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Psych Flashcards

1
Q

First line treatments for depression?

A

Mild: CBT, Supportive and monitoring

Mod to severe or depressed over 2 years: antidepressants and CBT

severe: ECT /rEMT

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2
Q

First line antidepressants

A 
SSRIs
- sertraline
- citalopram
- fluoxetine
- paroxetine
In elderly: mirtazapine should be considered
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3
Q

Second line antidepressants and reasons when used?

A

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

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4
Q

Last resort antidepressants? Name them

A

MAOIs- isocarboxid (irreversible)
- trancylyopromine
- phenelzine
Use - atypical depression, Parkinson’s.

TCAs - lometraine and nortryptyline
Triazone in dementia for agitation

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5
Q

Side effects of trancylpromide and phelyzine

A

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

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6
Q

What can TCAs be used for

A

Amitriptyline- neuropathic pain

Triazone- agitation in dementia

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7
Q

New antidepressants

A

Vortioxetine- well tolerated

Agomelatine- regulates melatonin and boosts NA and dopamine

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8
Q

Side effects of SSRIs

A

Weight loss, sexual dysfunction, anorexia, nausea, restlessness and agitation
Less common- suicidal thoughts, bleeding, headache
Rare- neurological , mania, extrapyramidal e.g. Tremor

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9
Q

Risks of using SSRIs with specific examples for each

A

Sertraline. General se
Citalopram- QT prolongation
Fluoxetine- serotonin syndrome
Paroxetine - discontinuation syndrome

All some cardiac risks but sertraline safest

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10
Q

What is mirtazapine and what are its side effects

A

Non selective SRI
Strong H1 activity so sedation, weight gain (2 stones)
Postural hypotension
Helps sleep sedation

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11
Q

Uses of MAOIS

A

MAOI- A e,g, trancylopromide. Atypical depression

MAOI B rasagiline anti Parkinson’s

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12
Q

Name first line drugs for schizophrenia

A 
Atypical antipsychotics 
Olanzapine
Quatiapine
Rispiridone
Paliperidone
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13
Q

How do antipsychotics work?

A

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)

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14
Q

Describe side effects of atypical antipsychotics

A

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

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15
Q

Why do side effects occur with antipsychotics

A

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

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16
Q

When would you avoid olanzapine? Rispiridone.

A

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

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17
Q

What is amisulphride used for?

A

Antipsychotic, blocks d receptors.
Least risk of weight gain and diabetes in antipsychotics

Schizophrenia, mania, psychosis

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18
Q

Side effects of clozapine

A

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

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19
Q

Name a typical antipsychotic, it’s use and SE

A 
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

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20
Q

Other typical antipsychotics

A

Haloperidol
Zuclopenthixol
Chlorpromazine
Pericyazine

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21
Q

Name some antipsychotics available as depot

A 
Rispiridone
Paliperidone
Olanzapine, needs 3hr wait period post injections
Zuclopenthixol
Haloperidol
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22
Q

How do you treat anxiety

A

CBT, psychoeducation, management techniques and mindfulness
Treat coexisting conditions e,g, depression
Pharmacological

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23
Q

First line pharmacology for anxiety

A

SSRIs

Similar and slightly higher dose than depression,in OCD increase the dose

24
Q

Alternative anxiety treatments, pharm

A

Beta blockers e.g, propranolol

Pregablin- neuropathic pain

Antipsychotics
Not really benzodiazepines e.g. Diazepam, lorezepam

25
Q

Mechanisms of pregablin

A

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

26
Q

Name some mood stabilisers

A 
Lithium
Sodium valproate
Carbamazepine 
Lamotrigene
Antipsychotics
27
Q

Side effects of lithium (not toxic)

A

Hypoparathyroidism
Hypothyroidism
Renal impairment

Se: memory problems
Confusion, fine tremor, n&vom, ataxia, seizures, anorexia
Metallic taste
Rash, 
Inc seratonin- so polyuria and dipsa
28
Q

Toxic effects of lithium what should you monitor

A

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

29
Q

Se of valporic acid

A

Aggression, confusion, deafness,
Extrapyramidal, convulsion, headaches, memory
GI- anaemia, diarrhoea irritation
Menstrual disturbance

30
Q

Toxic effects of sodium valproate

A

Liver toxicity

Tetatrogenic

31
Q

Interactions of sodium valproate

A

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

32
Q

Name p450 inducers

A 
CRAPS out drugs
Carbamazepine 
Rifampicin
bArbituates
Phenytoin 
St Johns wort
33
Q

Name p450 inhibitors

A

Some certain silly compounds annoyingly inhibit enzymes grrr

Sodium valproate
Ciprofloxacin
Sulphonamide 
Cimetidine, omeprazole
Antifungals, amiodarone
Isoniazid
Erythromycin, clarinthromycin
Grapefruit juice
34
Q

Se of carbamezapine

A

Cardiac toxicity

Allergic skin disease, dermatitis, fatigue, drowsy, anaemia, leukopenia, vomiting oedema

35
Q

Interactions of carbamazepine

A

P450 induced so decreases levels of OCO, warfarin, TCAs, other anticonvulsants

36
Q

Toxicity of carbamazepine

A

Cardiac diseas,e

Liver disease, caution needed

37
Q

Function of lamotrigene and its side effects

A

Mood stabilisers, that can be used in bipolar

Dizzy postural hypotension, blurred vision, coordination, rash
Risk of Steven Johnson

Monitor liver

38
Q

What can be given in acute manic episodes

A

Check mood stabilisers levels
Antipsychotics
Olanzaoine, rispiridone, aripriprazole

39
Q

Acute depressive enzymes

A

Check medication serum levels
Other medications hypothyroidism?
Add ssri or quituapine

40
Q

Medications for dementia. Which type of dementia do they treat

A

Acetyl cholinesterase inhibitors
Donepezil
Rivastigmine ((Lewy body)
Galantamine

Mild to mod dementia and Lewy body

NMDA antagonist, memantadine. Severe Alzheimer’s

41
Q

Alternative medications for people with dementia

A

TCAs for agitations

Trazadone

42
Q

First line pharmacology for ADHD
And its side effects
Other uses

A

Methylphenidate
CNS stimulants
Growth defect in children, monitor
Monitor pulse,
Nausea appetite loss insomnia, headaches,
Other uses: Tourette’s, anxiety, conduct disorders ,tics

43
Q

Alternative ADHD medications

A

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

44
Q

Antidepressants with sedative action

A

Mitrazipine

Trazodone

45
Q

Antipsychotics with sedative action

A

Promethazine

Has antihistamine ad antimuscurinc effects

46
Q

Sleeping tablets

A

Non benzos
Zopiclone and zopliedem

Benzos- lormetezepam,

47
Q

Drugs that can cause serotonin syndrome

A 
MAOIs
Other antidepressants 
Analgesics
Antiemetics, metoclopramide
Recreations, MDMA,coke
Others linozoid, tryptophan
48
Q

Features of seratonin syndrome

A

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

49
Q

Early and late signs of seratonin syndrome

A

Early- tremor akathsia (can’t sit still) diahorrhea

Late- agitation, hyper vigilance, pressure speech, acute delirium

50
Q

Differences between neuroleptic malignant syndrome and serotonin syndrome

A

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.

51
Q

Causes of NMS

A

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

52
Q

Pharmacological treatments for PTSD

A

Short term hypnotics

Antidepressants if severe
- mitrazipine
- paroxetine
Amitryptiline 
Phenelzine
53
Q

First line treatments for PTSD

A

Trauma focused CBT
EMDR- eye movement desensitisation and reprocessing

Psychoeducation
Peer support

54
Q

First line pharmacology for depression

A

SSRIs

  • fluoxetine
  • sertraline (not bipolar )

Venlafaxine
Metizapine

55
Q

First line pharmacology for depression

A

SSRIs

  • fluoxetine
  • sertraline (not bipolar )

Venlafaxine
Metizapine

56
Q

First line pharmacology for depression

A

SSRIs

  • fluoxetine
  • sertraline (not bipolar )

Venlafaxine
Metizapine

Pharm (6 decks)

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