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Year 4 > Psych Drugs > Flashcards

Psych Drugs Flashcards

1
Q

what can antidepressants be used for?

A

depression
anxiety disorders
bulimia
neuropathic pain

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2
Q

classifications of antidepressants?

A

monoamine oxidase inhibitors
monoamine reuptake inhibitors
atypical antidepressants

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3
Q

types of monoamine oxidase inhibitor?

A

phenelzine (non-selective)
moclobemide (selective)
(not used often)

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4
Q

groups of monoamine reuptake inhibitors?

A

tricyclics
SSRIs (first line generally)
serotonin + noradrenaline reuptake inhibitors (SNRIs)

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5
Q

types of tricyclics?

A 
amitriptyline 
notriptyline
imipramine 
lofepramine
clomipramine
dosulepin
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6
Q

types of SSRI?

A 
fluoxetine
escitalopram
citalopram 
sertraline
paroxetine
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7
Q

which SSRI is avoided in people with cardio problems and why?

A

citalopram

risk of prolonged QT (esp when combined with other drugs)

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8
Q

which SSRIs are used first in young people?

A 
fluoxetine = 1st
sertraline = 2nd
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9
Q

side effects of SSRIs?

A 
sexual dysfunction
vivid dreams
increased suicidal ideation in under 25s
nausea
headache 
can cause anxiety in first couple weeks
sweating
hyponatraemia (can be significant in elderly)
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10
Q

types of serotonin + noradrenaline reuptake inhibitor (SNRI)?

A

venlafaxine

duloxetine

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11
Q

types of atypical antidepressants?

A

mirtazepine (mixed receptor effect)

bupropion (dopamine uptake inhibitor)

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12
Q

general side effects of monoamine oxidase inhibitors?

A

can cause hypertensive crisis when combined with tyramine containing foods (eg red wine, cheese etc)
insomnia
postural hypotension
peripheral oedema

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13
Q

general side effects of tricyclics?

A 
anticholinergic effects - dry mouth, urinary retention, dry eyes, blurred vision, constipation
sedation
weight gain
postural hypotension
tachycardia
cardiotoxic in overdose
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14
Q

how do tricyclics work?

A

block reuptake of monoamines into pre-synaptic terminals

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15
Q

how do SSRIs work?

A

block reuptake of serotonin

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16
Q

what are the monoamines?

A

serotonin
noradrenaline
dopamine?

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17
Q

effects of stopping SSRIs?

A 
flu-like symptoms
insomnia
nausea
imbalance
sensory disturbance (hyperarousal)
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18
Q

side effects of SNRIs?

A

same as SSRIs

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19
Q

how does mirtazepine work and what are its side effects?

A

blocks alpha 2, 5-HT2 and 5-HT3

causes sedation and weight gain

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20
Q

what is serotonin syndrome?

A

too much serotonin in the synapses, usually due to drug effects

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21
Q

what drugs can cause serotonin syndrome?

A

antidepressants
analgesics (tramadol etc)
antiemetics
recreational drugs

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22
Q

symptoms of serotonin syndrome?

A 
autonomic instability (fluctuating BP, HR and temp, sweating etc)
neuromuscular abnormality (tremor, clonus, hypertonic, hyperreflexia)
mental state changes (delirium, agitation, pressured speech, confusion, coma etc)
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23
Q

what can serotonin syndrome be confused with?

A

catatonia
neuroleptic malignant syndrome
organic causes

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24
Q

how is serotonin syndrome managed?

A

stop causative drug

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25
Q

overall summary of depression management?

A

1st line = SSRI
2nd line = switch to another SSRI or SNRI
3rd line = switch to mirtazepine or augment SSRI/SNRI with another drug
4th line = try a different augmentation drug

26
Q

what drugs can SSRIs/SNRIs be augmented with?

A 
mirtazepine
antipsychotics (atypicals)
lithium
T3
bupropion
27
Q

risks when using 2 antidepressants?

A

serotonin syndrome

28
Q

how do you start treatment with antidepressants?

A

start drug an titrate to effective dose (often around 20mg)
reassess after 2 weeks of effective dose
if dose is effective then continue for 6-9 months

29
Q

what do you do if no effect after 2 weeks of antidepressants?

A

reassess after another 1-2 weeks then consider increasing dose if still no improvement
if still no effect after dose increase then change drug

30
Q

how is panic disorder managed?

A

1st line = SSRI
2nd line = tricyclics
also do CBT
(dont use benzodiazepines?)

31
Q

how is GAD managed?

A

1st line = SSRI
2nd line = SNRI or pregabalin benzodiazepines for acute episodes
also do CBT

32
Q

how is OCD managed?

A

1st line = intensive CBT + exposure response therapy (+/- SSRI)
2nd line = clomipramine
3rd line = clomipramine + citalopram, may add atypical antipsychotic

33
Q

how do benzodiazepines work?

A

block GABA receptors

34
Q

effects of benzodiazepines?

A

hypnosis/sedation
muscle relaxant
anticonvulsant
anterograde amnesia

35
Q

symptoms of benzodiazepines withdrawal?

A 
abdo cramps
anxiety/panic attacks
physical symptoms (muscle tension, pain, palpitations, sweating, shaking)
blurred vision
depression
insomnia
dizziness
headache
difficulty concentrating
nausea and vomiting
tingling in hands and feet
restlessness
sensory sensitivity
36
Q

main risk of lithium?

A

narrow therapeutic window so can cause toxicity

therefore need to monitor bloods

37
Q

side effects of lithium?

A 
dry mouth
metallic taste
polyuria and polydipsia
fine tremor
hypothyroid
long term renal dysfunction
weight gain
nephrogenic diabetes insipidus
38
Q

effects of lithium toxicity?

A 
vomiting
diarrhoea
ataxia
course tremor
drowsiness
convulsions
39
Q

what are the 3 main anticonvulsants?

A

sodium valproate
lamotrigine
carbamazepine

40
Q

side effects of sodium valproate?

A 
drowsiness
ataxia
cardio effects
hepatic enzyme inducer
teratogenic (neural tube defects)
41
Q

side effects of carbamazepine?

A

drowsiness
ataxia
cardio effects
hepatic enzyme inducer

42
Q

side effects of lamotrigine?

A

small risk of stevens johnson syndrome

43
Q

how do antipsychotics work in general?

A

dopamine antagonists + 5-HT antagonists

44
Q

general side effects of antipsychotics?

A

sedation
weight gain
metabolic syndrome
extra-pyramidal effects

45
Q

extra-pyramidal effects?

A

dystonia (sustained contraction)
akathisia (restlessness)
parkinsonism
tardive dyskinesia

46
Q

how do atypical antipsychotics work?

A

block dopamine and 5-HT

47
Q

why are atypical antipsychotics generally better than typical ones?

A

less likely to cause extra-pyramidal side effects

better efficacy against negative symptoms

48
Q

types of atypical antipsychotics?

A 
olanzapine
quetiapine
risperidone
clozapine
aripiprazole
amisulpride
49
Q

which atypical antipsychotic should generally be avoided in people with cardio risk factors (overweight, diabetic, high cholesterol, high BP etc)

A

olanzapine
causes weight gain and increased triglycerides and cholesterol
increased blood glucose

50
Q

general rule for antipsychotic prescribing in schizophrenia?

A

try 2 atypicals first then clozapine if not working

51
Q

when is clozapine used?

A

treatment resistant schizophrenia

52
Q

risks of clozapine?

A

agranulocytosis (immediate FBC if they get a sore throat)
myocarditis and cardiomyopathy
long QT

53
Q

side effects of clozapine?

A 
dizziness/drowsiness
hypersalivation
erectile dysfunction
hyperprolactinaemia 
hypotension
54
Q

management of acute bipolar presentation?

A
  1. stop antidepressant
  2. consider antipsychotic (if not already taking anti-manic drug)
  3. check anti-manic drug dose and compliance, increase dose, add lithium/valproate, and can add antipsychotic and short acting benzo if needed (if already taking anti-manic drug)
55
Q

steps in long term management of bipolar?

A
  1. lithium
  2. valproate (not in young women) or olanzapine/quetiapine
  3. alternative antipsychotic, carbamazepine, lamotrigine
    try to avoid long term antidepressant if possible
56
Q

how is schizophrenia management initiated?

A
  1. atypical antipsychotic and reassess after 2-3 weeks, if effective then continue for 18 months - 2 years
  2. try another antipsychotic (typical or atypical) and reassess after 2-3 weeks, if effective then continue for 18 months - 2 years
  3. clozapine
57
Q

what defines treatment resistant schizophrenia?

A

no response to 2 antipsychotics including an atypical one

58
Q

how is dopamine related to schizophrenia?

A

drug which release dopamine produce psychotic like state

therefore amphetamines and levodopa etc can make schizophrenia worse

59
Q

what is neuroleptic malignant syndrome?

A

rare but serious side effect of dopamine blockade which can occur in use of antipsychotics

60
Q

how is neuroleptic malignant syndrome managed?

A

stop drug therapy

dopamine agonist used to reverse blockade

61
Q

symptoms of neuroleptic malignant syndrome?

A 
fever
tachycardia
irregular pulse
tachypnoea 
altered mental state
muscle rigidity
autonomic dysfunction (can have high or low BP)

Year 4 (83 decks)

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