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Psychiatry > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Name the 3 groups of mood stabilizers and examples.

A
  1. Classic mood stabilizer: lithium
  2. Anticonvulsants (glutamate channel blockers): valproate , carbamazepine, lamotrigine,
  3. Atypical antipsychotics: olanzapine (dopamine + serotonin agonist), quetiapine, aripiprazole (dopamine/serotonin/NA multimodal)
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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

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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
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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

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5
Q

Name 8 common side effects of lithium

A

LITHIUM

  1. Lithium toxicity emergency
  2. increased urine output: Renal effects!: polyuria with secondary polydypsia, hypokalaemia, rarely nonspecific interstitial fibrosis with more than 10 years lithium dose
  3. thyroid Benign, reversible: hypothyroidism most commonly ; tremor (postural)
  4. Heart: Cardiac effects secondary to hypokalaemia: t wave flattering or inversion on ECG, sinus dysrhythmias, heart block, syncope episodes
  5. Increased Weight gain and fluid retention
  6. upset stomach : Nausea, vomiting, diarrhea
  7. Malformation: Teratogenesis: Ebstein’s anomaly (new research show risk is = to those not on lithium);
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6
Q

Name 6 symptoms of lithium toxicity

A

LITHUM

  1. Loc impaired/coma/seizure.
  2. increased urination: Renal dysfunction
  3. Tremor, dysarthria, ataxia
  4. Heart: Cardiovascular change
  5. Upset stomach: Nausea, vomit, diarrhea,
  6. Myoclonus, muscular fasciculations
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7
Q

What is the treatment of lithium toxicity?

A
  • Stop lithium

* push iv fluids to dilute lithium and promote renal secretion

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8
Q

Which special investigations must be checked before starting patient on lithium and monitored thereafter? (6)

A
  1. UKE: potassium and kidney function ! First month then 6 monthly
  2. Creatinine clearance: kidney function !. First month then 6 monthly
  3. fbc: leucocytosis
  4. TSH ! First month then 6 monthly
  5. B- HCG ! Cause cardiac defects teratogenesis
  6. ECG; First month then 12 monthly
  7. Lithium levels - 4 days then 3-6 monthly. Normal = 0,6 - 1,2 mmol/l
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9
Q

Indications of valproate? (3)

A
  1. first line treatment and maintenance bipolar (can titrate up quick)
  2. Effective for manic episodes (advantage: can titrate up dose rapidly if aggressive patient)
  3. Best for mixed features and rapid cycling!

NOT depressive episode

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10
Q

Dosage valproate as mood stabiliser?

A

250-1250 mg po bd

Able to titrate dose up rapidly unlike lithium

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11
Q

Name 7 common side effects of valproate

A
  1. Weight gain!
  2. pcos! In females (pelvic us)
  3. Teratogenic: neural tube defects, (supplement with folate) ( bhcg)
  4. Sedation
  5. Thrombocytopenia
  6. Hair loss at high doses
  7. Tremor
  8. Hepatotoxic (lft before tx + 6 monthly)
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12
Q

Indications of carbamazepine as mood stabiliser?

A

Same as valproate (manic episode) but much less effective. Not routinely used

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13
Q

Name 5 common side effects carbamazepine

A

HAMLET

  1. Hyponatraemia! And syndrome of inappropriate ADH secretion (siadh) (do uke)
  2. agranulocytosis / aplastic anaemia: Bone marrow suppression rarely (do FBC )
  3. metabolism other drugs interfere: inhibit cyp450!
  4. Liver: Hepatitis (do LFT)
  5. exfoliate dermatitis rash
  6. teratogenesis (ntd) (do bhcg )

Also git,

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14
Q

Indications of lamotrigine for mood stabilisation? (4)

A
  1. first line for prominent bipolar depression!
  2. Effective in treating depressive episodes! And prevent!
  3. Effective to prevent! Manic episodes. Not treat
  4. Bipolar maintenance
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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

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16
Q

Maintenance dose of lamotrigine as mood stabiliser?

A

100 - 200 mg po nocte

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17
Q

Name 5 most common side effects of lamotrigine

A
  1. Steven’s - Johnson syndrome! (If rash, stop immediately)
  2. Sedation
  3. Nausea and vomiting
  4. dizzy and ataxia!
  5. Blurred vision and diplopia
    Side effects rare.
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18
Q

Indications of atypical antipsychotic in mood stabilisation? (4)

A

Ie olanzapine (dopamine and serotonin antagonist), quetiapine + aripiprazole (dopamine, serotonin + NA multimodal)

  1. Effective treat manic episodes
  2. Prevent manic
  3. Treat depressive episodes
  4. Can consider to treat mixed features and rapid cycling but not first line
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19
Q

Most common side effect of atypical antipsychotics?

A

Metabolic syndrome

Also: cardiac conduction abnormalities

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20
Q

3 common side effects of olanzapine

A
  1. Severe ms! (Metabolic syndrome)
  2. Dry mouth
  3. Constipation
  4. Akathisia, dyspepsia
    Atypical antipsychotic
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21
Q

3 common side effects of quetiapine

A
  1. Metabolic syndrome
  2. Severe sedation
  3. Dizzy and postural hypotension
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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!

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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

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24
Q

Indication of ssri in depression?

A

First line for MDD

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25
Q

Name 6 examples of SSRIs

A
  1. Fluoxetine
  2. Paroxetine
  3. Sertraline
  4. Fluvoxamine (bd)
  5. citalopram
  6. Escitalopram
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26
Q

Name 3 most common side effects ssri

A
  1. Sexual dysfunction: decreased libido, anorgasmia
  2. Insomnia
  3. Nausea, vomiting, diarrhea
  4. Headache
  5. Suicidal ideation - black box warning
  6. Lack energy, irritable
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27
Q

Moa snri?

A

Serotonin noradrenaline reuptake inhibitor (same as ssri )

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28
Q

Indication serotonin- noradrenaline reuptake inhibitors in depression? (3)

A
  • Second line MDD
  • treatment augmentation:
  • treatment resistant MDD
  • MDD with prominent pain symptoms
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29
Q

3 examples of snri?

A
  1. Venlafaxine
  2. Desvenlafaxine
  3. Duloxetine
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30
Q

3 most common side effects duloxetine

A

Snri
1. Sedation
2. Sexual dysfunction
3. Hypotension or hypertension and tachycardia
4. Git discomfort but subside as gain tolerance
Mood derailments in bipolar?

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31
Q

Moa nri?

A

Noradrenaline reuptake inhibitor (as for ssri)

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32
Q

Indication of noradrenaline reuptake inhibitor in depression?

A

Ineffective. Use only for augmentation

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33
Q

Example of nri drug

A

Reboxetine

Atomoxetine

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34
Q

Moa NDRI?

A

Noradrenaline - dopamine reuptake inhibitor. As for ssri

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35
Q

Indications of ndri in depression? (3)

A

• 2nd line antidepressant
Augmentation:
• MDD with prominent hyperSomnia and fatigue
• patients with sexual dysfunction on other antidepressants

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36
Q

Example of noradrenaline-dopamine reuptake inhibitor

A

Bupropion

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37
Q

3 most common side effects bupropion

A 
(Ndri)
1. Increase seizure threshold-careful in epilepsy
2. Headache
3. Insomnia
Not sexual dysfunction!
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38
Q

Mechanism of action TAD and TTAD? (2)

A
  • 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.
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39
Q

Name indications for tad and TTAD in depression

A

Second line (although effective) in depression because more side effects and risk lethal arrhythmias with overdose

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40
Q

Name 5 examples of tricyclic antidepressants

A

1.amitriptylline
2. Clomipramine
3. Imipramine
4 trimipramine
5. Lofepramine

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41
Q

Name 1 examples of tetracyclic antidepressants

A

Maprotiline

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42
Q

Name 3 common side effects tad and TTAD

A
  1. Lethal cardiac arrhythmia! In overdose. Especially tad
  2. Severe anticholinergic side effects: constipation, urinary retention, dry mouth, blurred vision
  3. Sedation
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43
Q

Moa MAOI and RIMA? (4)

A

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.

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44
Q

Indication MAOI and RIMA in depression

A
  • Powerful antidepressants but not for first line treatment. Prescribed by specialists
  • refractory MDD
  • depression/phobias with atypical/ hysterical/ hypochondriac features
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45
Q

Example of mono amine oxidase inhibitor

A

Tranylcipromine

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46
Q

Example of reversible inhibitors of monoamine oxidase

A

Moclobemide

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47
Q

3 most common side effects of MAOI and RIMA

A

1 sexual dysfunction
2 insomnia
3 weight gain

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48
Q

NB side effect of mono-amine oxidase inhibitors? (and to lesser extent rima)

A

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

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49
Q

Moa NASSA? (3)

A

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
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50
Q

Indications NASSA in depression? (2)

A
  • First or second line

* augment MDD treatment with prominent insomnia.

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51
Q

Example of noradrenaline and specific serotonin antagonist?

A

Mirtazapine

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52
Q

3 most common side effects mirtazapine

A

NASSA

  1. Sedation!
  2. Weight gain!
  3. Increased appetite
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53
Q

Moa sari? (2)

A

Serotonin antagonist and reuptake inhibitor

  1. Inhibit reuptake presynaptically
  2. 5ht2c r antagonist
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54
Q

Indication of sari for depression?

A

Mdd with prominent insomnia (mostly prescribed for insomnia, not so good for mdd)

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55
Q

Example of serotonin antagonist/reuptake inhibitor

A

Trazodone

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56
Q

3 most common side effects trazodone

A

Sari

  1. Sedation
  2. Orthostatic hypotension
  3. Nausea
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57
Q

Moa ma?

A

Melatonin agonist on postsynaptic neuron to produce same effect as melanin.

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58
Q

Indication of ma in depression?

A

MDD with prominent insomnia

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59
Q

Example of melanin agonist?

A

Agomelatine

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60
Q

2 most common side effects agomelatine?

A

Melanin agonist.

  1. Dizzy
  2. Nausea
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61
Q

Vortioxetine moa? (3)

A

Serotonin specific

  1. Reuptake inhibitor
  2. 5ht2c r antag
  3. Other.
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62
Q

Indication for vortioxetine in depression?

A

MDD, especially if secondary cognitive problems

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63
Q

3 common side effects vortioxetine?

A
  1. Serotonin syndrome!
  2. Abnormal bleeding
  3. hyponatraemia
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64
Q

Cause of serotonin syndrome?

A

Raised plasma serotonin secondary to co -admin antidepressants. Especially ssri plus lithium/maoi

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65
Q

Symptoms of serotonin syndrome in order (5)

A
  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

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66
Q

Treatment serotonin syndrome (5)

A

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

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67
Q

Cause of antidepressant discontinuation syndrome?

A

Abrupt discontinuance antidepressant, especially ssri with short half life eg paroxetine.

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68
Q

4 symptoms antidepressant discontinuation syndrome and onset

A

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 )
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69
Q

Treat antidepressant discontinuation syndrome?

A

Usually resolve spontaneously after 3 weeks
Restart medication and taper slowly (fluoxetine bestbecause long half life )
Symptomatic rx

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70
Q

Pharmacology for acute management of aggressive psychosis? (5)

A
  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)
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71
Q

Name the 2 classes of antipsychotics and examples

A
  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
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72
Q

Which 2 SSRIS have been approved for use in childhood depression?

A

Fluoxetine (best) and escitalopram

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73
Q

Treatment for acute dystonia?

A

Anticholinergics eg biperidine 5 mg iv stat

( caused by antipsychotics and antidepressants )

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74
Q

Which antidepressant does not cause sexual dysfunction?

A

Ndri : bupropion

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75
Q

Which antipsychotic should never be given with benzo?

A

Olanzepine

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76
Q

Intermediate-term treatment of aggression?

A

Zuclopenthixol acetate 50-100mg im 72hrly

Never give to antipsychotic naive person

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77
Q

Which antipsychotic should never be given to an antipsychotic naive patient?

A

Zuclopenthixol

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78
Q

Which drugs cause paradoxical disinhibition in children and elderly?

A

Benzodiazepines

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79
Q

Treat respiratory depression caused by benzodiazepines?

A

Flumazenil

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80
Q

Name 5 common side effects of methylphenidate

A 
(Ritalin)
• appetite and weight loss
• headache
• delay sleep onset
• new onset tics, motor and vocal
• abdominal pain
81
Q

Cautions for using stimulants in adhd treatment? (5)

A
  • 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
Q

Name 4 adverse effects associated with discont of stimulants eg ritalin

A
  • Twitching - motor or vocal tics
  • Anorexic/growth retard/stunted growth
  • insomnia
  • tachycardia
83
Q

Name 5 contraindications to stimulant treatment

A 
• Anxiety disorder
• tourette's
• eating disorders
• structural cardiac lesions and hypertensive states
• mania or concurrent substance abuse
Florid psychosis
84
Q

Which antipsychotic is reserved for treatment resistant patients?

A

Clozapine (atypical)

85
Q

First line treatment of akathisia

A

Propanalol: beta blocker

Can add benzo.
If possible, change to low potency typical or decrease dose

86
Q

Name 5 side effects of clozapine

A
  1. Agranulocytosis!
  2. Cardiomyopathy and myocarditis
  3. Toxic megacolon
  4. Seizures
  5. Metabolic syndrome and weight gain
    Sedation
87
Q

Which antipsychotic does not cause weight gain?

A

Aripiprazole (atypical)

Also no effect on prolactin.

88
Q

Name 4 drugs that lower seizure threshold

A
  • tricyclic antidepressants
  • buproprion (ndri)
  • low potency antipsychotics eg chlorpromazine, thioridazine
  • lithium
89
Q

Which condition describes painful prolonged contraction of muscles resulting in abnormal movements or posture?

A

Acute dystonia

90
Q

What causes acute dystonia?

A

High potency antipsychotics , first 4-7 days of commence treatment or increase dose.

91
Q

Name 5 symptoms acute dystonia

A
  • Oculogyric crisis (upward deviation)
  • Torticollis
  • trismus
  • protrude tongue
  • Laryngo-pharyngeal spasm
  • Dysphagia
92
Q

Which condition is described by tremors, rigidity and bradykinesia caused by antipsychotic use?

A

Parkinsonism

93
Q

Treatment of parkinsonism caused by antipsychotic use?

A

Anticholinergics: biperidine, orphenadrine

Lower dose antipsych.

94
Q

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?

A

Tardive dyskinesia

95
Q

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?

A

Neuroleptic malignant syndrome

96
Q

Name 5 symptoms neuroleptic malignant syndrome

A

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
Q

Cause and onset neuroleptic malignant syndrome?

A

Antipsychotics first week

98
Q

Treatment neuroleptic malignant syndrome (5)

A
  • 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
Q

In which conditions caused by antipsychotics should anticholinergics be avoided? (2)

A

Neuroleptic malignant syndrome and tardine dyskinesia

100
Q

Mechanism of action antipsychotics? (6)

A
  • 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
Q

Difference between typical and atypical antipsychotics for negative symptoms?

A
  • Typicals, eg haloperidol, zuclopenthixol, chlorpromazine, worsen negative symptoms
  • Atypicals, eg clozapine, olanzapine, risperidone, ariprazole, alleviate negative symptoms
102
Q

Difference between typical and atypical antipsychotics for side effects?

A
  • 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
Q

Which antipsychotic safest for epilepsy?

A

Haloperidol

104
Q

Which antipsychotic best for psychomotor agitation?

A

Haloperidol

105
Q

First line treatment schizophrenia?

A

Olanzapine (atypical)

106
Q

Which antipsych should never be given with benzo

A

Olanzapine (respiratory depression)

107
Q

Main Side effect olanzapine?

A

Weight gain

No risk agranulocytosis, less sedation

108
Q

Which antipsychotic favoured for elderly?

A

Thioridazine (typical) (low potency phenothiazine)
- bc less motor side effects

109
Q

Side effect Thioridazine

A

( Typical)

Retinal deposits

110
Q

Which 3 antipsychotics are strong sedatives?

A

Chlorpromazine (typical)
Paliperidone (atypical)
Quetiapine (atypical) at a LOW dose (high dose = antipsychotic effects, less antihistamine sedative effect)

111
Q

Risperidone side effects? (3)

A

(Atypical)
• hyperprolatinemia!
• sedation
• extrapyramidal at high doses

112
Q

Which antipsychotic indicated for restless and agitation elderly?

A

Risperidone (atypical)

113
Q

Where is lithium excreted?

A

Kidneys

114
Q

Which mood stabiliser is best for bipolar depression?

A

Lamotrigine (anticonvulsant) . > lithium

Can also use olanzapine, quetiapine, aripiprazole

115
Q

Which 3 atypical antipsychotics have mood stabilising propenties and can be used in management bipolar?

A
  • Olanzapine
  • quetiapine
  • aripiprazole
116
Q

Which condition is described by tremor, dysarthria, ataxia, git upsets , cardiovas changes and renal dysfunction, myoclonus and fasciculations, seizures, impaired loc and coma?

A

Lithium toxicity. Clue in renal disfunction.

117
Q

Which mood stabilisers can treat mania?

A

• Lithium
• valproate
(Carbamazepine)
• olanzapine, quetiapine, aripiprazole

118
Q

Which mood stabiliser is best for mixed features and rapid cycling?

A

Valproate

119
Q

What type of drug is reboxetine?

A

Selective noradrenaline reuptake inhibitor

120
Q

Which antidepressant is also registered to aid smoking cessation?

A

Bupropion (ndri)

121
Q

What type of drug is mirtazapine?

A

Nassa

122
Q

What type of drug is tranylcypromine?

A

Maoi

123
Q

Which drug, when combined with tyramine containing goods, can cause tyramine induced hypertensive crisis?

A

Tranylcypromine (maoi)

Moclobemide (rima)

124
Q

What drug type is moclobemide?

A

Rima

125
Q

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

A

Serotonin syndrome

126
Q

Which condition characterised by dizzy, weak, nausea, rebound depression, anxiety, insomnia, poor conc, headache, migraine symptoms, paraesthesias and upper resp symptoms?

A

Antidepressant discontinuation syndrome

127
Q

Which drugs high risk antidepressant discontinuation syndrome?

A

Ssris , especially short half life eg paroxetine

128
Q

Which drug most likely to cause serotonin syndrome

A

Vortioxetine, because agonist 5- hta

129
Q

Which antidepressant for mdd with hypersomnia and fatigue?

A

Bupropion (ndri)

130
Q

Which antidepressants have risk of lethal arrythmia?

A

Tad: amitryptilline, clomipramide etc
Ttad: maprotiline

131
Q

Which antidepressants reserved for refractory mdd?

A

Maoi: tranylcypromine
Rima: moclobemide

132
Q

Which antidepressants can be prescribed for mdd with prominent insomnia? (3)

A
  • Agomelatine (melatonin agonist)
  • mirtazapine (nassa)
  • trazadone (sari)
133
Q

Which antidepressant best for patient that doesn’t want to gain weight?

A

Nri: reboxetine, atomoxetine

134
Q

Name drug interaction with ssri

A

MAOI

Potentially fatal serotonergic syndrome of hyperthermia + cardiovascular collapse

135
Q

Window of action for ssri?

A

4-6 weeks

136
Q

Name 4 indications snri

A
  • 2nd line MDD
  • augment for treatment resistant MDD
  • augment for MDD with prominent pain symptoms
  • anxiety
  • neuropathic pain
137
Q

Name 5 depot preparations (long-acting injections) for poor adherence to oral rX

A
  • 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
Q

Moa typical/ first generation antipsychotics

A

Dopamine R (D2) antagonist
Block dopamine receptors at mesocortical pathway

Some also antagonise serotonin: thioridazine, chlorpromazine, flupenthitol, trifluoperazine

139
Q

Treatment tardive dyskinesia?

A

Prevention>cure. No real rX.
Start at higher dose increases risk.

Reduce dose and stop anticholinergics.
Try second generation/ atypical antipsychotics

140
Q

When prefer atypical > typical antipsychotics

A
  • Young
  • bad side effects on typical
  • private sector - less severe extra pyramidal side effects but expensive
  • negative signs schizophrenia

Same efficacy!

141
Q

Name 4 contraindications benzodiazepines

A
  • Pregnancy
  • untreated OSA
  • substance abuse history
  • caution+ monitor: hepatic / renal/lung disease; elderly
142
Q

Name 9 side effects benzodiazepines

A
  • Respiratory depression (hypoventilation)
  • anterograde amnesia
  • withdrawal, dependence, tolerance
  • residual daytime sedation
  • rebound insomnia
  • impaired cognition + falls in elderly
  • paradoxical disinhibition
  • hypotension
  • blurred vision
143
Q

Name the 4 types postsynaptic serotonin receptors and their effects when stimulated

A
  • 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
Q

Indication nri?

A

Augment rx mdd - mostly ineffective

145
Q

What is sertraline

A

SsRI

146
Q

What is paroxetine

A

SsRI

147
Q

What is venlafaxine

A

Snri

148
Q

What is duloxetine

A

Snri

149
Q

What is vortioxetine

A

5HTA agonist + serotonin reuptake antagonist

150
Q

What is reboxetine

A

Nri

151
Q

What is atomoxetine

A

Nri

152
Q

What is bupropion

A

NDRI

153
Q

What is imipramine

A

Tad

154
Q

What is clomipramine

A

Tad

155
Q

What is maprotiline

A

TTAD

156
Q

What is tranylcypromine

A

Maoi

157
Q

What is moClobemide

A

RIMA

158
Q

What is mirtazapine

A

NaSSA

159
Q

What is agomelatine

A

Melatonin agonist

160
Q

What is trazodone

A

Sari

161
Q

Name 6 pathways that antipsychotics work on (block dopamine) and their effects

A
  • 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
Q

Name 5 typical antipsychotics

A

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
Q

Name 7 atypical antipsychotics

A

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
Q

What is haloperidone

A

Typical antipsychotic (high potency, butyrophenone)

165
Q

What is zuclopenthixol

A

Typical antipsychotic (high potency, thioxanthene )

166
Q

What is chlorpromazine

A

Typical antipsychotic ( low potency, phenothiazine )

167
Q

What is thioridazine

A

Typical antipsychotic ( low potency, phenothiazine )

168
Q

What is clozapine

A

Atypical antipsychotic

169
Q

What is olanzapine

A

Atypical antipsychotic + mood stabiliser

170
Q

What is quetiapine

A

Atypical antipsychotic + mood stabiliser

171
Q

What is paliperidone

A

Atypical antipsychotic

172
Q

What is risperidoNe

A

Atypical antipsychotic

173
Q

What is ziprasidone

A

Atypical antipsychotic

174
Q

What is aripiprazole

A

Atypical antipsychotic + mood stabiliser

175
Q

What is carbamazepine

A

Anticonvulsants + mood stabiliser

176
Q

What is valproate

A

Anticonvulsants + mood stabiliser

177
Q

What is lamotrigine

A

Anticonvulsants + mood stabiliser for depressive episode. Can prevent, but not treat, manic episode

178
Q

Dose haloperidol

A

0,5 - 15 mg

179
Q

Dose risperidone

A

1-8 mg

180
Q

Dose olanzapine

A

10 - 20mg

181
Q

Dose quetiapine

A

300 - 800 mg

182
Q

Dose clozapine

A

100 - 800 mg

  • day 1: 12, 5 mg
  • day 2: 25-50 mg
  • titrate up by 25 - 50mg until 300mg for maintenance
183
Q

Dose chlorpromazine

A

200 - 800 mg

184
Q

Treatment hyper salivation caused by clozapine

A

Buscopan: hyoscine butylbromide / butylscopolamine

Or biperidine

185
Q

Name 5 benzodiazepines

A
  • Lorazepam
  • clonazepam
  • Alprazolam
  • diazepam
  • Oxazepam (contraindicated in liver disease)
186
Q

What is lorazepam

A

benzodiazepine

187
Q

What is clonazepam

A

benzodiazepine

188
Q

What is alprazolam

A

benzodiazepine

189
Q

What is diazepam

A

benzodiazepine

190
Q

What is oxazepam

A

benzodiazepine

191
Q

Name 3 formulations methylphenidate

A
  • Ritalin Ir 10 mg
  • Ritalin La 10/20/30 mg tabs
  • concerta (long half life 9 -12h ) 18 → 27 → 36 → 54 mg
192
Q

Name 4 pre-treatment tests that should be done before prescribing methylphenidate

A
  • ECG: exclude arrhythmia / heart condition
  • baseline weight , bp
  • EEG, Ct brain
  • baseline bloods: FBC, UKE, lft, tsh
193
Q

Which antipsychotic may be useful in autism

A

Risperidone: improve social withdrawal, hyperactivity, stereotype, inappropriate speech

194
Q

Which disorder will worsen if started on ssri

A

Panic disorder

195
Q

Which is the only antipsychotic that doesn’t cause weight gain

A

Aripiprazole

196
Q

First line antipsychotic

A

Haloperidol

197
Q

Which antidepressant has the worst sexual dysfunction

A

Paroxetine (SSRI)

198
Q

Name 5 ae paroxetine

A

SSRI

  • worst sexual dysfunction!
  • congenital heart defects
  • sedation
  • high risk antidepressant discontinuation syndrome
  • cholinergic adverse effects

Psychiatry (31 decks)

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