Psych Flashcards
What are the common adrenergic receptor effects?
Sweating Tremor Headaches Nausea Dizziness
What are the common acetycholin receptor effects?
Dry mouth Urinary retention Dry skin Thirst Hot and flushed
What are the common histaine effects?
Dizziness
Drowiness
Dizziness
N and V
What are the common side effects of serotonin?
Restlessness, agitation on initiation Nausea GI disturbance Headache Weight changes Sexual dysfunction Less common- bleeding and suicidal ideation
What is the safest SSRI in heart disease?
Sertraline
What is the caution with citalopram?
QTc prolongation
Do an ECG before and after
Do not use with other meds that cause QTc prolongation!
When is fluoxetine given and when do you have to be careful with its use?
It is given as first line to children
You have to be careful when switching to other SSRIs because it can cause serotonin syndrome
What SSRI can you experience discontinuation syndrome with?
Paroxetine
What are the two types of NSRIs?
Duloxetine and venlaxafine (co not use in heat disease, can also cause hypertension)
What are the major side effects of mitazapine?
Weight gain and sedation (act on histamine receptors too)
What is the downside of TCAs?
They can be fatal in overdose, they can cause QTc prolongation and arrythmias
What are the dangers of MAOIs?
Have lots of interactions with other drugs
Can cause a thyramine reaction and lead to a hypertensive crisis
What is discontinuation syndrome?
Non life threatening!
Sweating, shakes, agitation, insomnia, headaches, irritability, nausea
Paroxetine and venlaxafine= trickiest to stop
Can do alternative days of taking, snap tablets in half
What is serotonin syndrome?
Essentially you get too much of serotonin
It is a very vague presentation
Can cause… Cognitive Headaches Agitation Hypomania Confusions Coma
Autonomic Shivering Sweating Hyperthermia Tachy Nausea Diarrhoea
Somatic
Myoclonus
Hyper reflexia
Tremor
Treatment is usually fluids and monitoring
How do antipsychotics work?
They reduce the level of dopamine avtivity at the D2 receptors
What are the target pathways for antipsychotics and what pathways are also affected by mistake?
Target pathways= mesocortical and mesolimbin
But unwanted pathways which are also affected include nigrostriatal (movement) and tuberoinfundibular (hyothalamic pituitary adrenal axis)
What are the potential side effects for antipsychotics?
All antipsychotics have the potential for sedation, extrapyramidal side effects and weight gain
All antipsychotics can cause acute dystonia, incling oculogyric crisis (eyes point involuntary upwards)
What are the typical vs atypical antipsychotics?
Typical= haloperidol, chlorpromazine
Atypical= clozapine, onlanzapine, risperidoe, quietiapine, amisulpride, apiprazole
What are the typical antipsychotics more likely to cause?
Extra pyramidal side effects- bradykinesia, muscle stiffness and tremor, tardive dyskinesia (involuntary chewing/movement of jaw), akathisia
Dizziness
Sexual dysfunction
What are atypical antipsychotics more likely to cause
Weight gain
Dyslipidsemia
Diabetes
What is the serious risk with clozapine?
Should be used in schizophrenia after two orher antipsychotics have nor worked
The significant problem is that is a serious potential for agranulocytosis (severe leukopaenia) therefore close monitoring of FBC- weekly for first 18 weeks then fortnightly, then monthly
Other than agranulocytosis, what is one of the reasons patients can die on clozapine?
Clozapine has a significant potential for GI hypomobility which causes constipation and a potentially fatal bowel obstruction
Side effects of clozapine?
Constipation
Agranulocytosis
Hypersalivation
Urinary incontinence
What is neuroleptic malignant syndrome?
What is the treatment?
Rare, life threatening reaction to antipsychotics
Fever, confusion, muscle rigidity, sweating, autonomic instability
Death is usually due to:
Rhabdomyolysis, renal failure, seizures
It usually happens in people that have never had antipsychotics before
Treatment involves emergency referral to A and E, stopping the antipsychotic, fluid rescucitation and reducing temperature
What can be used to treat extra pyramidal side effects?
Anticholinergics (reduce acetylcholine)
Procyclidine
Benzatropine (parkinsons)
Its not effective for tardive dyskinesia, if this is the only side effect a patient has got then dont give them procyclidine as it can make it worse!
What are anxiolytics and give examples…
Drugs that reduce anxiety! Beta blockers (reducing ANS activation) Benzodiazepines Pregabalinn Antidepressants
How do benzodiazepines work?
Examples are diazepam and lorazepam
They work by binding to GABA receptors and therefore reduce the excitability of neurones
They have a significant potential for tolerance and dependence
They have a significant potential for mishse
Use very cautiously for no more than 6 weeks
What is pregabalin used for?
How does it work?
What side effects does it cause?
Anxiety, neuropathic pain, epilepsy
Works by increasing GABA concentrations in the brain
Causes sedation and weight gain
What is lithium excreted by?
The kidneys
Why does lithium have to be so regularly monitored?
It has a narrow therapeutic window (the gap between the effective dose and the toxic dose) so a requirement for regular serum lithium levels- 3 monthly once stable
What are the side effects of lithium?
GI disturbance (especially on initiation) Metallic taste Dry mouth Fine tremor Polydypsia Polyuria Weight gain
Long term effects are;
- hypothyrodism (usually reversible)
- renal impairment (usually irreversible)
Annual UEs and TFTs are needed
What are the signs of lithium toxicity?
Confusion, coarse tremor, nause and vomiting, ataxia and seizures
It is treated with supportive measures- dialysis if necessary
The potential for toxicity increases w/ dehydration- advise to drink lots of water in hot climates
What interactions can cause dangerously high levels of lithium?
NSAIDS, loop diuretics, ACE-I
What do you use for long term mood stabilisers for bipolar affective disorders?
Can use lithium, quietiapine
Can use anticonvulsants
Sodium valproate (be wary in women of child bearing age due to teratogenicity, check LFTs before and soon after starting too)
Carbamazepine
Lamotrigine- potential for steven johnson syndrome
Pregabalin
Most anticonvulsants have the potential to cause thrombocytopenia so check FBC
Side effects include weight gain and sedation
What are the drugs use for the cognitive symptoms of dementia?
The drugs do not prolong life or slow down neurodegeneratibe changes, but they do improve cognitive and emotional/behavioural symptoms
Acetylcholinesterase imhibitors (cholinesterase inhibitors)
Memantine (NDMA agonist)
What is the difference between acetylcholinesterase inhibitors and anticholinergics?
Anticholinergics cause a decrease in acetylcholine, acetylcholinesterase inhibitors cause an increase in acetylcholine (they prevent acetylcholine from breaking down).
What are the side effects of cholinesterase inhibitors?
Nausea Diarrhoea Vomiting Insomnia Muscle cramps Anorexia
What monitoring do you need with cholinesterase inhibitors?
What are examples of cholinesterase inhibitors?
Pulse check at every appointment
ECG before starting treatment
Examples= donepezil, galantamine, rivastigmine (can be given as a patch, good for concordance and less GI side effects)
What is memantine used for?
How does it work?
Side effects?
Glutamine (NDMA) receptor agonist- leading to lower neuronal excitability
Used in moderate to severe Alzheimers
Used most for agitated and challenging behaviour in alzheimers
Generally well tolerated if initiated slowly
No specific monitoring
Side effects= headache, drowsiness, insomnia, nausea
What are the drugs used in ADD and ADHD?
What needs to be monitored?
Methylphenidate
Weight, height, pulse
