Psych drugs Flashcards
Lithium monitoring drugs to order
U&Es: every 6 mo
TFTs: every 6 mo
Lithium levels
Side effects of lithium
increased thirst dry mouth metallic taste Weight gain Then usual systemic upset
Symptoms of lithium toxicity
- severe tremor/twitching
- vomiting/diarrohoea
- confusion
- gait imbalance
- blurred vision
- coma
Lithium in pregnancy
- First 3 months are vital
- weight up risks and benefits, done by specialist doctor
- heart malformations, Epstein anomaly
- No breastfeeding
Why must you do an ECG prior to starting sertraline
Can cause long QT
Why should we be cautious when prescribing anti-psychotics in the elderly
increased risk of stroke
Increased risk of VTE
What is tardive dyskinesia
(late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)
What are types of extra-pyramidal side effects
Parkinsonism
acute dystonia
akathisia
tardive dyskinesia
What is akathisia
severe restlessness
How can we manage extra-pyramidal SE
procyclidine
Which psychotics are responsible for causing the msot problems with extra-pyramidal side effects
Typical anti-psychotics e.g.
- haloperidol
- chlorpromazine
Common side effects of anti-psychotics
- 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)
What are the features of neuroleptic malignant syndrome
pyrexia
muscle stiffness
confusion
How do benzodiazepines work
Benzodiazepines enhance the effect of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA)
- Increase frequency of chloride channels
What are benzodiazepines commonly used for
sedation hypnotic anxiolytic anticonvulsant muscle relaxant
How do you stop someone on benzodiazepines
With draw slowly, reducing 1/8 dose every 2 weeks
What are the withdrawal symptoms from benzodiazepines
insomnia irritability anxiety tremor loss of appetite tinnitus perspiration perceptual disturbances seizures
How do barbiturates work
increase the duration of chloride channel opening
What are the main side effects of atypical antipsychotics
- weight gain
- clozapine: agranulocytosis (see below)
- hyperprolactinaemia
What are examples of atypical anti-psychotics
clozapine olanzapine: higher risk of dyslipidemia and obesity risperidone quetiapine amisulpride aripiprazole:
Which atypical anti-psychotic has the most tolerated side effect profile
aripiprazole: generally good side-effect profile, particularly for prolactin elevation
What rae the adverse effects of clozapine
- agranulocytosis (1%), neutropaenia (3%)
- reduced seizure threshold - can induce seizures in up to 3% of patients
- constipation
- myocarditis: a baseline ECG
- hypersalivation
What might have an impact on dosing of clozapine
smoking
What type of drug is mirtazapine
blocking alpha2-adrenergic receptors,
Who should be given mirtazepine
- older people, few drug interactions
- underweight: increases appetite
- Can’t sleep: sedation
Risk of using SSRIs in pregnancy
- 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
How often should you take litium levels
- 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
What should all patients on lithium be issued with
- information booklet
- alert card
- record book
What ECG changes may you see in lithium
T wave flattening/inversion
What may lithium do to the kidneys
- polyuria: secondary to nephrogenic diabetes insipidus
- thyroid enlargement
- may lead to hypothyroidism
Side effects of SSRIs
- Nausea & vomiting
- Dizziness
- Blurred vision
- tired/lethargic
- erectile dysfunction
- sometimes problems with urination
Which SSRI is most safe in cardiac disease
sertraline
