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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
overall summary of depression management?
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
what drugs can SSRIs/SNRIs be augmented with?
``` mirtazepine antipsychotics (atypicals) lithium T3 bupropion ```
27
risks when using 2 antidepressants?
serotonin syndrome
28
how do you start treatment with antidepressants?
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
what do you do if no effect after 2 weeks of antidepressants?
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
how is panic disorder managed?
1st line = SSRI 2nd line = tricyclics also do CBT (dont use benzodiazepines?)
31
how is GAD managed?
1st line = SSRI 2nd line = SNRI or pregabalin benzodiazepines for acute episodes also do CBT
32
how is OCD managed?
1st line = intensive CBT + exposure response therapy (+/- SSRI) 2nd line = clomipramine 3rd line = clomipramine + citalopram, may add atypical antipsychotic
33
how do benzodiazepines work?
block GABA receptors
34
effects of benzodiazepines?
hypnosis/sedation muscle relaxant anticonvulsant anterograde amnesia
35
symptoms of benzodiazepines withdrawal?
``` 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
main risk of lithium?
narrow therapeutic window so can cause toxicity | therefore need to monitor bloods
37
side effects of lithium?
``` dry mouth metallic taste polyuria and polydipsia fine tremor hypothyroid long term renal dysfunction weight gain nephrogenic diabetes insipidus ```
38
effects of lithium toxicity?
``` vomiting diarrhoea ataxia course tremor drowsiness convulsions ```
39
what are the 3 main anticonvulsants?
sodium valproate lamotrigine carbamazepine
40
side effects of sodium valproate?
``` drowsiness ataxia cardio effects hepatic enzyme inducer teratogenic (neural tube defects) ```
41
side effects of carbamazepine?
drowsiness ataxia cardio effects hepatic enzyme inducer
42
side effects of lamotrigine?
small risk of stevens johnson syndrome
43
how do antipsychotics work in general?
dopamine antagonists + 5-HT antagonists
44
general side effects of antipsychotics?
sedation weight gain metabolic syndrome extra-pyramidal effects
45
extra-pyramidal effects?
dystonia (sustained contraction) akathisia (restlessness) parkinsonism tardive dyskinesia
46
how do atypical antipsychotics work?
block dopamine and 5-HT
47
why are atypical antipsychotics generally better than typical ones?
less likely to cause extra-pyramidal side effects | better efficacy against negative symptoms
48
types of atypical antipsychotics?
``` olanzapine quetiapine risperidone clozapine aripiprazole amisulpride ```
49
which atypical antipsychotic should generally be avoided in people with cardio risk factors (overweight, diabetic, high cholesterol, high BP etc)
olanzapine causes weight gain and increased triglycerides and cholesterol increased blood glucose
50
general rule for antipsychotic prescribing in schizophrenia?
try 2 atypicals first then clozapine if not working
51
when is clozapine used?
treatment resistant schizophrenia
52
risks of clozapine?
agranulocytosis (immediate FBC if they get a sore throat) myocarditis and cardiomyopathy long QT
53
side effects of clozapine?
``` dizziness/drowsiness hypersalivation erectile dysfunction hyperprolactinaemia hypotension ```
54
management of acute bipolar presentation?
1. stop antidepressant 2. consider antipsychotic (if not already taking anti-manic drug) 2. 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
steps in long term management of bipolar?
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
how is schizophrenia management initiated?
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
what defines treatment resistant schizophrenia?
no response to 2 antipsychotics including an atypical one
58
how is dopamine related to schizophrenia?
drug which release dopamine produce psychotic like state | therefore amphetamines and levodopa etc can make schizophrenia worse
59
what is neuroleptic malignant syndrome?
rare but serious side effect of dopamine blockade which can occur in use of antipsychotics
60
how is neuroleptic malignant syndrome managed?
stop drug therapy | dopamine agonist used to reverse blockade
61
symptoms of neuroleptic malignant syndrome?
``` 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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