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Psychiatry > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Antidepressants (types and examples)

A 
SSRI – citalopram
TCA – Amitriptyline
SNRI – venlafaxine
SARI – trazodone 
MAOi - Selegiline
OTC – St John’s wort
NaSSA – Mirtazapine

All work on monoamines within the brain. Can be used to treat depression or anxiety disorders

  • SSRIs are considered first line for depression
  • TCAs increasingly being used in the management of chronic pain
    (SSRIs, NaSSAs Safer in overdose, TCAs, MAOi More dangerous in overdose)
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2
Q

side effect of antidepressants

A

SSRIs – GI disturbance, insomnia, hyponatraemia, agitation, dry mouth, headaches, discontinuation syndrome, serotonin syndrome
TCAs – Dry mouth, constipation, Prolonged QTc/arrhythmias, sedation
SNRIs – Dizziness, dry mouth, nausea, sweating, agitation
SARIs – Fatigue, constipation, dizziness, dry mouth, headaches, blurring of vision
MAOi – Tyramine reaction, dry mouth, nausea, GI disturbance, dizziness
NaSSAs – Increased appetite, sedating (particularly at low doses), neutropenia, agranulocytosis
St John’s Wort (OTC) – CYP inducer, fatigue, dry mouth

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3
Q

what is seretonin syndrome?

A

Medical emergency caused by enhanced serotonin transmission within the brain

Agitation
GI overstimulation
Tremor 
Myoclonus
Fever
Impaired consciousness
BP & pulse instability

Creatinine Kinase can be elevated
Risk of serotonin syndrome is increased if patient using cocaine, LSD, St John’s Wort or co-prescribed with other antidepressants, lithium and/or MAOIs

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4
Q

what is tyramine reaction?

A
  • Monoamine oxidase can be found in the gut as well as the brain. Usually breaks down tyramine found in foods
  • Inhibition of this results in an excess of tyramine within the body
  • Increased tyramine causes an increase in noradrenaline
  • Resulting in a sudden & sometimes extreme rise in BP, flushing, headaches and indigestion
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5
Q

what is neuroleptic malignant syndrome?

A

Classically associated with typical antipsychotics, but can occur in patients on atypicals
Within the first two weeks, patients present with
Pyrexia
Muscle rigidity
Autonomic instability (BP, pulse)
Fluctuating level of consciousness
Creatinine kinase raised
Treatment requires physiological support and removal of antipsychotics for a minimum of two months

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6
Q

neurleptic malignant syndrome
Vs
serotonin syndrome

A 
neuroleptic malignant syndrome
•Hyporeflexia
•Bradykinesia
•Lead pipe rigidity
•Fluctuating consciousness
seretonin syndrome
•Agitation
•Hyperreflexia
•Hyperkinesia
•Shivering
•Increased bowel sounds
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7
Q

examples of mood stabilisers (and the side effects)

A

Lithium (gold standard), anticonvulsants, antipsychotics

Lamotrigine: used to treat epilepsy or bipolar when depression is the main problem (not recommended for mania)
tablet/dispersible
Rashes, can develop Steven- Johnson’s Syndrome

Carbamazepine
CYP inducer, hyponatraemia, leukopenia

Sodium valproate

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8
Q

lithium

A

1st choice in mania episodes and long term. should check levels every 3-6 months
aim for level 0.6-1.0mmol/L

Comes in 2 forms: 
•	Tablets – Lithium carbonate
1.	Camcolit – Treatment – 1-1.5g daily and as prophylaxis 300-400mg a day. 
2.	Priadel
3.	Liskonum
•	Liquid – Lithium citrate
1.	Priadel liquid 
2.	Li-liquid
side effects:
hypothyroidism
cardiac arrhythmias
GI upset
diabetes insipidus
thirst
teratogenic in pregnancy
renal failure
polyruia
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9
Q

lithium toxicity

A 
mild/moderate >1.5mmol/L
Nausea
Diarrhoea
Ataxia
Drowsiness
Coarse tremor
severe toxicity >2mmol/L
Disorientation
Seizures
Coma
Death
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10
Q

benzodiazepines and Z drugs

A

Benzodiazepines are agonists for GABA receptors (GABA = inhibitory neurotransmitter)

Shorter acting
Lorazepam
Diazepam

Longer-acting
Clonazepam

Chlordiazepoxide
Z drugs
Zopiclone
Zolpidem

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11
Q

what are the side effects of benzo’s?

A 
Drowsiness
Dizziness
Risk of falls – particularly in the elderly
Memory impairment
Paradoxical agitation
Reduced psychomotor function
Can reduce respiratory rate in overdose
Risk of tolerance and addiction
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12
Q

features of benzo withdrawal

A

Common
Anxiety, Insomnia, Restlessness, tension

Less common
Nausea, sweating, blurred vision, nightmares

Rare features:
Hallucinations, seizures, tinnitus, paranoia

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13
Q

mood stabilisers

A

indicate to help out highs/lows in manic and depressive episodes such as bipolar, schizoaffective disorder, personality disorder.

can be taken short term or long term

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14
Q

lithium contraindications

A
  • Addison’s disease
  • Cardiac disease associated with rhythm disorder
  • Cardiac insufficiency
  • Dehydration
  • Low sodium diet
  • Untreated hypothyroidism

Salt consumption can cause fluctuations in serumlithium levels. While takinglithium, do not make sudden changes to your salt intake. A sudden decrease insodiumintake (a component of salt) may result in higher serumlithium levels, while a sudden increase insodiummight prompt yourlithium levelsto fall.

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15
Q

sodium valporate

A

*used if lithium is unsuitable or unaffective. treat epilepsy and mania.
Diarrhoea, hair loss, weight gain, peripheral oedema
can cause increased testosterone (can stop periods, abnormal hair growth, PCOS, should not be perscribed in pregnancy, LFT’s stat and 6 months)

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16
Q

antipsychotics in bipolar

A
  • Olanzapine
  • Haloperidol
  • Quetiapine
  • Risperidone
Side Effects: 
•	Aggression
•	Joint Pain 
•	Agitation 
•	Vomiting and diarrhoea
•	Drowsiness
•	Dizziness
•	Dry mouth 
•	Tiredness
•	Irritability
•	Headaches
•	Tremors
•	Sleep problems.
17
Q

stopping mood stabilisers, effect on other meds + breasfeeding

A

Stopping Mood Stabilisers:
• Reduce the dose slowly over a few weeks
• Look for withdrawal symptoms

Effects on other medications:
• Codeine
• Paracetamol
• Iboprofen

Alcohol is not recommended

Breastfeeding – antipsychotics should be used

18
Q

Tardive dyskinesia

A

Involuntary muscle movements- usually affecting tongue, lips, trunk and extremities. seen in patients who are on long term anti dopaminergic meds such as antipsychotics medication (typica/atypical) some antidepressants, metaclopromide, prochhloperazene, carbamezapine, phenytoin

stiff and jerky movements of body and face. blink/stick out tongue, wave arms

caused by halopreidol, chlorpromazine (antipsychotics)

can also give extrapyramidal side effects

e.g. bradykinesia

19
Q

seretonin syndrome

A

OD or combo of SSRI’s / SNRI’s

3 of the following:
ataxia, diarrhoea, hypereflexia, agitation, tremor, clonus, change in mental status

complications:
renal failure, respiratory failure, rhabdomyolysis, arrhythmia’s

supportive mx

20
Q

akathisia

A

restlesness
associated with antipsychotic use
inability to remain motionless

21
Q

neuroleptic malignant syndrome

A

antipsychotic meds
life threatening
hyperthermia, muscle rigidity, change in level of consciousness, autonomic instability.

mx: discontinuemeds, dantrolene, bromocriptine. solve in 1-2 weeks

22
Q

acute dystonia

A

spasm in various muscle groups caused by haloperidol (few hours after administration)

treatment- anticholinergics

23
Q

important notes for starting on SSRI

A

Increased risk of suicidal thinking and self harm in <30 y/o

Benefit 4-6 weeks after SSRI but full benefit can take 12 weeks

Seen every 2-4 weeks for first 3 months after starting meds, every 3 months after

discontinuation symptoms:
ebound enxiety, depressive symptoms, flu like symptoms, dizzy, nausea, sleep disturbances if stop SSRI abruptly

24
Q

ECT

A

catatonia
Severe depression
Prolonged or severe mania
Not recommended in schizophrenia

25
Q

clozapine

A

1st line is olanzoopine
2nd line clozapine (started on specialist advice if other antipsychotic meds have not been effective) ! risk of agranulocytosis !

if missed for >48 hours, restart with dose of 12.5mg (can be titrated more rapidly if patient is clozapine-naive)

26
Q

treatment for hypersalavation (a side effect of clozapine)

A

most commonly occurs in first 4 weeks, can wear off but can persist. worse at night

can be a cause of aspiration pneumonia

tx: hyoscine

27
Q

management of insomnia

A

tx: zopiclone

melatonin is given in children or adults with learning difficulties as they often have chronic sleep-wake cycle disruptions.

promethazine can be given for agitation or insomnia and helpful in maintaining sleep/

28
Q

methadone

A

given to patients dependent on illicit opioids (heroin)
full opioid agonist

alternative- buprenorphine (partial opioid agonist)

29
Q

important to check before starting on antipsychotics

A

weight, waist circumference, BP, Hba1c, fasting glucose, lipid levels, prolactin levels, diet and exercise, movement disorder

Psychiatry (17 decks)

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