Psych Flashcards - Pharm Flashcards by David Townsend

What is the MoA of anti-psychotics?

Dopamine (D2) receptor antagonists - decrease stimulation

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Name 3 typical antipsychotics

Chlorpromazine, haloperidol, flupentixol decanoate (depot)

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What is the MoA of antipsychotics?

Block DA receptors

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What are the S/E of typical antipsychotics?

Extrapyramidal S/Es

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Name 6 atypical antipsychotics

Olanzapine, Risperidone, Quetiapine, Aripiprazole, Amisulpiride, Clozapine

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What are the s/e of antipsychotics?

Antidopaminergic effects (EPSE)
hyperprolactinaemia
Obesity
Sedation
Increased DM risk
Dyslipidaemia
Anticholinergic effects
Arrythmias
Seizures (esp clozapine)
Neuroleptic malignant syndrome

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What is the MoA of Atypical anti-psychotics?

Block DA and 5HT2 receptors

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What are the indications for atypical antipsychotics?

New onset schizophrenia
Unacceptable side effects from typical antipsychotics
Relapse occurs on typical anti-psychotics

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What are the commonly used mood stabilisers?

Valproate
Lithium
Carbamazepine

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Name 4 typical antipsychotics

Chlorpromazine
Haloperidol
Flupenthixol
Decanoate

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What are the signs of lithium toxicity?

GI disturbance
Sluggishness
Giddiness
Ataxia
Gross tremor
Fits
Renal failure

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What is Disulfirams MoA?

Irreversible aldehyde dehydrogenase inhibitor

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What are the s/e of atypical antipsychotics?

Metabolic s/e

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What is Acamprosate’s MoA?

GABA analogue - reduces cravings

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What is the MoA of Lofexidine?

Alpha 2 agonist

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What is notable about clozapine?

Needs blood level monitoring due to risk of agranulocytosis and consequent neutropenia
High seizure risk

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What class of drug are benzodiazepines?

Anxiolytic

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What is the MoA of benzodiazepines?

Binds to GABA to enhance neurotransmission

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What is resistant schizophrenia?

Schizophrenia that does not respond to two or more antipsychotics, at least one atypical, given for at least 6 weeks.

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What do you need to be careful of when using benzodiazepines?

Tolerance / dependence!

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What is Chlordiazepoxide?

Benzodiazepine

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What would you monitor in PTs on long term anti-psychotics?

BMI
BP
Bloods: FBC, LFT, U&E, OGTT, Lipids
Prolactin
ECG - QTc intervals

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How can you tell a benzo by its name?

Ends in -pam/-am (occasionally -pate)

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What are the s/e of benzodiazepines (4)?

Drowsiness
Ataxia
Impaired driving skills
Paradoxical aggression

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What is neuroleptic malignant syndrome?

Potentiall fatal s/e of antipsychotics causing sympathetic overactivity

What are the symptoms of benzodiazepine withdrawal (6)?

``` Apprehension and anxiety Insomnia Tremor Sensitive to noise Muscle twitching Seizures (rarely) ```

What are the indications for benzodiazepines (10)?

``` Schizophrenia / psychosis Mania Severe anxiety Anxiety and restlessness in the elderly Psychomotor agitation Violent / dangerous / impulsive behaviour Antiemetic Depression Intractable hiccups Sedation ```

What is the MoA of buspirone?

5HT-1A receptor agonist

What are the risk factors for neuroleptic malignant syndrome?

Psychosis Organic brain disease Alcoholism Agitation

How is buspirone different to benzodiazepines (3)

Non-sedating No apparent tolerance / dependence Slower and less powerful

What are the s/e of buspirone (3)?

Headaches Nervousness Lightheadedness

What are the risks of tricyclic antidepressants?

Overdose Lots of s/e

Why are beta-blockers used in anxiety?

Relieve physical symptoms - palpitations / tremor

What are the contraindications to beta-blocker use?

Asthma, Bronchospasm, COPD HF, heart block Systolic BP <90 Low pulse

What is the antidote for benzodiazipine OD?

Flumazenil

Name 3 Monoamine Oxidase Inhibitors

Phenelzine Isocarboxaid Tranylcypromine

What is Zopiclone?

Hypnotic, cyclopyrrolone

What is the MoA of zopiclone?

Potentiates GABA

What is zolpidem?

Hypnotic, imidazopyridine

Name an SNRI

Venlafaxine

What do antipsychotics do?

Reduce hallucinations Reduce delusions Reduce psychomotor excitement

Name a NaSSa

Mirtazapine

What are the unwanted targets of antipsychotics?

Block Noradrenergic and chlinergic receptors

Name an NRI

Reboxitine

What are the indications for antipsychotics?

``` Schizophrenia Psychosis Mania Severe anxiety Psychomotor agitation / excitement Violent / dangerous / impulsive behaviour Antiemesis Depression Intractable hiccups Sedation Anxiety / restlessness in the elderly ```

What are the s/e of typical antipsychotics?

Acute extrapyramidal s/e Hyperprolactinaemia Tardive dyskinesia

What situations is haloperidol particularly good in?

Head injuries | Polypharmacy

What would affect lithium levels?

Dehydration Sodium depletion Thiazide diuretic use

Name 6 atypical antipsychotics

``` Olanzapine Risperidone Quetiapine Aripiprazole Amisulpiride Clozapine ```

What are the indications for ECT?

Severe depression Catatonia Prolonge / severe manic episodes Resistant depression

What is the indication for clozapine?

Resistant schizophrenia

What antipsychotics are available as depots?

Typical - clopixol, depixol | Atypical - risperdal consta, paliperidone

Which antipsychotic would you worry about prolactin levels?

Risperidone

What are the symptoms of neuroleptic malignant syndrome?

``` Fever Sweating Rigidity Confusion Fluctuating consciousness Labile BP Tachycardia Elevated CPK Leucocytosis ```

Which antipsychotics normally cause neuroleptic malignant syndrome?

High potency typicals with a recent / rapid change in dose. Or abrupt withdrawal of anticholinergics.

Name 2 tricyclic antidepressants

Imipramine | Amitryptaline

Name 3 SSRIs

Fluoxetine Paroxetine Sertraline

What are the risks of SSRIs

Increased suicide risk | Withdrawal syndrome

What are the risks of monoamine oxidase inhibitors?

Hazardous interactions with food and drugs

Which foods do monoamine oxidase inhibitors interact with?

Red wine | Cheese

What is an SNRI?

Serotonin and noradrenaline reuptake inhibitor

What is a NaSSa?

Noradrenergic and specific serotonergic antidepressants

What is an NRI?

Noradrenaline reuptake inhibitor

What are the s/e of mood stabilisers?

Achaphysia - this correlates with high suicide rate

What are the risks of Lithium?

Narrow therapeutic window | Many interactions

How is litihium excreted?

Renally

Name 5 mood stabilisers

``` Litihium Sodium valproate Carbamazepine Lamotrigine Topiramate ```

What is a typical course of ECT?

6-12 sessions, twice a week