Psych Drugs Flashcards by Euan Mckeating

Sodium Valproate side effects

Do NOT give unless contraception

Tiredness and Dizziness
Nausea and Diarrhoea
Hair-loss and curly regrowth

Change in blood counts
Rarely - Pancreatitis and Liver failure

CYP450 inhibitor

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Carbamazepine side effects

Consider contraception
or High dose Folic acid

10% develop mild rash
Nausea, Diarrhoea
Tiredness, Dizziness

Rarely - 1 in 200 develop serious rash
Reduced blood count causing infection

CYP450 Inducer

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Lamotrigine side effects

Stevens-Johnsons syndrome

Nausea, Diarrhoea
Tiredness, Dizziness

Rarely - very serious rash

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Lithium common side effects:

First: Tiredness
Dry mouth
Metallic taste in the mouth
Slight shaking of hands

Later: More thirsty
Urinating more often
Weight gain
Under-active thyroid gland

Rarely - lithium toxicity if the levels get too high

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Lithium toxicity:

Feel very thirsty 
Bad diarrhoea and vomiting 
Obvious shaking of hands and legs
Twitching of muscles
Confusion

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Sensible precautions when taking lithium:

Lithium is a safe drug when taken at the correct dose

Drink plenty of non alcoholic fluids
Avoid low salt diets
Be careful when exercising and in hot climates
Don’t use saunas

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Monitoring for lithium

To check the levels of lithium in blood
and to check kidney and thyroid function

Taken every week at first or if dose change
Exactly 12 hours after the last dose
Once levels are stable - every 3 - 4 months

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Olanzapine side effects

Very high metabolic
Weight gain +++
Diabetes +++

Medium Sedation ++

Low Prolactin +
Hypotension +
Anti-cholinergic +
Very little ExP +/-

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Risperidone side effects

Very high Prolactin +++

Medium Metabolic
Weight gain ++
Diabetes +

Hypotension ++
ExP +
Anticholinergic +
Sedation +

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Aripiprazole side effects

Very little side effects

Weight gain +/-
ExP +/-

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Amisulpride side effects

Very high Prolactin +++

Weight gain +
Diabetes +
ExP +

Sedation -
Anticholinergic -
Hypotension -

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Chlorpromazine side effects

Sedation +++
Hypotension +++
Prolactin +++

ExP ++
Weight gain ++
Diabetes ++
Anticholinergic ++

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Haloperidol side effects

Very high ExP +++
Very high Prolactin +++

Sedation +
Hypotension +
Anticholinergic + 
Weight gain +
Diabetes +/-

Prolonged Q/T interval

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Clozapine side effects

Sedation +++
Weight gain +++
Diabetes +++
Anti cholinergic +++
Hypotension +++

ExP -
Prolactin -

Monitor white cell count - agranulocytosis

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What are the extra pyramidical side effects?

Parkinsonism
Acute dystonia (e.g. torticollis, oculogyric crisis)
Akathisia - severe restlessness
Tardive dyskinesia

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What are the anticholinergic side effects?

Can’t see - blurred vision
Can’t pee - urinary retention
Can’t spit - dry mouth
Can’t shit - constipation

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Gabapentin

Tiredness and Dizziness

Nausea, Vomitting
Weight gain and increase in appetite
Ankle swelling
Sexual dysfunction

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Pregabalin side effects

Tiredness and Dizziness

Nausea, Vomiting
Weight gain and increase in appetite
Ankle swelling
Sexual dysfunction

Gabapentin side effects

Tiredness and Dizziness

Nausea, Vomitting
Weight gain and increase in appetite
Ankle swelling
Sexual dysfunction

What do antipsychotics increase the risk of in the elderly?

increased risk of stroke

increased risk of venous thromboembolism

What do antipsychotics increase the risk of in the elderly?

increased risk of stroke

increased risk of venous thromboembolism

What is Neuroleptic malignant syndrome?

Pyrexia
Tachycardia
Lead pipe Rigidity
Reduced reflexes
Normal pupils

After starting antipsychotics - reduction in dopamine
Onset usually in first 10 days or after increasing dose
More common in young men
Mx: supportive - IV fluids

What is Serotonin syndrome?

Pyrexia
Tachycardia
Rigidity
Increased reflexes 
Dilated pupils

After taking SSRIs, MAOs, MDMA
Onset usually hours after taking
Mx: supportive - IV fluids, benzodiazepines

Amitriptyline, Clomipramine and

Dosulepin side effects:

Sedating TCAs = Drowsiness

Can’t see - blurred vision
Can’t pee - urinary retention
Can’t spit - dry mouth
Can’t shit - constipation

High risk of death in overdose

Imipramine, Lofepramine and Nortriptyline:

``` Less sedating TCAs but some Drowsiness Can't see - blurred vision Can't pee - urinary retention Can't spit - dry mouth Can't shit - constipation ``` High risk of death in overdose

What are the features of TCA overdose?

Sedation -> Coma -> Seizures Tachycardia -> arrhythmias Metabolic acidosis ECG- sinus tachycardia widening of QRS prolongation of QT interval

What dose of amitriptyline is dangerous in overdose?

>10 mg/kg is potentially life-threatening. >30 mg/kg is expected to result in severe toxicity with pH-dependent cardiotoxicity and coma lasting >24 hours

Management of TCA overdose:

ABCDE - supportive Antidotes: IV Bicarbonate If seizures - Benzodiazepines

Fluoxetine side effects:

Agitation Insomnia- take in the morning Sexual dysfunction Nausea Thoughts of self harm in first weeks Highest risk of drug interactions

Sertraline side effects:

Nausea and Diarrhoea Sexual dysfunction Insomnia - take in the morning Thoughts of self harm in first weeks

Benefits of Fluoxetine over Sertraline:

More evidence to support it Less nausea and Diarrhoea Lower risk of weight gain Fewer discontinuation symptoms

Benefits of Sertraline over Fluoxetine:

Considered to be better tolerated Lower risk of drug interactions than Fluoxetine Safer during breastfeeding Safer post MI

SSRI of choice in children:

Fluoxetine

What is the risk of citalopram over other SSRIs?

Q/T elongation

Which SSRI has the worst discontinuation symptoms?

Paroxetine due to short half life

Venlafaxine:

``` SNRI = Dizziness and hypotension Headache Tiredness Nausea Sexual dysfunction ``` Thoughts of self harm in the first weeks

Duloxetine:

``` SNRI = Dizziness and hypotension Headache Tiredness Nausea Sexual dysfunction ``` Thoughts of self harm in the first weeks

Mirtazapine:

NaSSA = Sleepiness Dizziness Weight gain Dry mouth Thoughts of self harm in the first weeks

What investigations need to be performed before starting lithium?

Bedside: Weight, ECG, Pregnancy test Blood: FBC, U&Es, TFTs, Calcium

What investigations should be performed before starting antipsychotics?

Bedside: ECG, BMI, Weight + Waist, BP, Pulse, Bloods: FBC, U&Es, LFTS, TFTs, BM, Lipids and cholesterol, HbA1C, Prolactin

Pregnancy in Lithium:

Ebstein's anomaly a congenital heart defect characterised by low insertion of the tricuspid valve resulting in a large atrium and small ventricle. It is sometimes referred to as 'atrialisation' of the right ventricle.

Pregnancy and SSRIs:

Weight up the risk/benefit Use in first trimester gives a small increased risk of congenital heart defects Use in third trimester can result in persistent pulmonary hypertension of the newborn

If a patient is on triptans for migraine, what drugs should be avoided?

SSRIs

If a patient is taking warfarin or heparin, what drug should be used to treat depression?

Avoiding SSRIs Considering Mirtazapine