Psych Drugs Flashcards
Name the pathway responsible for +ve SZ symptoms
Mesolimbic pathway
Ventral Tegmental Area -> Nucleus Accumbens
Improvement when reduced DA due to APs
Name the pathway responsible for -ve SZ symptoms
Mesocortical pathway
Ventral Tegmental Area -> Cortex
Worsen when reduced DA due to APs
Name the pathway responsible for EPSEs
Nigrostriatal pathway
Substantia Nigra -> Striatum
Parkinsonian Sx when reduced DA due to APs
Parkinsonian Sx examples (3)
Cog-wheel rigidity
Mask facies
Resting tremor
Name the pathway responsible for hyperprolactinaemia
Tuberofundibular pathway
Hypothalamus -> Pituitary Gland
Increased prolactin when reduced DA due to APs
Effects of hyperprolactinaemia (4)
Amenorrhoea - due to decreased FSH
Galactorrhoea
Gynaecomastia
Sexual dysfunction
Two examples of FGAs
Haloperidol
Chlorpromazine
Mechanism of action of FGAs
Inhibit D2 receptors
What receptors are also blocked by FGAs
HAM-1
Histamine-1 block -> weight gain and sedation
Alpha-1 block -> orthostatic hypotension and sexual dysfunction
Muscarinic-1 block -> dry mouth etc
Mechanism of action of SGAs
Inhibit D2 and 5-HT2a receptor
How do SGAs reduce EPSEs?
5-HT2a block causes a slight increase in dopamine production, preventing complete blockade of D2 receptors
60% D2 block = therapeutic level
80% D2 block = EPSEs
S/Es of SGAs
WEIGHT GAIN - esp Olanzapine (HAM-1 block)
Dyslipidaemia - may need statin
Hyperprolactinaemia - esp. Risperidone
Agranulocytosis - Clozapoine
Features and treatment of acute dystonia
Features = sustained muscle contraction eg. occulogyric crisis, torticollis
Treatment = Procylidine (anticholinergic)
Features and treatment of akathisia
Features = unbearable restlessness, pacing, tapping
Treatment = propranolol
Features and treatment of tardive dyskinesia
Features = lip smacking, repetitive and uncontrolled movements
Treatment = Tetrabenzine and discontinue AP
Clozapine may help
Features of Neuroleptic Malignant Syndrome (4)
And blood test features (3)
Features = fever, tachycardia, muscle rigidity and confusion
Blood tests = increased CK, K+ and WBC
Treatment of Neuroleptic Malignant Syndrome
3D’s
Discontinue AP
Dantrolene - protective for ANS
DA-agonist
What investigations do you need before starting APs (10)
FBC U+E LFT HbA1c Prolactin Lipids Weight BP ECG Waist circumference
How long to trial an SSRI for before changing?
4 weeks - if no response consider changing
S/Es of SSRIs that you need to tell patients (5)
N&V - will stop after few weeks
Sexual dysfunction
Short-term anxiety - will go after few weeks
Suicidal ideation - give phone numbers
Serotonin Syndrome
Other SSRI S/Es to bear in mind (2)
GI bleeds - careful with elderly
Hyponatraemia - check renal function
What are the features of Serotonin Syndrome?
Restlessness Fever Tachycardia Myoclonus Confusion Vomiting Seizures
