Psych- Medications Flashcards
Give 3 examples of typical antipsychotics
Chlorpromazine
Haloperidol
Flupentixol
Give 3 examples of atypical antipsychotics
Clozapine
Olanzapine
Quetiapine
Risperidone
What are the dopamine related SEs of typical antipsychotics?
- Hypothalamic-pituitary:
Galactorrhoea
Impotence
2. Nigrostriatal: Parkinsonism Acute dystonia Tardive dyskinesia Akathisia
What are the main symptoms of Parkinsonism?
Tremor
Bradykinesia
Shuffling gait
Rigidity
Which group of antipsychotics poses the greatest risk of neuroleptic malignant syndrome?
Typical antipsychotics
Other than dopamine related SEs, what are the other SEs of typical antipsychotics?
- Histamine related: sedation
- Anticholinergic: dry mouth, constipation, confusion, blurred vision
- alpha 2 related: postural hypotension, impotence
- Neuroleptic malignant syndrome
- Weight gain
- Arrhythmias
- Decreased seizure threshold
Which antipsychotic is proven to decrease the negative symptoms of schizophrenia?
Clozapine
What are the main side effects of atypical antipsychotics?
- Weight gain
- Decreased seizure threshold
- Sedation
- Metabolic syndrome
- Extra pyramidal SEs at higher doses
What are the side effects of Clozapine?
- Agranulocytosis
- Sedation
- Weight gin
- Decreased seizure threshold
- Anticholinergic SEs
- Excess salivation
How often should bloods be monitored in patients in Clozapine?
- BEFORE commencing
- Weekly for 18 weeks
- Fortnightly until 1 year
- Monthly from 1 year onwards
Which anticholinesterase is used in Alzheimer’s?
Donepezil
Disulfiram, Acamprosate and Naltrexone are used for what?
Abstinence from alcohol
What are the 3 groups of symptoms for alcohol withdrawal?
- Simple withdrawal symptoms
- Delirium tremens
- Seizures
Which 2 main groups of drugs are used for alcohol detox?
1, Sedatives- eg. Benzodiazepines or Chlordiazepoxide
2. Vitamin B- Pabrinex
What are the 3 main features of Wernicke’s encephalopathy?
Confusion
Ataxia
Ophthalmoplegia (weakness of extra occular eye muscles)
Which drugs can be used for abstinence from alcohol?
Disulfiram
Acamprosate
Naltrexone
________ is a GABA analog which reduces cravings for alcohol.
Acamprosate
_________ is an aldehyde dehydrogenase inhibitor which gives an unpleasant reaction if patients drink alcohol.
Disulfiram
Which drugs are used for neurotic disorders (panic/ anxiety)?
- SSRIs
- SNRIs
- TCAs/ Pregabalin
Which drug class is used for OCD?
SSRIs
Which drug class is used for bulimia?
SSRIs
Which drug classes are used for PTSD?
SSRIs
Benzodiazepines
Which drug classes are used for insomnia?
- Benzodiazepines
2. Z drugs- Zopiclone, Zolpidem
What is the most commonly used class of antidepressants? Give examples
SSRIs
Sertraline
Citalopram
Fluoxetine
Paroxetine
What are the 1st, 2nd and 3rd line drug treatments for depression?
1st line- SSRI eg. Sertraline
2nd line- Switch SSRI or try SNRI eg. Venlafaxine, or Mirtazapine
3rd line- SNRI or Mirtazapine or TCA
What are the key side effects of SSRIs?
- GI- Diarrhoea, vomit
- Sweating
- Insomnia
- Agitation
- Hyponatraemia
- Discontinuation syndrome
________ is an SNRI and can cause side effects such as hypertension.
Venlafaxine
__________ works as an antidepressant by being an alpha2 antagonist, and is also an antagonist at some post synaptic serotonin receptors.
Mirtazapine
or Mianserin
What are the potential SEs of Mirtazapine?
Weight gain
Sedation
What are the potential SEs of Mianserin?
Blood dyscrasias
Give examples of 2 TCAs.
Amitriptyline
Impipramine
What are the potential SEs of TCAs?
- Anticholinergic- dry mouth, constipation, decreased urine, blurred vision
- Histamine- sedation
- Alpha1- Postural hypotension, impotence
- ECG changes and arrhythmias
- Tremor
- Serotonin- GI upset, sweating
MAOIs such as Rasagiline and Selegiline can prevent breakdown of _________ causing the “cheese reaction”
Tyramine
What are the 5 steps of NICE guidelines for treating depression?
- Recognise and diagnose
- Treat mild depression in primary care
- Treat moderate- severe depression in primary care
- Treatment by specialist mental health services
- Inpatient treatment for severe or resistant depression
What are the NICE guidelines for treating acute mania?
- Stop any antidepressants
- Start anti psychotic eg. Olanzapine, Risperidone, Haloperidol, Quetiapine
- Give lithium if needed/ optimise dose of lithium
What are the potential SEs of lithium?
Tremor Hypothyroidism/ goitre Weight gain Teratogenicity Renal impairment
What are the signs of lithium toxicity?
Tremor Diarrhoea and vomit Ataxia Slurred speech UMN signs Seizures Can be fatal
What are the 3 main groups of drugs used for bipolar disorder?
- Lithium
- Antipsychotics
- Anticonvulsants
What are the side effects of sodium valproate?
Teratogenicity
Weight gain
Hirtuism
What are the side effects of Lamotrigine?
Steven Johnson’s syndrome
Headaches
Ataxia
Diplopia
What are the side effects of Carbamazapine?
Weight gain Hyponatraemia Skin rash Diplopia Headache
Which 2nd gen antipsychotic can cause weight gain and metabolic syndrome?
Olanzapine
Quetiapine
Which 2nd gen antipsychotic can cause sedation, metabolic syndrome and postural hypotension?
Quetiapine
Which antipsychotic can cause akathisia as a SE?
Aripriprazole
What are the NICE guidelines for treating bipolar depression?
Mild- psychological therapy
Moderate-severe- SSRIs (Fluoxetine) plus Olanzapine or Quetiapine
After one week of use what should lithium blood levels be?
0.5 -1.0 mmol/L
What can increase blood lithium levels?
ACEIs NSAIDS Diuretics Dehydration Hyponatraemia
How often should TFTs and U+Es be monitored in patients on lithium?
Every 6 months
How often should lithium levels be monitored?
Every 3 months
What is the SSRI of choice in children and adolescents?
Fluoxetine
What is the SSRI of choice in adultss?
Sertraline
When discontinuing a SSRI, the dose should gradually be reduced over what time period?
4 weeks
not necessary with Fluoxetine
What are the symptoms of discontinuation syndrome from stopping an SSRI abruptly?
Mood changes Sweating Difficulty sleeping GI disturbances Paraesthesia Restlessness
A 45-year-old man with schizophrenia taking chlorpromazine develops a bilateral resting tremor. What side-effect of antipsychotic medication is this an example of?
Parkinsonism
How might smoking cessation affect clozapine blood levels?
Smoking cessation causes INCREASED clozapine levels
Which atypical antipsychotic has the highest risk of dyslipidaemia and obesity?
Olanzapine
Which atypical antipsychotic has the best side effect profile for prolactin elevation?
Aripiprazole
Mirtazapine is an alpha 2 receptor _______ and has a SE of increased appetite.
Antagonist
