Psych medications quiz Flashcards
What type of drug is amitriptyline?
Amitriptyline is a Tricyclic antidepressant
What type of drug is fluoxetine?
Fluoxetine is a Selective serotonin reuptake inhibitor (SSRI)
What type of drug is phenelzine?
Phenelzine is a monoamine oxidase inhibitor (MAOI)
What type of drug is aripiprazole?
aripiprazole is an atypical AKA second generation antipsychotic
- it is a Partial D2 (dopamine) agonist
What type of drug is haloperidol?
Haloperidol is an atypical or first generation antipsychotic
they are D2 agonists
What type of drug is lithium?
= mood stabiliser
has numerous effects on biological systems
Unclear mechanism
thought to replace intracellular secondary messenger systems
e.g. substitutes for Na/K/Ca/Mg and enters cells so interferes w.NT release and 2nd messenger systems. TF it can block release of certain NT and hormones
What is donepezil?
an Acetylcholinesterase inhibitor
What is acamprosate?
a glutamate receptor antagonist
GABA-A agonist
What is olanzapine?
it is an atypical AKA 2nd generation antipsychotic dopamine antagonist
What is memantine?
an NMDA antagonist (e.g. glutamate receptor)
What is venlafaxine?
venlafaxine is a serotonin and NA reuptake inhibitor (SNRI)
What is diazepam?
A benzodiazepine:
GABA-A agonist
What is promethazine?
a H1 antagonist e.g. anti-emetic
What is disulfiram?
It binds irreversibly to aldehyde dehydrogenase
which receptors are never involved in atypical (2nd) antipsychotic medication
while atypicals have higher affinity to other receptors and looser binding to D2 (than typicals/1st gen - thought to be why the 2nd gen are more efficacious in treatment resistant schizo) they never bind GABA-A
(whilst A-1, D2, H1 and M1 can be)
what are the side effects asosciated with SSRI
Nausea, diarrhoea prolonged QT hyponatraemia altered libido headaches
What are the clinical features of serotonin syndrome?
Autonomic instability
altered mental state
altered neuromuscular excitability
What are signs of autonomic instability in serotonin syndrome?
(high everything)
hyperthermia & sweating
inc HR and RR
incr pupil size (mydriasis)
What are signs of altered mental state in serotonin syndrome?
agitation
excitation
confusion
coma
What are signs of altered neuromuscular excitability in serotonin syndrome?
clonus hyperreflexia myoclonus tremor or rigidity (basically everything)
What are the complications of serotonin syndrome?
seizures
rhabdomyolysis
DIC
multiple organ failure
What are the main differentials for serotonin syndrome?
neuroleptic malignant syndrome (rare rxn to antipsychotic drugs)
malignant hyperthermia (high temp when given GA)
CNS infections
What is the cause of serotonin syndrome?
usually taking a combination of serotonergic agents
e.g. SSRIs, SNRIs, tricyclic, MOIs
other meds with serotonergic actions include: Opioids, 5ht antagonists (anti emetic), triptans (headache), trazodone, mirtazapine (antidepressants) and methylene blue
Which type of antipsychotic is more likely to give extrapyramidal side effects?
in typical/first generation
from the D2 blockade in nigrostriatal pathways
What are the extrapyramidal side effects of first generation antipsychotics?
Akathesia (restlessness)
acute dystonia (tongue protrusion, torticollis, head tilt to one side + chin lift and oculogyric crisis e.g. abnormal eyeball rotation)
parkinsonism (tremor, rigidity, brady-kinesia)
tardive dyskinesia (lip smaking, involuntary face/jaw movements)
What are the other side effects of antipsychotics?
H1 antagonism = sedation and weight gain due
from blocking tuberoinfundibular D2 = high prolactin (esp 1st gen) = galactorhoea, gynaecomastia, amenorrhoea, impotence
M1 antagonism: dry mouth, constipation, blurred vision, urinary retention
postural hypotension,
A1 antagonism = problems ejaculating, postural hypotension, nasal stuffiness
increased seizure risk esp in those already with epilepsy
prolonged QT - predisposing to ventricular arrhythmias
What are the 4 dopamine pathways in schizophrenia? (and they are the 4 major pathways of D generally)
mesolimbic mesocortical nigrostriatal tuberoinfundibular - action of drugs that target all the D receptors = TF lead to side effects because Extra pyramidal due to NS and high PRL due to tuberoinfundibular.(D2 normally inhibs PRL)
Which of the dopamine pathways are the negative and positive schizophrenia symptoms linked to?
the positive symptoms in schizophrenia are liked to (inc) D in the mesolimbic pathway
the negative symptoms in schizophrenia are linked to the (inc) D in the mesocortical pathway
What are the important SE of clozapine (atypical antipsychotic)
neutropenia and agranulocytosis
constipation
myocarditis
weight gain
What monitoring is needed for clozapine?
WBC monitoring –> @baseline, then 1/7 for 18 weeks then 1/14 for 1 year then monthly thereafter
also regular lipid and weight screens and
regular fasting glucose
What is neuroleptic malignant syndrome?
the main psychiatric emergency = a life threatening rxn to antipsychotic medication (albeit its rare)
it is potentially fatal w untreated mortality in 70-90%
What are the sx and syx of neuroleptic malignant syndrome?
(up) hyperthermia, tachycardia, tachypnoea,
severe muscle rigidity
fluctuating consciousness levels, increased creatinine phosphokinase (CPK, found in heart, brain and muscle tissue)
What is the treatment for neuroleptic malignant syndrome?
ABC
stop antipsychotic
fluid balance
supportive
What are the indications for lithium?
acute manic or hypomanic episode management
recurrent depressive disorder
prophylaxis of bipolar affective disorder
What are the common side effects of lithium?
Early: abdo pain, nausea, metallic taste, fine tremor, thirst, polyuria, weight gain, oedema Longer term: thyroid dysfunction renal impairment
What is lithium toxicity?
lithium has a narrow therapeutic window.
it is excreted by the kidneys and is treated by the body like sodium
–> plasma lithium levels are affected by hydration levels
and other meds that affect the kidneys e.g. diuretics and NSAIDs
What are the symptoms of lithium toxicity?
reduced consciousness cerebellar ataxia coarse tremor dysarthria (musc control disorder) D&V --> if untreated --> seizures, cardiac arrest, renal failure, coma, death
What is valproate?
mood stabiliser, not to be prescribed to women of child bearing age due to teratogenicity which is 1/10
What are the other mood stabiliser drugs?
valproate lithium lamotrigine carbamazepine quetiapine
What is acamprosate?
drug used to control alcohol dependence cravings (after detox programmes)
what is chlordiazepoxide?
a benzodiazepine used to prevent seizure risk in heavy alcoholism
(prescribed in a stepwise sliding regimen)
What is used for the treatment of alzheimers disease?
acetylcholinesterase inhibitors are first line e.g.
DONEPEZIL
What is rivastigmine?
another option for the tx of alzheimers disease (ach-esterase inhibitor) than 1st line donepezil
What are the improvements seen with ach-esterase inhibitors and AD?
40-70% of people with AD benefit from the drugs
they report reduced anxiety,
memory, motivation and concentration improvements and improved ability to continue ADLs
What are the common side effects of ach-esterase inhibitors?
loss of appetite nausea vomiting diarrhoea caution: pts with bradycardia
What is 2nd line for AD after donepezil/riviastigmine (ach-esterase inhibitors)?
if the SE of donepezil are intolerable to the patient…
memantine is another option…
an NMDA receptor antagonist
blocks excess glutamate so the progression of symptoms slows
e.g. disorientation and ADL difficulties
also evidence of it helping w/ delusions, aggression and agitation
