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Prescribing PSA / Management > Psych drugs > Flashcards

Psych drugs Flashcards

1
Q

Someone with BPAD has tried quetiapine but it’s been ineffective. What’s the next step?

A

Try another of the oral antipsychotics from quetiapine, olanzapine, risperidone, haloperidol

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2
Q

Which TCA is commonly used for neuropathic pain and headache prophylaxis?

A

amitriptyline

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3
Q

Presentation of serotonin syndrome

A
  • Tachycardia, HTN, fever
  • Rigidity, clonus
  • Increased reflexes
  • Dilated pupils
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4
Q

Mx of neuroleptic malignant syndrome

A
  • stop antipsychotic
  • admit to medical ward / ICU
  • IV fluids (monitor U+Es as risk of AKI from rhabdomyolysis)
  • Dantrolene / bromocriptine if severe
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5
Q

Give 4 side effects on starting lithium

A

Initially: nausea, diarrhoea, vertigo, muscle weakness, ‘dazed’ feeling, fine tremor, polyuria, polydipsia

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6
Q

Can you breastfeed if you have BPAD?

A

Yes except if taking lithium

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7
Q

What 3 things need monitoring specifically if taking clozapine / olanzapine and why?

A

FBC for clozapine bc of neutropenia / agranulocytosis

Smoking bc stopping can increase the doses

At 1 month measure plasma glucose / HbA1c

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8
Q

Give 2 examples of SNRIs

A

Duloxetine

Venlafaxine

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9
Q

What are the - hyperprolactinaemia Sx seen from antipsychotics?

A

Galactorrhoea, amenorrhoea, gynaecomastia, hypogonadism, sexual dysfunction, osteoporosis

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10
Q

What are the extrapyramidal Sx seen from antipsychotics? Which types of antipsychotics have these side effects more often?

A

dystonic reactions, akathisia, tardive dyskinesia, oculogyric crisis, pseudoparkinsonism

More common with 1st generation (typicals)

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11
Q

Give 3 examples of when to avoid lithium

A 
o	Cardiac rhythm disorders
o	Sig. renal impairment
o	Untreated/untreatable hypothyroidism
o	Low sodium
o	Hx of DI
o	Addison's disease
o	Brugada syndrome
o	Breastfeeding
o	High risk of overdose
o	Refuse regular blood tests
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12
Q

Which antipsychotics are good if someone’s getting prolactin side effects?

A

aripiprazole, clozapine, quetiapine, olanzapine

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13
Q

What drugs cause serotonin syndrome?

A

SSRIs
MAOIs
Ecstasy / novel psychoactive stimulants

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14
Q

Which TCA is best if high risk of overdose?

A

lofepramine

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15
Q

What are the signs of lithium toxicity and at what levels might you see toxicity?

A

Signs occur at >1.5mmol/L
 D&V, anorexia, muscle weakness, lethargy, dizziness, ataxia, lack of coordination, tinnitus, blurred vision, coarse tremor of extremities and jaw, muscle hyper-irritability, choreoathetoid movements, dysarthria, drowsy

Severe toxicity at >2mmol/L
 Hyperreflexia, hyperextended limbs, syncope, toxic psychosis, seizures, polyuria, renal failure, electrolyte imbalance, dehydration, circulatory failure, coma, death

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16
Q

Who shouldn’t take sodium valproate and why?

A

NICE/MHRA recommend women of childbearing age:

DON’T take sodium valproate
• Unless very severe and no effective alternative
• Risks of fetal malformation, adverse neurodevelopment

Wean off it over 4w if already taking
• BUT only do this after speaking to a specialist

If taking, they should be enrolled in a preg prevention plan

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17
Q

Which antipsychotics are good if someone’s getting lots of sedation?

A

Amisulpride, Aripiprazole

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18
Q

What drug should you advise pts on lithium to avoid?

A

NSAIDs

19
Q

What’s the antidote to lithium?

A

There isn’t one!

Supportive care
Possibly alkaline diuresis / dialysis

20
Q

What do you give someone presenting with 9 days of persistently elevated mood who’s lost their job and started gambling? Presume you’re in secondary care

A

Manic episode

Oral antipsychotic from quetiapine, olanzapine, risperidone, haloperidol

21
Q

How is lithium monitored?

A

ECG before starting if risk of/existing CVD

Measure lithium levels:
 12 hours post-dose
 Aim for plasma level 0.6-0.8mmol/L (0.8-1.0mmol/L if still sub-threshold Sx or previously relapsed)
 1w after staring and 1w after every dose change
 Weekly until levels stable, then every 3m

Measure BMI, U&Es, eGFR, Ca, TFTs every 6m

22
Q

Which antipsychotics should be avoided if someone’s at increased risk of stroke and they’re elderly?

A

Risperidone

Olanzapine

23
Q

Common side effects of TCAs

A 
drowsiness
dry mouth
blurred vision
constipation
urinary retention
lengthening of QT interval
24
Q

What medication for OCD?

A

SSRI e.g. fluoxetine

25
Q

Which antipsychotics are good if someone’s at risk of long QT?

A

Aripiprazole

26
Q

Give 2 examples of SSRIs

A
  • Sertraline
  • Paroxetine
  • Escitalopram
27
Q

What drugs cause neuroleptic malignant syndrome?

A

Antipsychotics

Can also occur when stopping/reducing dopaminergic drugs suddenly (e.g. levodopa for Parkinson’s)

28
Q

What are 4 risks of taking sodium valproate which you should advise pts

A

Be aware of signs of bleeding, liver disorders, pancreatitis

Teratogenic

29
Q

Which antipsychotic’s ass.w. oculogyric crisis?

A

Aripiprazole

30
Q

Which antipsychotic in particular should be avoided if someone’s at increased risk of seizures?

A

Clozapine

31
Q

Give 4 risks of taking lithium long term

A

 Hypothyroidism: continue lithium but give levothyroxine
 Hyperthyroidism: specialist advice
 Hyperparathyroidism: stop lithium
 Nephrotoxicity, interstitial nephritis, nephrogenic DI, renal tumours
 Rhabdomyolysis

32
Q

What are the anticholinergic Sx seen from antipsychotics?

A

Dry mouth, blurred vision, urinary retention, constipation, cutaneous flushing

33
Q

What needs monitoring if taking antipsychotics?

A
  • Pulse and bp
  • ECG
  • BMI
  • Lipids, plasma glucose/HbA1c
  • Prolactin
34
Q

Which antipsychotics are best avoided if breast feeding?

A

carbamazepine or clozapine

35
Q

Someone with BPAD has tried olanzapine and risperidone but it’s been ineffective. What’s the next step?

A

Add lithium to one of their antipsychotics

36
Q

What drugs can be given for severe cases of serotonin syndrome?

A

Cyproheptadine or chlorpromazine

37
Q

Someone with a Hx of BPADI has been feeling really low and tired for the last 3 weeks. What do you give? Presume you’re in secondary care

A

Depressive episode can have one of:
o Quetiapine
o Olanzapine (+fluoxetine)
o Lamotrigine

38
Q

Is lithium safe in breast feeding

A

Nah

39
Q

Give 10 side effects / risks of antipsychotics

A
  • Extrapyramidal Sx (dystonic reactions, akathisia, tardive dyskinesia, oculogyric crisis, pseudoparkinsonism)
  • Anticholinergic Sx (dry mouth, blurred vision, urinary retention, constipation, cutaneous flushing)
  • Salivary hypersecretion
  • Weight gain
  • Dyslipidaemia
  • HTN
  • Impaired glucose tolerance
  • Increase stroke risk
  • Increased VTE risk
  • Hyperprolactinaemia (galactorrhoea, amenorrhoea, gynaecomastia, hypogonadism, sexual dysfunction, osteoporosis)
  • Sedation
  • QT interval prolongation
  • Reduced seizure threshold
  • Postural hypotension
  • Abnormal LFTs
  • Neuroleptic malignant syndrome
40
Q

What are the signs of neuroleptic malignant syndrome? And the blood markers?

A

Fever, sweating, rigidity, confusion, fluctuating consciousness, fluctuating bp, tachycardiac

Raised CK, leucocytosis, raised LFTs, reduced reflexes

41
Q

Which antipsychotics could you try if someone’s getting metabolic syndrome?

A

Aripirazole

Amisulpride

42
Q

Which antipsychotics should be avoided if someone’s worried about weight gain?

A

2nd generation (atypicals), especially:
Clozapine
Olanzapine

43
Q

Give 2 examples of drugs and doses for generalised anxiety disorder

A

All po od

  • Sertraline 25mg
  • Paroxetine 20mg
  • Escitalopram 10mg

Others

  • Citalopram 20mg
  • Fluoxetine 20mg
  • Fluvoxamine 50mg
  • Venlafaxine (2nd line) 75mg

Prescribing PSA / Management (8 decks)

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