Psych Flashcards
First line treatments for depression?
Mild: CBT, Supportive and monitoring
Mod to severe or depressed over 2 years: antidepressants and CBT
severe: ECT /rEMT
First line antidepressants
SSRIs - sertraline - citalopram - fluoxetine - paroxetine In elderly: mirtazapine should be considered
Second line antidepressants and reasons when used?
NSRIs e.g. venlafaxine can go to higher doses, also inhibits NA uptake. Low doses affect serotonin, high doses affect noradrenaline.
Duloxetine- lower dose range,
Similar side effects to SRIS but more sedation, nausea and sexual dysfunction.
Caution with venlafaxine at high dose
Last resort antidepressants? Name them
MAOIs- isocarboxid (irreversible)
- trancylyopromine
- phenelzine
Use - atypical depression, Parkinson’s.
TCAs - lometraine and nortryptyline
Triazone in dementia for agitation
Side effects of trancylpromide and phelyzine
SE: postural hypotension, dizzy. Can cause hallucinations. Uncommon- change in behaviour, and agitation
Can’t eat cheese and wine
Risk: tyramine reaction potential causing HTN crisis
What can TCAs be used for
Amitriptyline- neuropathic pain
Triazone- agitation in dementia
New antidepressants
Vortioxetine- well tolerated
Agomelatine- regulates melatonin and boosts NA and dopamine
Side effects of SSRIs
Weight loss, sexual dysfunction, anorexia, nausea, restlessness and agitation
Less common- suicidal thoughts, bleeding, headache
Rare- neurological , mania, extrapyramidal e.g. Tremor
Risks of using SSRIs with specific examples for each
Sertraline. General se
Citalopram- QT prolongation
Fluoxetine- serotonin syndrome
Paroxetine - discontinuation syndrome
All some cardiac risks but sertraline safest
What is mirtazapine and what are its side effects
Non selective SRI
Strong H1 activity so sedation, weight gain (2 stones)
Postural hypotension
Helps sleep sedation
Uses of MAOIS
MAOI- A e,g, trancylopromide. Atypical depression
MAOI B rasagiline anti Parkinson’s
Name first line drugs for schizophrenia
Atypical antipsychotics Olanzapine Quatiapine Rispiridone Paliperidone
How do antipsychotics work?
Majority block dopamine receptors. Block mesocorticol and mesolimbic pathways but also affect the nigostriatal and tuberoinfundibular pathways
Atypicals e.g olanzapine also block alpha adrenoreceptors therefore antihistamine like effect e.g, drowsy
clozapine- seratonin ,a1aR and M aswell (ANTAGONIST)
Describe side effects of atypical antipsychotics
All antipsychotics
Sedation
Extrapyramidal- dyskinesia, akathisia, bradykinesia, muscle stiffness, tremor,
Endocrine- weight gain, hyperprolactinaemia, pigmentation
Atypical- more endocrine weight gain and serotinergic than extrapyramidal. Caution with prolactin in rispiridone
Typical- more extrapyramidal and less endocrine weight gain and reduced DM risk
Why do side effects occur with antipsychotics
The antipsychotic targets not only mesocorticol and mesolimbic pathways but also the nigostriatal (movement ) and tuberoinfundibular pathways (HPO axis)
Typical anticholinergic SE
- can’t pee
Can’t see
Can’t shit
When would you avoid olanzapine? Rispiridone.
Not working
Acute MI
Severe problems with oedema or weight
Rispiridone- women who are planning pregnancies or any younger women really caution with prolactin–> sterile
What is amisulphride used for?
Antipsychotic, blocks d receptors.
Least risk of weight gain and diabetes in antipsychotics
Schizophrenia, mania, psychosis
Side effects of clozapine
Sever neutropenia and leukocytosis
Severe constipation and potentially fatal bowel obstruction
More common: weight gin, anortedia, cvs risks, postural hypotension
Hyperprolactinaemia
Regular monitoring and 1-2 weeks to withdraw
Name a typical antipsychotic, it’s use and SE
Haloperidol Used in emergencies, short term, occasionally long term Causes more extrapyramidal side effects Less sedation and antimuscurinic, Can cause over excitement
Risk- neuroleptic malignant syndrome
Toxic- CNS depression, cardiac, risk of sudden death
Other typical antipsychotics
Haloperidol
Zuclopenthixol
Chlorpromazine
Pericyazine
Name some antipsychotics available as depot
Rispiridone Paliperidone Olanzapine, needs 3hr wait period post injections Zuclopenthixol Haloperidol
How do you treat anxiety
CBT, psychoeducation, management techniques and mindfulness
Treat coexisting conditions e,g, depression
Pharmacological
First line pharmacology for anxiety
SSRIs
Similar and slightly higher dose than depression,in OCD increase the dose
Alternative anxiety treatments, pharm
Beta blockers e.g, propranolol
Pregablin- neuropathic pain
Antipsychotics
Not really benzodiazepines e.g. Diazepam, lorezepam
Mechanisms of pregablin
Bind to VGCC in neurones , increase concentration of the enzyme needed to produce GABA
CNS depressant so reduces neuronal activity
Use. Neuropathic pain, anxiety, epilepsy
Name some mood stabilisers
Lithium Sodium valproate Carbamazepine Lamotrigene Antipsychotics
Side effects of lithium (not toxic)
Hypoparathyroidism
Hypothyroidism
Renal impairment
Se: memory problems Confusion, fine tremor, n&vom, ataxia, seizures, anorexia Metallic taste Rash, Inc seratonin- so polyuria and dipsa
Toxic effects of lithium what should you monitor
Thyroid toxicity
Risk of hypoparathyroidism and hypothyroidism
(Tingling, muscle ache, spasm) and (Stones moans and groans)
Renal toxicity- hypokalaemia
Early, constipation, fatigue,muscle weakness and spasms dysrhythmia,
Toxic- Convulsions, coarse tremor, n and vom, ataxia, seizures, anorexia,
Emergency- convulsions, dehydration, collapse
Se of valporic acid
Aggression, confusion, deafness,
Extrapyramidal, convulsion, headaches, memory
GI- anaemia, diarrhoea irritation
Menstrual disturbance
Toxic effects of sodium valproate
Liver toxicity
Tetatrogenic
Interactions of sodium valproate
Is a P450 inhibitor
Therfore can affect drugs such as OCP, warfarin, corticosteroids and statins
Other inhibitors can decreases the levels
Other inducers e,g, carbamazepine increase levels
Name p450 inducers
CRAPS out drugs Carbamazepine Rifampicin bArbituates Phenytoin St Johns wort
Name p450 inhibitors
Some certain silly compounds annoyingly inhibit enzymes grrr
Sodium valproate Ciprofloxacin Sulphonamide Cimetidine, omeprazole Antifungals, amiodarone Isoniazid Erythromycin, clarinthromycin Grapefruit juice
Se of carbamezapine
Cardiac toxicity
Allergic skin disease, dermatitis, fatigue, drowsy, anaemia, leukopenia, vomiting oedema
Interactions of carbamazepine
P450 induced so decreases levels of OCO, warfarin, TCAs, other anticonvulsants
Toxicity of carbamazepine
Cardiac diseas,e
Liver disease, caution needed
Function of lamotrigene and its side effects
Mood stabilisers, that can be used in bipolar
Dizzy postural hypotension, blurred vision, coordination, rash
Risk of Steven Johnson
Monitor liver
What can be given in acute manic episodes
Check mood stabilisers levels
Antipsychotics
Olanzaoine, rispiridone, aripriprazole
Acute depressive enzymes
Check medication serum levels
Other medications hypothyroidism?
Add ssri or quituapine
Medications for dementia. Which type of dementia do they treat
Acetyl cholinesterase inhibitors
Donepezil
Rivastigmine ((Lewy body)
Galantamine
Mild to mod dementia and Lewy body
NMDA antagonist, memantadine. Severe Alzheimer’s
Alternative medications for people with dementia
TCAs for agitations
Trazadone
First line pharmacology for ADHD
And its side effects
Other uses
Methylphenidate
CNS stimulants
Growth defect in children, monitor
Monitor pulse,
Nausea appetite loss insomnia, headaches,
Other uses: Tourette’s, anxiety, conduct disorders ,tics
Alternative ADHD medications
Atomoxetine, non stimulatnnCNS
More anorexia, less growth suppression, fatigue dry mouth
Dexamphetamine
- CNS stimulant
Not first line but if atypical
Stunted growth so only give to improve concentration E.g term time
Antidepressants with sedative action
Mitrazipine
Trazodone
Antipsychotics with sedative action
Promethazine
Has antihistamine ad antimuscurinc effects
Sleeping tablets
Non benzos
Zopiclone and zopliedem
Benzos- lormetezepam,
Drugs that can cause serotonin syndrome
MAOIs Other antidepressants Analgesics Antiemetics, metoclopramide Recreations, MDMA,coke Others linozoid, tryptophan
Features of seratonin syndrome
Autonomic hyperactivity. HTN, hyperthermia, excessive sweating
Neuromuscular abnormality, tremor, clonus, hyperreflexia
Mental state changes, anxiety, agitation, confusion, coma
Presents after increasing medication or adding an additional one . Within 6hrs
Early and late signs of seratonin syndrome
Early- tremor akathsia (can’t sit still) diahorrhea
Late- agitation, hyper vigilance, pressure speech, acute delirium
Differences between neuroleptic malignant syndrome and serotonin syndrome
NMS- hypoventilation from muscle rigidity, shuffling gait and difficulty walking
Potential oculogyric crisis (eyes rolled up) or seizure
Occurs over longer time over 10 days not 6 hrs.
Causes of NMS
Drop in dopamine
Blocking receotirs
Stopping Parkinson’s treatments - block dop levels
Starting anypsychotics, and
Antiparkinsons: anticholinergics, levodopa, amantadine
Antidepressants , venlafaxine, clopramine
Oral contraceptives , lithium, carbamezapine
Pharmacological treatments for PTSD
Short term hypnotics
Antidepressants if severe - mitrazipine - paroxetine Amitryptiline Phenelzine
First line treatments for PTSD
Trauma focused CBT
EMDR- eye movement desensitisation and reprocessing
Psychoeducation
Peer support
First line pharmacology for depression
SSRIs
- fluoxetine
- sertraline (not bipolar )
Venlafaxine
Metizapine
First line pharmacology for depression
SSRIs
- fluoxetine
- sertraline (not bipolar )
Venlafaxine
Metizapine
First line pharmacology for depression
SSRIs
- fluoxetine
- sertraline (not bipolar )
Venlafaxine
Metizapine
