Psych: Drugs

Question 1

What is mirtazapine used to treat?

Answer 1

-Schizophrenia. (NaSSA anrtideppressant, take nocturnally)

Question 2

Psych drug classes?

Answer 2

Anti-depressants (TCAs, SSRIs, NaSSA) Mood stabilisers (Lithium, sodium valproate, carbamazepine, lamotrigine) Anti-psychotics (1G: Chlorpromazine, 2G: Clozapine). Anxiolytics and hypnotics (benzodiazepines and ‘z drugs’, eg zopiclone) ”AdMApAH”

Question 3

What is clozapine used to treat?

Answer 3

Schizophrenia Schizoaffective disorder Delusional disorder

Question 4

Clonazepam: Mechanism of action?

Answer 4

Long acting benzodiazopine

Question 5

Quetiapine: What class of drug is this?

Answer 5

2nd gen anti psychotic (and mood stabiliser)

Question 6

Duloxetine: What drug class is this?

Answer 6

Anti-depressant

Question 7

Standard first line treatment for depression?

Answer 7

Citalopram: 20mg

Question 8

Adverse effects of clozapine

Answer 8

-agranulocytosis (1%), neutropaenia (3%) -reduced seizure threshold - can induce seizures in up to 3% of patients -constipation -myocarditis: a baseline ECG should be taken before starting treatment -hypersalivation -Doesn’t have extrapyrimidal symptoms because it’s an atypical antipsychotic

Question 9

Extra-pyramidal side effects of antipsychotics?

Answer 9

“PAD Thai” -Parkinsonism -Akathisia -Dystonia, acute -Tardive dyskinesia More info: /////////////////// -Parkinsonism -Akathisia (severe restlessness) -Acute Dystonia: sustained muscle contraction (e.g. torticollis, oculogyric crisis) -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) (EPSEs may be managed with procyclidine)

Question 10

Antipsychotics in elderly patients: Main risks to consider?

Answer 10

-Increased risk of stroke -Increased risk of venous thromboembolism

Question 11

Discontinuation symptoms of SSRIs?

Answer 11

“PSI DRUG” -Paraesthesia -Sweating -Increased mood change -Difficulty sleeping -Restlessness -Unsteadiness -Gastrointestinal symptoms: pain, cramping, diarrhoea, Vomiting

Question 12

Interactions of SSRIs?

Answer 12

“BATMAN” -Blood thinners -Asthma treatment, theophylline -Triptans -MAOIs -Antiplatelets/Aspirin -NSAIDs

Question 13

Which SSRI is associated with prolonged QT interval?

Answer 13

-Citalopram

Question 14

What is Selegiline?

Answer 14

A monoamine oxidase inhibitor which are an older class of antidepressant. ////////////////////////////// These have been largely phased out due to their side effects.

Question 15

Side effects of Mirtazepine?

Answer 15

-Significant increase in appetite leading to weight gain -Significant drowsiness

Question 16

Outline the risks of SSRIs used in pregnancy

Answer 16

• 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
• Paroxetine has an increased risk of congenital malformations, particularly in the first trimester
• BNF says to weigh up benefits and risk when deciding whether to use in pregnancy.

Question 17

What is the SSRI of choice in children and adolescents?

Answer 17

-Fluoxetine

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-Discontinuation symptoms much less severe

Question 18

Clozapine: Most common side effects?

Answer 18

• Agranulocytosis
• Chronic constipation
• Weight gain
• Hyperprolactinaemia

Question 19

What is Clozapine?

Answer 19

Atypical antipsychotic

Question 20

What is olanzapine?

Answer 20

Atypical antipsychotic

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higher risk of dyslipidemia and obesity

Question 21

What is risperidone?

Answer 21

Atypical antipsychotic

Question 22

What is Quetiapine?

Answer 22

Atypical antipsychotic

Question 23

What is amisulpride?

Answer 23

Atypical antipsychotic

Question 24

What is aripriprazole?

Answer 24

Atypical antipsychotic

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generally good side-effect profile, particularly for prolactin elevation

Question 25

Metabolic side effects of antipsychotics (3)?

Answer 25

• Dysglycaemia
• Dyslipidaemia
• Diabetes Mellitus

Question 26

What effect do anti psychotics have on prolactin levels?

Answer 26

-Anti-psychotics are dopamine antagonists so would cause hyperprolactinemia, as dopamine is a prolactin antagonist.

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Anti psychotics are dopamine antagonists

Dopamine is a prolactin antagonist

Therefore. Antipsychotics reduce the reduction of prolactin, causing an increase.

Question 27

Non-extrapyramidal side effects of antipsychotics?

Answer 27

(Other side-effects)

antimuscarinic: dry mouth, blurred vision, urinary retention, constipation

sedation, weight gain

raised prolactin

may result in galactorrhoea

due to inhibition of the dopaminergic tuberoinfundibular pathway

impaired glucose tolerance

neuroleptic malignant syndrome: pyrexia, muscle stiffness

reduced seizure threshold (greater with atypicals)

prolonged QT interval (particularly haloperidol)

Question 28

What antidepressant has the most significant effect on appetite and weight gain?

Answer 28

Mirtazapine

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Mirtazapine is an antidepressant that works by blocking alpha2-adrenergic receptors, which increases the release of neurotransmitters.