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Psych drugs Flashcards

1
Q

Name some tricyclics

A

imipramine, dosulepin, amitriptyline, lofepramine

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2
Q

when to use tricyclics

A

Mainly chronic pain and sometimes depression

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3
Q

tricyclic mech of action

A

Block the reuptake of monoamines (mainly noradrenaline and 5-HT) into presynaptic terminals

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4
Q

when not to use tricyclics

A

In manic phase of bipolar

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5
Q

When to use SSRIs

A

Depression

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5
Q

Name some SSRIs

A

fluoxetine, citalopram/escitaloprim, sertraline

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5
Q

SSRI mech of action

A
  • Selectively inhibit reuptake of serotonin (5-HT) from the synaptic cleft
  • Escitalopram probably best all round SSRI
    • Dose dependent QT prolongation
  • Sertraline is well established, has a good cardiac safety profile and allows easy dose titration
  • Mirtazapine promotes sleep and appetite/weight gain, less likely to cause nausea or sexual side effects
  • Fluoxetine has the longest half-life so least discontinuation syndrome, only SSRI licensed for under 18s
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6
Q

SNRIs name

A

venlafaxine, duloxetine

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7
Q

Contraindications to SSRIs

A

Not in Manic phase
Give PPI if pt on NSAID
Mirtazapine if on warafarin
No if they are on triptans
No in preg

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8
Q

When to use SNRIs

A
  • Major depression
  • Generalised anxiety disorder, social anxiety disorder, panic disorder
  • Duloxetine is also good for neuropathic pain and urge incontinence
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9
Q

SSRI and SNRI side effects

A
  • GI - nausea, vomiting, dyspepsia
  • CNS - dizziness, agitation, insomnia, headache
  • Spinal - sexual dysfunction
  • Misc. - dry mouth, bleeding disorders, weight loss, hyponatraemia in elderly
  • Can cause transient increase in self-harm/suicidal ideation, especially in < 25 years
  • Also cause discontinuation effects: mood change, dizziness, nausea, diarrhoea, headache
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10
Q

SNRIs mech of action

A
  • Block the reuptake of monoamines (noradrenaline and 5-HT) into presynaptic terminals - block SERT and NET
  • May be slightly more effective than SSRIs but associated with a higher rate of adverse effects
  • Venlafaxine - SSRI at low doses, at higher doses starts targeting noradrenaline receptors
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11
Q

Contras to SNRIs

A

in uncontrolled hypertension

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12
Q

Name some atypical antidepressants

A

Mirtapine, trazodone, bupropion

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13
Q

Mirtapine mech and side effects

A
  • Mixed receptor effects - blocks ⍺2, 5-HT2 and 5-HT3
  • Side effects - weight gain (increases appetite) and sedation
  • Less of the other side effects than SSRIs or venlafaxine
  • Can be used synergistically with SSRIs and blocks serotenergic side effects
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14
Q

Name some 1st Gen dopamine antagonist (typical antipsychotics)

A

haloperidol, prochloperazine, fluphenazine, chlorpromazine, trifluperazine

15
Q

1st gen Dopamine antagonists mech of action (typical antipsychotics)

A
  • Non-selectively block D2 and other receptors
  • Reduce positive symptoms
15
Q

When to use first gen dopamine antagonists (typical antipsychotics)

A

Haloperidol is commonly used for delirium or psychosis
Others for schizo and bipolar

16
Q

1st gen Dopamine antagonists side effects (typical antipsychotics)

A

Worsen negative symps, extra-pyramydal side effects (parkinsonism, dyskinesia), Neuroleptic malig syndrome, hyperprolactinaemia, restless legs

17
Q

2nd gen dopamine antagonists (atypical antipsychotics) names

A

olanzapine, rispiridone, quetiapine, aripiprazole, clozapine, amisulpride, lurasidone

18
Q

Atypical (2nd gen) antipsychotics mech of action

A
  • Work on D2 and 5HT-3 (serotonin) to reduce side effect profile
  • Also work on H1, alpha and cholinergic
  • Reduce positive symptoms with no worsening of negative symptoms
  • Less likely to cause extra-pyramidal side effects
  • Clozapine is better for treatment non-responders
19
Q

Contras to clozapine

A
  • Strict monitoring protocol for clozapine due to side effects
    • ECG and FBC before starting
    • FBC every week for 18 weeks then every 2 weeks thereafter
    • Patient must notify if started or stopping smoking
    • Weight calculated on each visit to ensure dose remains in therapeutic range
20
Q

Atypical (2nd gen) antipsychotics side effects

A
  • Risperidone is most likely to cause EPSE and increased PRL side effects (e.g. galactorrhoea)
  • Olanzapine - metabolic syndrome
  • Quetiapine - sedation and weight gain
  • Clozapine - agranulocytosis, neutropenia, seizures, metabolic syndrome, weight gain and sedation
21
Q

Name some benzos

A

Midazolam, clonezepam

22
Q

when to use benzos

A

Short-term (2-4 weeks) management of anxiety

23
Q

benzos mech of action

A
  • Positive allosteric modulators of GABAa receptors in the CNS
  • The GABA-A receptor is an inhibitory ionotropic receptor
  • Benzodiazapines will increase the Cl- entering the neurons, resulting in membrane hyperpolarisation producing an inhibitory postsynaptic potential → reduced neuronal firing
24
Q

Contras to benzos

A
  • Avoid prolonged use - develop tolerance, are addictive
  • Avoid in pregnancy
    • Risk of foetal malformation, ‘floppy baby syndrome’, also lethargy with breastfeeding
  • Increase falls risk, can worsen delirium also
25
Q

Benzo side effects

A

Rapid action, well tolerated, efficacious but can be problems (particularly if used over 2 weeks):

  • Sedation and psychomotor impairment
  • Discontinuation/withdrawal problems
  • Dependency and abuse - hence only used for short term
  • Alcohol interaction
  • Can worsen co-morbid depression
26
Q

When to use lithium

A

Management of bipolar affective disorder:

  • Acute treatment of symptoms - to reduce mood in episodes of mania and raise mood in episodes of depression
  • Long term treatment - to stabilise mood and prevent recurrence of both mania and depression
27
Q

contras to lithium

A
  • If possible avoid in pregnancy (particularly 1st trimester) and breast feeding
    • Associated with Ebstein’s anomaly of the heart
    • Medication-free pregnancy is suggested for women with less severe illness and good supports
    • Full or partial prophylaxis with a mood stabiliser is recommended for women at higher risk of relapse
  • Drug interactions predisposing to toxicity include medications such as NSAIDs, furosemide, thiazide diuretics, ACE inhibitors and some antidepressants
28
Q

lithium side effects

A
  • Dry mouth/strange taste
  • Polydipsia and polyuria
  • Tremor
    • Fine tremor seen at therapeutic dose - coarse tremor indicates toxicity
  • Hypothyroidism
  • Long term reduced renal function
  • Nephrogenic diabetes insipidus
  • Weight gain
  • Toxic effects:
    • Vomiting
    • Diarrhoea
    • Ataxia/coarse tremor
    • Drowsiness/altered conscious level
    • Convulsions
    • Coma
29
Q

Side effects of sodium val

A

teratogenicity (neural tube defects)

Drugs (10 decks)

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