Psych Flashcards
What are the indicators of first generation antipsychotics and some examples?
psychomotor agitation, nausea and vomiting
schizophrenia, bipolar
haloperidol, chlopromazapine, prochlorperazine
What is the mechanism of action for haloperidol?
block post-synaptic D2 receptors
What are some adverse affects of haloperidol?
extrapyramidal
acute dystonic reactions - parkinsonian movements, akathisia
neuroleptic malignant syndrome - rigidity, confusion
drowsy, hypotension, QT prolongation, erectile dysfunciton
What are some warnings of haloperidol?
elderly, dementia, PD
What are important interactions of haloperidol?
drugs that prolong QT e.g. amiodarone
Name some acetylcholinesterase inhibitors and how they work
donepezil, rivastigmine
increase the availability of acetylcholine which improves cognitive function and slows rate of cognitive decline
What is the indication for acetylcholinesaterase inhibitors?
alzheimer’s disease and dementia in PD
What are some adverse effects of acetylcholinesterase inhibitors?
nausea, diarrhoea, vomiting
asthma and COPD can worsen symptoms
peptic ulcers, bleeding, bradycardia, heart block
hallucinations, aggressive behaviour
extrapyramidal symptoms, neuroleptic malignant syndrome
What are some warnings with acetylcholinesterase inhibitors?
asthma, COPD
peptic ulcer
heart block
PD disease
What are some important interactions with acetylcholinesterase inhibitors?
NSAIDs, corticosteroids can increase risk of peptic ulcers
antipsychotics can worsen risk of neuroleptic malignant syndrome
What are the indications of amitriptyline?
second line depression treatment?
What is the mechanism of action of amitriptyline?
inhibits neuronal reuptake of 5-HT and noradrenaline
What are some adverse reactions of amitriptyline?
antimuscarinic - dry mouth, constipation, urinary retention, hypotension arrhthymias convulsions, hallucinations breast changes, sexual dysfunction extrapyramidal symptoms overdose, withdrawal
What are some warnings of amitriptyline?
elderly patients, epilepsy, CVS prostatic hypertrophy, glaucoma, constipation
What are some interactions of amitriptyline?
monoamine oxidase inhibitors
can augment antimuscarinic, sedative or hypotension
What are examples of SSRIs and how does it work?
citalopram, fluoxetine, sertraline, escitalopram
inhibits neuronal reuptake of 5-HT
What are indications of SSRIs?
depression
panic disorder
OCD
What are important adverse reactions of SSRIs?
GI upset, appetite, hypersensitivity hyponatraemia suicidal thoughts and behaviour lower seizure threshold prolong QT increase risk of bleeding serotonin syndrome sudden withdrawal
What are warnings of SSRs?
epilepsy
peptic ulcer disease
young people
hepatic impairment
What are interactions with SSRIs?
monoamine oxidase inhibitors serotonergic drugs gastroprotection with SSRIs drugs that prolong QT bleeding risk with anticoagulants
What are indications of venlafaxine and mirtazapine?
depression, GAD
What are mechanism of action of venlafaxine and mirtazapine?
increase availability of monoamines for neurotransmission
What are adverse efects of venlafaxine and mirtazapine?
GI upset, neuro effects hyponatraemia, serotonin syndrome suicide long QT sudden drug withdrawal
What are warnings of venlafaxine and mirtazapine?
elderly
hepatic or renal impairment
arrhythmias
What are important interactions of venlafaxine and mirtazapine?
serotonin syndrome
What is necessary with lithium prescribing?
keep same brand
What needs monitoring if prescribed lithium?
thyroid and renal function BMI calcium - do at baseline and every 6 months serum lithium concentration - every 3 months
What are some examples of second generation antipsychotics, what are they used for and how do they work?
quetiapine, olanzapine, risperidone, clozapine
to treat psychomotor agitation, schizoprenia, bipolar
blocks post-synaptic dopamine D2 receptors
What are some important adverse effects of second generation antipsychotics?
sedation extrapyramidal effects metabolic disturbance -weight gain prolong QT breast symptoms, sexua dysfunction clozapine - reduces neutrophils, myocarditis
What are some warnings and interactions of second generation antipsychotics?
cardiovascular disease, neutropenia
don’t prescribe with other drugs that block dopamine or prolong QT interval
What are some examples of benzodiazepines and what are they used for?
diazepam, tamazepam, lorazepam, chlordiazepoxide, midazolam
first line seizures, alcohol withdrawal, sedation, anxiety and insomnia
What are some adverse reactions of benzos?
drowsy, sedation, coma, overdose, airway obstruction, death, dependence and withdrawal
What are some warnings and interactions of benzos?
caution in elderly
avoid in respiratory impairment, NM disease, liver failure
don’t give with other sedating drugs
need CYP to be elimnated
