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Year 3 random facts to know > Psych Meds > Flashcards

Psych Meds Flashcards

1
Q

Tx of severe depression in pregnancy

A

Antidepressant + ECT (may be indicated in severe post-natal depression to ensure quick exposure to child)

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2
Q

low acuity depression treatment

A

CBT > then SSRI > different SSRI > SNRI > …

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3
Q

moderate acuity depression

A

SSRI + CBT > TCA or combination therapy + CBT > MAOi + CBT > ECT

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4
Q

Severe acuity depression

A

Hospitalisation + Psychiatry referral +/- ECT + 2nd/3rd gen antidepressant

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5
Q

In younger people what therapy should you often consider first?

A

CBT

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6
Q

What is the general purpose of Antidepressants?

A

Serotonin, Noroadrenaline and dopamine = three main monoamines involved in depression. They are all metabolised by monoamine oxidase.

Depression = reduced levels of these metabolites. Drugs aim to increase amount of metabolite available.

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7
Q

1st gen antidepressants

A

MAOi + TCAs

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8
Q

2nd/3rd gen antidepressants

A

SSRIs/SNRIs

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9
Q

MAOi mechanism + indication + examples

A

Inhibits monoamine oxidase

3rd line moderate depression

Socarboxazide, Phenelzine. “Chairman Mao loves drinking Sodas and Phencing”

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10
Q

Side effects of MAOi

A

TIPO

Tyramine (hypertensive crisis); Insomnia; Postural hypotension; Oedema.

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11
Q

TCA mechanism + indication + examples

A

Blocks the reuptake of monamines at the presynaptic terminal.

2nd line moderate depression.

Amitriptyline, Imipramine.

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12
Q

side effects of TCAs

A

tCa - anti Cholinergic (blurred vision, dry mouth, constipation, retention);
Cvs (postural hypotension, arrythmias, tachycardia); Cognitive impairment elderly.
+ Anti-Histamine effect (weight gain, sedation).

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13
Q

Be cautious with what groups with TCAs

A

Suicidal persons.

Suicidal tendencies may increase before antidepressant effect takes place!

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14
Q

SSRIs mechanism + indication + examples

A

Selectively inhibit reuptake of serotonin from the synaptic cleft

1st line in all depressions

Fluoxetine, Citalopram, Sertraline, Paroxetine

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15
Q

Caution of SSRIs in what groups?

A

Elderly (hyponatraemia);
Increase self harm in <25s;
Pregnant persons (discontinuation issues)

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16
Q

SSRI side effects

A

DASH - Dreams (vivid); Anxiety; Sexual dysfunction; Headache (nausea).

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17
Q

SNRIs mechanism + indication + examples

A

Selectively inhibit reuptake of serotonin + noradrenaline from the synaptic cleft

1st line in all depressions (usually after failure of multiple SSRIs)

Venlafaxine, Duloxetine. “In VENice they paint the walls with DULux”

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18
Q

SNRI side effects

A

Same as SSRIs but slightly milder. Far fewer than TCAs.

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19
Q

used to treat energy loss

A

Reboxetine (NRI - Noroadrenaline Reuptake Inhibitor) - “won’t get tired with ypur REEBOKS on!”

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20
Q

What is used to treat Insomnia?

A

Quetiapine “Insomnia is were you can’t QUite get to sleep”

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21
Q

What is used to treat catatonia?

A

Abnormality of movement - Lorazepam

22
Q

What may be used to supplement an SSRI?

A

Mirtazapine (TeCA - tetracyclic antidepressant) - blocks serotonin side effects (e.g. nausea) BUT ant-histaminergic (weight gain + sedation).

23
Q

Why must you be careful with Paroxetine (SSRIs) and Venlafaxine (SNRIs)?

A

Low half life and risk of discontinuation affects

24
Q

What drugs cause weight gain?

A

Anti-Histaminergic - TCAs + Mirtazapine.

25
Q

What might you need to mention to patients about ADs in OSCE scenario?

A

2-6 week gradual time to effectiveness; Importance of taking meds as prescribed and continuing beyond remission; Side effects and interactions; Addiction does not occur
SSRIs may cause transient INCREASE in depression and suicidal thoughts in <25

26
Q

Gold standard treatment for Bipolar Disorder

A

Lithium (carbonate);

12 hour post dose blood levels because of narrow therapeutic index (0.5-1.0).
Test thyroid every 6 months (hypo).

27
Q

Side effects of Lithium

A

dry mouth/ strange taste, polyuria/ polydipsia, tremor, long term reduced renal function!!!, nephrogenic DI; Hypothyroidism + Hyperparathyroidism.

To remember: think of lithium salts: dry mouth > tastes strange > need to drink lots > need to pee lots > affects your KIDNEYS

28
Q

Toxic effects of lithium

A

D&V, ataxia/ coarse tremor, drowsiness, convulsions, coma

29
Q

2nd line for bipolar disorder

A

Lamotrigine or Carbamazepine (anticonvulsants)

30
Q

Psychological therapies for PTSD

A

trauma focussed CBT or EMDR

31
Q

pharmacological therapy of PTSD?

A

Non-specialist - Paroxetine

Specialist - Amitryptiline

32
Q

Anticonvulsants mechanism + indication + examples

A

Blockage of Na+ channel

Epilepsy + Mania

Valproic acid, Lamotrigine, Carbamazepine

33
Q

Side effects of anticonvulsants

A

Carbamazepine: drowsy, ataxia, CVS, liver enzyme inducer
Valproate: teratogenic (neural tube defects, cleft palate, CVS abnormalities)

34
Q

Which drug is particularly useful in patients with bipolar disorder who are primarily manic/hypomanic?

A

Sodium Valproate

35
Q

Typical antipsychotics mechanism + indication + examples

A

D2 antagonist

schizophrenia, mania in bipolar

Chlorpromazine, haloperidol. “Chloe has a Halo, so typical”

36
Q

Side effects of typical antipsychotics

A

Sexual Side Effects due to hyperprolactinaemia,

EPSEs (acute dystonic reaction, parkinsonism, akathisia, tardive dyskinesia)

37
Q

Tardive dyskinesia

A

Tardive dyskinesia: prolonged exposure to typical antipsychotics can cause involuntary facial and body movements e.g. blinking, lip licking, foot tapping, twisting or rocking etc.

38
Q

acute dystonic reaction

A

Acute dystonic reaction: tends to occur within hours of exposure to a typical antipsychotic. Spasmodic or sustained contraction of muscles in the face, neck, trunk or extremities

39
Q

Atypical antipsychotics mechanism + indication + examples

A

D2 AND serotonin antagonist (better efficacy in negative symptoms)

schizophrenia, mania in bipolar

Quetiapine, arpiprazole, olanzapine, clozapine, risperidone

40
Q

Atypical antipsychotics side effects

A 
weight gain (esp olanzapine), metabolic syndrome, sedation, CVS risk
Agranulocytosis - Clozapine (also excessive drooling)
41
Q

when would clozapine be indicated and what might be given alongside it?

A

treatment resistant schizophrenia

Hyoscine to stop excessive drooling

42
Q

Benzodiazepines mechanism + indication + examples

A

Allosteric modulators at GABA receptors –> enhances it (=increased inhibition in CNS)

alcohol dependence, seizures, anxiety disorders, insomnia

Lorazepam, diazepam, chlordiazepoxide

43
Q

Side effects of benzodiazepines

A

Paradoxical aggression, anterograde amnesia, impaired coordination, tolerance and dependence

44
Q

side effects of benzodiazepine rapid withdrawal

A

Confusion, psychosis, convulsions, tachycardia, sweating, HTN, agitation, tremor

45
Q

Med management of ADHD

A

1 - Ritalin (methylphenidate)
2 - Atomoxetine (NA reuptake inhibitor)
3 - Antidepressants, antihypertensive, antipsychotics

46
Q

What is given in alcohol withdrawal?

A

Chlordiazepoxide (benzodiazipine)
Thiamine duh (parenteral)
Acamprosate (reduces cravings)
Antabuse (deterrant, makes you feel sick - inhibits acetyl dehydrogenase)

47
Q

1st line alcohol relapse prevention drug

A

Naltrexone

48
Q

OCD treatment

A

CBT + ERP,
SSRI,
Clomipramine (TCA)

49
Q

Mild-moderate Alzheimer’s

A 
Cholinesterase Inhibitors (rivastigimine, donepezil)
increase ACh
50
Q

Moderate - Severe Alzheimer’s

A

Memantine (blocks glutamate so dampens neurotoxicity)

Year 3 random facts to know (18 decks)

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