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Psychiatry > Psych medication > Flashcards

Psych medication Flashcards

1
Q

Name 6 categories of antidepressants

A

Selective serotonin reuptake inhibitor (SSRI)
Noradrenergic and specific serotonergic antidepressant (NASSA)
Serotonin and noradrenaline reuptake inhibitors (SNRI)
Tricyclic Antidepressants (TCA)
Monoamine oxidase inhibitors (MAOI)
Serotonin 2 antagonist/reuptake inhibitors (SARI)

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2
Q

When should SSRIs be used?

A

Depression- 1st Line
Bipolar
Anxiety- Panic disorders, social anxiety, PTSD, OCD, chronic pain, eating disorders.

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3
Q

How do SSRIs work?

A

Selectively inhibits synaptic 5-HT reuptake transporters, thereby increasing synaptic 5-HT concentration

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4
Q

Give some side effects of SSRIs

A

‘Hangover’- N+V, diarrhoea, headache GI bleeds with NSAID Anxiety Insomnia Sexual dysfunction Hyponatraemia Increased suicide risk Seizures in epileptics Serotonin syndrome

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5
Q

Who should you be cautious giving SSRIs to?

A

Epileptics- lowers seizure threshold
Congenital long QT syndrome, bradycardia, hypokalaemia, hypomagnesemia, recent acute myocardial infarction, or uncompensated heart failure

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6
Q

Give some example agents of SSRIs

A 
Fluoxetine
Sertraline
Citalopram
Escitalopram
Paroxetine
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7
Q

What is paroxetine used as first line for?

A

Anxiety

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8
Q

What can discontinuation of SSRIs cause?

A

Shivering, anxiety, dizziness, ‘electric shocks’, headache and nausea

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9
Q

What are NASSAs used for?

A

Depression- 1st line if have insomnia or poor appetite. 2nd line if SSRI failed. 3rd line in combo with SSRI.

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10
Q

How do NASSAs work?

A

Increases activity in the NA and 5-HT systems by blocking the negative feedback (presynaptic DA) of NA on presynaptic alpha-2 receptors.

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11
Q

What are some side effects of NASSAs?

A

Agranulocytosis
Constipation
Dizziness Falls Dry mouth GI upset with alcohol
Sedation
Weight gain

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12
Q

What should NASSAs not be taken with ?

A

Don’t take with MAOI

Be careful with other sedatives

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13
Q

Give an example of NASSAs

A

Mirtazapine

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14
Q

What is a potentially useful side effect of mirtazapine?

A

Sedation

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15
Q

What are SNRIs used for?

A

Depression- Not 1st line due to SE. Second line if SSRI and NASSA don’t work.

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16
Q

How do SNRIs work?

A

Potently block 5-HT and NA reuptake but do not block cholinergic receptors

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17
Q

What are some side effects of SNRIs?

A 
Arrhythmias                                  
GI bleeds with NSAID                        
Hypertension                      
Insomnia                             
Sexual dysfunction      
Hyponatraemia                          
Increased suicide risk         
Cardiac arrhythmias       
Seizures in epileptics    
Serotonin syndrome
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18
Q

Who should SNRIs NOT be given to?

A

Do NOT give to those with hypertension or arrhythmias

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19
Q

Who should venlafaxine not be given to?

A

Do NOT give to those with hypertension or arrhythmias

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20
Q

Give an example SNRI agent

A

Venlafaxine

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21
Q

What drug does venlafaxine work well with?

A

Mirtazapine

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22
Q

What are TCAs used for?

A

Depression- Not 1st line due to SE and lethal in OD. Use if intolerant or unresponsive to SSRI. Rapid anxiolytic effects

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23
Q

How do TCAs work?

A

Inhibit presynaptic NA and 5-HT transporters therefore increase concentrations.
Anti-muscarinic.

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24
Q

What are some side effects of TCAs?

A 
Sedation                     
Confusion                     
Dizziness                           
Sexual dysfunction           
Constipation                            
Tremour                           
Blurred vision               
Postural hypotension                          
Weight gain                           
Arrhythmias (Long QT)
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25
Q

Who should TCAs not be given to?

A 
Cardiac problems           
Elderly                           
Suicidal intent (cardiotoxic in OD)      
Epilepsy (lower seizure threshold)      
Bipolar- can cause mania
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26
Q

Give some example TCA agents

A 
Amtitriptyline 
Clomipramine
Imipramine
Lofepramine
Dosulepin
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27
Q

What does cloipramine act on?

A

5-HT

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28
Q

What are MOAI used for?

A

Depression- Effective but only use in treatment resistant due to side effects.
Don’t use in bipolar due to ability to cause mania.

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29
Q

How do MOAI work?

A

MAO breaks down: NA and 5-HT (MAO1) and DA (MAO2). Inhibitors prevent this therefore increased levels.

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30
Q

Give some side effects of MOAI

A 
Postural hypertension 
Drowsiness     
Insomnia                    
Nausea                      
Tiredness                   
Constipation
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31
Q

What should MOAI not be taken with?

A

Causes dangerous hypertension when combined with tyramine

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32
Q

What foods contain tyramine?

A

Cheese, alcohol, red meat, caffeine

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33
Q

What can taking MOAI with tyramine cause?

A

Hypertensive crisis

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34
Q

What are some symptoms of a hypertensive crisis?

A

Headache, SOB, epistaxis, anxiety

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35
Q

Give some example agents of MOAI

A

Phenelzine
Tramylcypromine
Isocarboxazid
Moclobemide

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36
Q

When are SARI used?

A

Depression- When sedation is needed or as an add on to others

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37
Q

How do SARI work?

A

Block serotonin R and transporter

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38
Q

What are some side effects of SARI?

A 
GI upset                     
Dizziness                      
Sedation                           
Tiredness                    
Headache                   
Hypotension               
Oedema                      
Priapism- Painful erection
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39
Q

Give an example SARI agent

A

Trazodone

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40
Q

Name three mood stabalisers

A

Lithium carbonate
Sodium valproate
Lamotrigine

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41
Q

What is Li2CO3 used for?

A

Bipolar- Relapse prevention. Good for both mania and depression.
Depression- Add to antidepressants in treatment resistant depression.

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42
Q

How does Li2CO3 work?

A

Decreases NA release and increases serotonin release

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43
Q

What are some side effects of Li2CO3

A 
N+D                                         
Dry mouth                   
Feeling of weakness Sedation                       
Weight gain                       
Fine tremor           
Polydipsia + polyuria   
Ankle swelling              
Renal impairment 
Arrhythmias 
Hypothyroidism and hypoparathyroidism
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44
Q

What is an issue for Li2CO3?

A

Therapeutic dose close to toxic dose. Causes Li toxicity

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45
Q

How do you treat Li toxicity?

A

Stopping Li and starting IV fluids

46
Q

What are some symptoms of Li toxicity?

A 
GI Upset                       
Blurred vision              
Coarse tremor            
Ataxia                             
Drowsiness                
Confusion                           
Loss of consciousness  
Seizures                            
Coma                                
Death
47
Q

How long does Li2CO3 take to have full effect?

A

18 months

48
Q

What is sodium valproate used for?

A

Bipolar- Fast acting so good when rapid treatment needed or for cycling between mania and depression. Good when Li is ineffective, contraindicated or not tolerated.

49
Q

How does sodium valproate work?

A

Blocks voltage sensitive sodium channels. Increase levels of GABA

50
Q

What are some side effects of sodium valproate?

A 
Sedation                  
Tremour                        
Dizziness                        
GI Upset                   
Tiredness                       
Weight Gain
51
Q

When must a woman NOT get sodium valproate?

A

When pregnant or trying to get pregnant.

52
Q

What should you do before starting sodium valproate?

A

Check platelets and LFTs

53
Q

What is lamotrigine used for?

A

Bipolar- Treatment and prophylaxis of depressive episodes.

54
Q

How does lamotrigine work?

A

Blocks voltage sensitive sodium and calcium channels, and decreases glutamate release

55
Q

Give some examples of lamortigine

A 
Rash                                  
GI Upset                         
Insomnia                    
Sedation                   
Dizziness                      
Ataxia                      
Stevens Johnson syndrome- Life threatening skin condition
56
Q

What must you NEVER combine lamotrigine with and why?

A

Carbamazepine as causes neurotoxicity

57
Q

What are the two categories of antipsychotics?

A

Typical

Atypical

58
Q

What are the two categories of typical antipsychotics?

A

Phenothiazines

Butyrophenones

59
Q

Name the most common phenothiazine

A

Chlorpromazine

60
Q

Name the most common butyrophenone

A

Haloperidol

61
Q

What are typical antipsychotics used for?

A

Bipolar- Treatment and prophylaxis of hypo/manic and depressive episodes.
Depression- Adjunct to antidepressants Psychosis- Acute positive symptoms

62
Q

How do typical antipsychotics work?

A

Block DA1+2R thus reducing DA activity

63
Q

Give some side effects of antipsychotics

A 
Extrapyramidal- (Parkinsonism- Akinesia (inability to initiate movement), Akathisia (inability to remain motionless), bradykinesia, dystonia)                       Sedation                                    
Dizziness                                   
QT prolongation                     
Neuroleptic Malignant Syndrome (Fever, muscle rigidity, altered mental state)
Hypotension                      
Dry mouth                       
Urine retention          
Constipation                 
Blurred vision               
Weight gain                
Glaucoma                    
Arrhythmias                
Seizures
64
Q

What kind of drug is chlorpromazine?

A

Phenothiazine typical antipsychotic

65
Q

What is chlorpromazine used for?

A

Use for acute treatment resistant psychosis

66
Q

What is a drawback of chlorpromazine?

A

Severe extrapyramidal symptoms

67
Q

What kind of drug is haloperidol?

A

Butyrophenone typical antipsychotic

68
Q

What is a benefit of butyrophenones over phenothiazine?

A

Less sedation

69
Q

What are butyrophenone good for?

A

Acute psychosis and mania

70
Q

What is haloperidol used for?

A

Use for alcohol withdrawal, delirium and acute psychosis

71
Q

What should you prescribe along with antipsychotics?

A

Anticholinergics- to treat extrapyramidal symptoms

72
Q

How do you treat the extrapyramidal symptoms in antipsychotics?

A

Antipsychotics

73
Q

What are atypical antipsychotics used for?

A

Bipolar- Treatment and prophylaxis of hypo/manic and depressive episodes.
Depression- Adjunct to antidepressants Psychosis- First line chronic

74
Q

How do atypical antipsychotics work?

A

Block DA1R thus reducing DA activity

75
Q

What are some side effects of atypical antipsychotics?

A 
Sedation              
Weight Gain                
Metabolic syndrome   
Diabetes Mellitus         
Extrapyramidal           
Stroke          
Constipation                
QT prolongation                
Neuroleptic Malignant Syndrome
76
Q

Give some example agents of atypical antipsychotics

A 
Olanzapine
Risperidone
Quetiapine
Clozapine
Amisulpride
77
Q

What is olanzapine additionally used for?

A

Also used in PTSD

78
Q

What are some additional side effects of olanzapine?

A

Bad for weight gain and hyperglycemia (T2DM)

79
Q

What is a benefit of risperidone?

A

Low extrapyramidal SE

80
Q

What is clozapine used for?

A

Use for treatment resistant schizophrenia, aggression and suicidal

81
Q

What are some additional side effects of clozapine?

A

Bad for weight gain and hyperglycemia (T2DM). Agranulocytosis

82
Q

What do you need to check before and after starting clozapine?

A

Full check (BP, FBC, U&E etc) prior to initiation, at 1 month and yearly thereafter.

83
Q

Give some examples of anxiolytics?

A

Benzodiazepines

Beta Blockers

84
Q

What are bzd used for?

A

Anxiety, panic disorder, phobic anxiety and insomnia- Relief
Acute psychosis- Sedation
Alcohol withdrawal and delirium

85
Q

How do bzd work?

A

GABAR Agonist

86
Q

What are some side effects of bzd?

A 
Drowsiness            
'Hangover'                   
Nausea                       
Delirium                     
Aggression
87
Q

What is a major issue with bzd?

A

Sedation can interfere with driving.

88
Q

What should you not do while on bzd?

A

Drive

89
Q

Give some example agents of bzd

A

Diazepam

Lorazepam

90
Q

How should you stop bzd?

A

Tapper down dose to prevent withdrawal symptoms: insomnia, anxiety, twitching, visual hallucinations, hypersensitivity

91
Q

What are BB used for?

A

Anxiety- Relief somatic symptoms

92
Q

Who should you not give BB to?

A

Avoid in asthmatics

93
Q

What is the most widely used BB in psych?

A

Propranolol

94
Q

What are some symptoms of serotonin syndrome?

A
  • Tachycardia
  • Shivering
  • Sweating
  • Hyperthermia
  • Hyperreflexia
  • Renal failure
  • Shock
95
Q

Combinations of which drugs can cause serotonin syndrome?

A

SSRI
MAOIs
Lithium
St John Wort

96
Q

What is agranulocytosis?

A

Severely low WCC

97
Q

Give some symptoms of extrapyramidal side effects

A
  • Acute dystonia – painful contraction of muscles in the neck, jaw or eyes
  • Parkinsonism – decreased facial movements, shuffling gait, stiffness and sometimes tremor. Common in early weeks of treatment
  • Akathisia – a feeling of restlessness and a need to walk around
  • Tardive dyskinesia – uncontrollable grimacing movements of the face, tongue or upper body
98
Q

What can Parkinsonism be mistaken for?

A

Negative symptoms in Schizophrenia

99
Q

How do you treat Akathisia?

A

Reduce dose or give BB

100
Q

What drugs can cause neuroleptic malignant syndrome?

A

Antipsychotics

101
Q

What are some symptoms of neuroleptic malignant syndrome?

A

Pyrexia
Stiffness
Autonomic
Instability (tachycardiac, fluctuating blood pressure) Seizures

102
Q

What are some signs of neuroleptic malignant syndrome?

A

Raised serum creatine kinase
Metabolic acidosis
Leukocytosis

103
Q

When should you suspect NMS?

A

Fever without obvious cause

104
Q

Which antipsychotic is closely associated with NMS?

A

Haloperidol

105
Q

Which antidepressants are safe in pregnancy?

A

SSRI
TCA
ECT

106
Q

Which mood stabilizers should not be used in pregnancy?

A

Lithium carbonate

Sodium valproate

107
Q

How should antidepressants be stopped in an episode of mania?

A

Abruptly.

108
Q

What neurotransmitter is closely associated with bipolar and schizophrenia?

A

Dopamine

109
Q

What neurotransmitter is closely associated with depression and anxiety?

A

Serotonin

110
Q

Which antipsychotic is good in pregnancy?

A

Olanzapine

111
Q

What is the LD50 of diazepam?

A

2g/70kg

112
Q

How should you decrease diazepam levels?

A

By 1mg per week

Psychiatry (22 decks)

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