergic syndrome of hyperthermia + cardiovascular collapse
135
Window of action for ssri?
4-6 weeks
136
Name 4 indications snri
- 2nd line MDD
- augment for treatment resistant MDD
- augment for MDD with prominent pain symptoms
- anxiety
- neuropathic pain
137
Name 5 depot preparations (long-acting injections) for poor adherence to oral rX
- Flupentixol decanoate 10-60 mg IM 2-4 weekly
- fluphenazine decanoate
- zuclopenthixol decanoate
- risperidone 25 - 50 mg a weekly
- paliperidone
Higher incidence long term side effects so oral preferred
138
Moa typical/ first generation antipsychotics
Dopamine R (D2) antagonist
Block dopamine receptors at mesocortical pathway
Some also antagonise serotonin: thioridazine, chlorpromazine, flupenthitol, trifluoperazine
139
Treatment tardive dyskinesia?
Prevention>cure. No real rX.
Start at higher dose increases risk.
Reduce dose and stop anticholinergics.
Try second generation/ atypical antipsychotics
140
When prefer atypical > typical antipsychotics
- Young
- bad side effects on typical
- private sector - less severe extra pyramidal side effects but expensive
- negative signs schizophrenia
Same efficacy!
141
Name 4 contraindications benzodiazepines
- Pregnancy
- untreated OSA
- substance abuse history
- caution+ monitor: hepatic / renal/lung disease; elderly
142
Name 9 side effects benzodiazepines
- Respiratory depression (hypoventilation)
- anterograde amnesia
- withdrawal, dependence, tolerance
- residual daytime sedation
- rebound insomnia
- impaired cognition + falls in elderly
- paradoxical disinhibition
- hypotension
- blurred vision
143
Name the 4 types postsynaptic serotonin receptors and their effects when stimulated
- 5HT1A (central): depression relief, anxiolytic
- 5HT2A (spinal cord): sexual dysfunction
- 5HT2C / 5HT2A (brain): activation = anxiety + insomnia first 1-2 weeks. Worst with fluoxetine, paroxetine
- 5HT3A (gut): gi upset
144
Indication nri?
Augment rx mdd - mostly ineffective
145
What is sertraline
SsRI
146
What is paroxetine
SsRI
147
What is venlafaxine
Snri
148
What is duloxetine
Snri
149
What is vortioxetine
5HTA agonist + serotonin reuptake antagonist
150
What is reboxetine
Nri
151
What is atomoxetine
Nri
152
What is bupropion
NDRI
153
What is imipramine
Tad
154
What is clomipramine
Tad
155
What is maprotiline
TTAD
156
What is tranylcypromine
Maoi
157
What is moClobemide
RIMA
158
What is mirtazapine
NaSSA
159
What is agomelatine
Melatonin agonist
160
What is trazodone
Sari
161
Name 6 pathways that antipsychotics work on (block dopamine) and their effects
- Mesolimbic pathway: positive symptoms
- mesocortical pathway: negative symptoms
- nigrostriatal pathway: extrapyramidal motor symptoms
- tuberoinfundibular: hyperprolactinaemia (especially atypicals)
- chemoreceptor trigger zone: vomiting
- medullary periventricular: increase appetite.
162
Name 5 typical antipsychotics
HORRIBLE ZCHIZOPHRENIA PILLS TAKES CENTURIES
High potency (extrapyramidal ae more severe )
- haloperidol 0,5 - 15 mg (butyrophenone)
- zuclopenthixol
- pimozide
Low potency (sedation)
- thioridazine
- chlorpromazine
163
Name 7 atypical antipsychotics
CRAP OZ Q
- Clozapine 100 - 800 mg; start day 1 at 12,5mg ; day 2 25 - 50 mg and increase by 25 -50mg until 300 mg.
- olanzepine
- quetiapine 300 - 800mg
- paliperidone
- risperidone 1-8 mg
- ziprasidone
- aripiprazole
164
What is haloperidone
Typical antipsychotic (high potency, butyrophenone)
165
What is zuclopenthixol
Typical antipsychotic (high potency, thioxanthene )
166
What is chlorpromazine
Typical antipsychotic ( low potency, phenothiazine )
167
What is thioridazine
Typical antipsychotic ( low potency, phenothiazine )
168
What is clozapine
Atypical antipsychotic
169
What is olanzapine
Atypical antipsychotic + mood stabiliser
170
What is quetiapine
Atypical antipsychotic + mood stabiliser
171
What is paliperidone
Atypical antipsychotic
172
What is risperidoNe
Atypical antipsychotic
173
What is ziprasidone
Atypical antipsychotic
174
What is aripiprazole
Atypical antipsychotic + mood stabiliser
175
What is carbamazepine
Anticonvulsants + mood stabiliser
176
What is valproate
Anticonvulsants + mood stabiliser
177
What is lamotrigine
Anticonvulsants + mood stabiliser for depressive episode. Can prevent, but not treat, manic episode
178
Dose haloperidol
0,5 - 15 mg
179
Dose risperidone
1-8 mg
180
Dose olanzapine
10 - 20mg
181
Dose quetiapine
300 - 800 mg
182
Dose clozapine
100 - 800 mg
- day 1: 12, 5 mg
- day 2: 25-50 mg
- titrate up by 25 - 50mg until 300mg for maintenance
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Dose chlorpromazine
200 - 800 mg
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Treatment hyper salivation caused by clozapine
Buscopan: hyoscine butylbromide / butylscopolamine
Or biperidine
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Name 5 benzodiazepines
- Lorazepam
- clonazepam
- Alprazolam
- diazepam
- Oxazepam (contraindicated in liver disease)
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What is lorazepam
benzodiazepine
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What is clonazepam
benzodiazepine
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What is alprazolam
benzodiazepine
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What is diazepam
benzodiazepine
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What is oxazepam
benzodiazepine
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Name 3 formulations methylphenidate
- Ritalin Ir 10 mg
- Ritalin La 10/20/30 mg tabs
- concerta (long half life 9 -12h ) 18 → 27 → 36 → 54 mg
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Name 4 pre-treatment tests that should be done before prescribing methylphenidate
- ECG: exclude arrhythmia / heart condition
- baseline weight , bp
- EEG, Ct brain
- baseline bloods: FBC, UKE, lft, tsh
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Which antipsychotic may be useful in autism
Risperidone: improve social withdrawal, hyperactivity, stereotype, inappropriate speech
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Which disorder will worsen if started on ssri
Panic disorder
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Which is the only antipsychotic that doesn't cause weight gain
Aripiprazole
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First line antipsychotic
Haloperidol
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Which antidepressant has the worst sexual dysfunction
Paroxetine (SSRI)
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Name 5 ae paroxetine
SSRI
- worst sexual dysfunction!
- congenital heart defects
- sedation
- high risk antidepressant discontinuation syndrome
- cholinergic adverse effects
