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Mental Health > Pharmacotherapy > Flashcards

Pharmacotherapy Flashcards

Exam Prep

1
Q

Antipsychotic drug indications.

A
  1. Schizophrenia, schizoaffective disorder, delusional disorder
  2. Bipolar disorder (especially manic phase)
  3. Major depression with psychotic features
  4. Some autism or Tourette’s syndrome
  5. Psychosis associated with dementia or delirium
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2
Q

Antipsychotic drug mechanisms of action.

A
  1. Dopamine receptor blockers in the CNS
  2. G-protein coupled receptors
  3. Antipsychotic effect through blockade of post-synaptic D2 receptors
  4. Blockade leads to up-regulation of dopamine receptors
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3
Q

The four dopaminergic pathways.

A
  1. Mesolimbic pathway
  2. Mesocortical pathway
  3. Nigrostriatal pathway
  4. Tubuloinfundibular pathway
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4
Q

Dopamine blockades clinical effect on the dopaminergic pathways.

A
  1. Mesolimbic pathway: improves positive psychotic symptoms.
  2. Mesocortical pathway: worsens cognition and negative symptoms.
  3. Nigrostriatal pathway: extrapyramidal side effects.
  4. Tubuloinfundibular pathway: increased prolactin.
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5
Q

Antipsychotic drug classes.

A
  1. 1st Generation - Typical
  2. 2nd Generation - Atypical
  3. 3rd Generation (not recognised) partial D2 antagonists.
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6
Q

Generic names of (3) 1st Generation (Typical) antipsychotic drugs.

A
  1. Haloperidol
  2. Chlorpromazine
  3. Pericyazine
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7
Q

Generic names of (5) 2nd Generation (Atypical) antipsychotic drugs.

A
  1. Aripiprazole
  2. Clozapine
  3. Olanzapine
  4. Quetiapine
  5. Risperidone
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8
Q

Extrapyramidal Side Effects

A
  1. Dystonia
  2. Akathisia
  3. Parkinsonism
  4. Tardive dyskinesia
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9
Q

Management plan for onset of Extrapyramidal Side Effects.

A
  1. Reduce the dose or change antipsychotic.
  2. Consider anticholinergic agents Benzotropine and Benzhexol to treat dystonia and parkinsonism.
  3. Anticholinergics are ineffective for akathisia and tardive dyskinesia.
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10
Q

Benzotropine dosage for extrapyramidal side effects.

A
  1. Dystonia; 2mg IM intial then PRN

2. Parkinsonism; 1-2 mg PO BD or TDS (half dose for elderly)

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11
Q

Metabolic adverse effects of antipsychotic medications.

A
  1. Weight gain
  2. Hyperglycaemia
  3. Hyperlipidaemia
  4. Glucose intolerance and diabetes
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12
Q

Other adverse effects of antipsychotic medications.

A
  1. Sedation
  2. Postural hypotension.
  3. Constipation
  4. Hyperprolactinaemia
  5. Neuroleptic malignant syndrome.
  6. Prolongation of the QTc interval and sudden cardiac death
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13
Q

Potential adverse effects of hyperprolactinaemia with antipsychotic medication use.

A
  1. Amenorrhoea
  2. Galactorrhoea
  3. Gynaecomastia
  4. Erectile dysfunction
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14
Q

Additional adverse effects of Clozapine.

A
  1. Agranulocytosis.
  2. Myocarditis.
  3. Smoking induces livers metabolism clozapine.
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15
Q

Blood tests for Clozapine.

A
  1. WBC’s and Serum Clozapine Levels
  2. Weekly for first 18 weeks and then monthly
  3. WBC must be greater than 3.5x 10-9L and neutrophils greater than 2.0x 10-9L
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16
Q

The 4 common broad actions of benzodiazepines.

A
  1. Anxiolytic
  2. Sedative-hypnotic
  3. Anticonvulsant
  4. Muscle relaxant
17
Q

Generic names for short acting benzodiazepines.

A
  1. Lorazepam

2. Temazepam

18
Q

Generic names for long acting benzodiazepines.

A
  1. Clonazepam

2. Diazepam

19
Q

Class effects of benzodiazepines.

A
  1. Drowsiness and cumulative sedation
  2. Ataxia, dizziness
  3. Respiratory depression
  4. Ante-retrograde amnesia
  5. Disinhibition
20
Q

Class interactions of benzodiazepines.

A
  1. Increased effect with other CNS depressants
  2. Ataxia and dysarthria with Lithium and antipsychotics
  3. Delirium with Clozapine
  4. Increases plasma concentrations of digoxin and phenytoin
21
Q

The 2 drug classes used for cognitive impairment in dementia.

A
  1. Cholinesterase inhibitors aka (acetylcholinesterase inhibitors)
  2. N-methyl-D-aspartate (NMDA) agonist
22
Q

The 3 cholinesterase inhibitors used to treat cognitive impairment in dementia.

A
  1. Donepezil
  2. Rivastigmine
  3. Galantamine
23
Q

The NMDA agonist used as a potential adjunct therapy in dementia.

A
  1. Memantine
24
Q

The mechanism of action for cholinesterase inhibitors.

A
  1. Prevents acetlycholinesterase (enzyme) from breaking down acetlycholine (neurotransmitter) into choline and acetate.
  2. This increases the levels of acetlycholine within the synaptic cleft.
25
Q

Common class adverse effects of cholinesterase inhibitors.

A
  1. Increased dreams
  2. Anorexia, nausea, vomiting, diarrhoea
  3. Bronchoconstriction
  4. Muscle cramps
  5. Bradycardia, heart block, syncope
26
Q

Clinical approach to starting cholinesterase inhibitors for dementia.

A
  1. Confirm probable diagnosis
  2. Baseline cognitive function - MMSE 10-24
  3. Check for history of PUD or GI problems
  4. Select appropriate medication
  5. Warn of potential side effects.
  6. Arrange later review.
27
Q

First line medication (cholinesterase inhibitor) for dementia.

A
  1. Donepezil
28
Q

What is the preferred medication (cholinesterase inhibitor) choice if there is a history of significant GI disease in the dementia patient.

A
  1. Rivastigmine (transdermal patch)
29
Q

Indications for antipsychotic medications in patients with dementia.

A
  1. Severe agitation and aggression with risk of harm.
  2. Delusions and hallucinations.
  3. Co-morbid pre-existing mental health conditions.
30
Q

What antipsychotic is currently the recommended first-line choice for behavioural and psychological symptoms of dementia.

A
  1. Risperidone.
31
Q

Specific risks associated with antipsychotic use in dementia patients.

A
  1. Increased risk of cerebrovascular events.
32
Q

Common SSRI’s

A
  1. Sertaline
  2. Citalopram
  3. Escitalopram
  4. Fluoxetine
33
Q

Common SNRI’s

A
  1. Venlafaxine

2. Duloxetine

34
Q

Common NaSSA’s (Noradrenaline and specific serotonergic antidepressants)

A
  1. Mirtazapine

2. Mianserin

35
Q

Common TCA

A
  1. Amitriptyline

Mental Health (4 decks)

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