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Psychiatry > Psych drugs > Flashcards

Psych drugs Flashcards

1
Q

Lithium monitoring drugs to order

A

U&Es: every 6 mo
TFTs: every 6 mo
Lithium levels

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2
Q

Side effects of lithium

A 
increased thirst
dry mouth
metallic taste
Weight gain
Then usual systemic upset
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3
Q

Symptoms of lithium toxicity

A
  • severe tremor/twitching
  • vomiting/diarrohoea
  • confusion
  • gait imbalance
  • blurred vision
  • coma
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4
Q

Lithium in pregnancy

A
  • First 3 months are vital
  • weight up risks and benefits, done by specialist doctor
  • heart malformations, Epstein anomaly
  • No breastfeeding
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5
Q

Why must you do an ECG prior to starting sertraline

A

Can cause long QT

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6
Q

Why should we be cautious when prescribing anti-psychotics in the elderly

A

increased risk of stroke

Increased risk of VTE

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7
Q

What is tardive dyskinesia

A

(late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)

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8
Q

What are types of extra-pyramidal side effects

A

Parkinsonism
acute dystonia
akathisia
tardive dyskinesia

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9
Q

What is akathisia

A

severe restlessness

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10
Q

How can we manage extra-pyramidal SE

A

procyclidine

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11
Q

Which psychotics are responsible for causing the msot problems with extra-pyramidal side effects

A

Typical anti-psychotics e.g.

  • haloperidol
  • chlorpromazine
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12
Q

Common side effects of anti-psychotics

A
  • Antimuscarinic: dry mouth, blurred vision, urinary retention, constipation
  • sedation, weight gain
  • raised prolactin: galactorrhoea, impaired glucose tolerance
  • neuroleptic malignant syndrome:
  • reduced seizure threshold (greater with atypicals)
  • prolonged QT interval (particularly haloperidol)
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13
Q

What are the features of neuroleptic malignant syndrome

A

pyrexia
muscle stiffness
confusion

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14
Q

How do benzodiazepines work

A

Benzodiazepines enhance the effect of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA)
- Increase frequency of chloride channels

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15
Q

What are benzodiazepines commonly used for

A 
sedation
hypnotic
anxiolytic
anticonvulsant
muscle relaxant
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16
Q

How do you stop someone on benzodiazepines

A

With draw slowly, reducing 1/8 dose every 2 weeks

17
Q

What are the withdrawal symptoms from benzodiazepines

A 
insomnia
irritability
anxiety
tremor
loss of appetite
tinnitus
perspiration
perceptual disturbances
seizures
18
Q

How do barbiturates work

A

increase the duration of chloride channel opening

19
Q

What are the main side effects of atypical antipsychotics

A
  • weight gain
  • clozapine: agranulocytosis (see below)
  • hyperprolactinaemia
20
Q

What are examples of atypical anti-psychotics

A 
clozapine
olanzapine: higher risk of dyslipidemia and obesity
risperidone
quetiapine
amisulpride
aripiprazole:
21
Q

Which atypical anti-psychotic has the most tolerated side effect profile

A

aripiprazole: generally good side-effect profile, particularly for prolactin elevation

22
Q

What rae the adverse effects of clozapine

A
  • agranulocytosis (1%), neutropaenia (3%)
  • reduced seizure threshold - can induce seizures in up to 3% of patients
  • constipation
  • myocarditis: a baseline ECG
  • hypersalivation
23
Q

What might have an impact on dosing of clozapine

A

smoking

24
Q

What type of drug is mirtazapine

A

blocking alpha2-adrenergic receptors,

25
Q

Who should be given mirtazepine

A
  • older people, few drug interactions
  • underweight: increases appetite
  • Can’t sleep: sedation
26
Q

Risk of using SSRIs in pregnancy

A
  • First trimester: small risk of congenital heart defects
  • third trimester: persistent pulmonary hypertension of the newborn
  • Paroxetine: increased risk of congenital malformations, particularly in the first trimester
27
Q

How often should you take litium levels

A
  • Weekly after each dose until levels stable
  • Then every 3 months
  • after a change in dose, lithium levels should be taken a week later and 12 hours after the last dose
28
Q

What should all patients on lithium be issued with

A
  • information booklet
  • alert card
  • record book
29
Q

What ECG changes may you see in lithium

A

T wave flattening/inversion

30
Q

What may lithium do to the kidneys

A
  • polyuria: secondary to nephrogenic diabetes insipidus
  • thyroid enlargement
  • may lead to hypothyroidism
31
Q

Side effects of SSRIs

A
  • Nausea & vomiting
  • Dizziness
  • Blurred vision
  • tired/lethargic
  • erectile dysfunction
  • sometimes problems with urination
32
Q

Which SSRI is most safe in cardiac disease

A

sertraline

Psychiatry (6 decks)

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