Psych Meds Flashcards by Craig MacPhee

Tx of severe depression in pregnancy

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

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low acuity depression treatment

CBT > then SSRI > different SSRI > SNRI > …

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moderate acuity depression

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

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Severe acuity depression

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

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In younger people what therapy should you often consider first?

CBT

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What is the general purpose of Antidepressants?

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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1st gen antidepressants

MAOi + TCAs

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2nd/3rd gen antidepressants

SSRIs/SNRIs

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MAOi mechanism + indication + examples

Inhibits monoamine oxidase

3rd line moderate depression

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

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Side effects of MAOi

TIPO

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

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TCA mechanism + indication + examples

Blocks the reuptake of monamines at the presynaptic terminal.

2nd line moderate depression.

Amitriptyline, Imipramine.

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side effects of TCAs

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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Be cautious with what groups with TCAs

Suicidal persons.

Suicidal tendencies may increase before antidepressant effect takes place!

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SSRIs mechanism + indication + examples

Selectively inhibit reuptake of serotonin from the synaptic cleft

1st line in all depressions

Fluoxetine, Citalopram, Sertraline, Paroxetine

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Caution of SSRIs in what groups?

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

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SSRI side effects

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

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SNRIs mechanism + indication + examples

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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SNRI side effects

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

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used to treat energy loss

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

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What is used to treat Insomnia?

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

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What is used to treat catatonia?

Abnormality of movement - Lorazepam

What may be used to supplement an SSRI?

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

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

Low half life and risk of discontinuation affects

What drugs cause weight gain?

Anti-Histaminergic - TCAs + Mirtazapine.

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

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

Gold standard treatment for Bipolar Disorder

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

Side effects of Lithium

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

Toxic effects of lithium

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

2nd line for bipolar disorder

Lamotrigine or Carbamazepine (anticonvulsants)

Psychological therapies for PTSD

trauma focussed CBT or EMDR

pharmacological therapy of PTSD?

Non-specialist - Paroxetine | Specialist - Amitryptiline

Anticonvulsants mechanism + indication + examples

Blockage of Na+ channel Epilepsy + Mania Valproic acid, Lamotrigine, Carbamazepine

Side effects of anticonvulsants

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

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

Sodium Valproate

Typical antipsychotics mechanism + indication + examples

D2 antagonist schizophrenia, mania in bipolar Chlorpromazine, haloperidol. "Chloe has a Halo, so typical"

Side effects of typical antipsychotics

Sexual Side Effects due to hyperprolactinaemia, | EPSEs (acute dystonic reaction, parkinsonism, akathisia, tardive dyskinesia)

Tardive dyskinesia

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.

acute dystonic reaction

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

Atypical antipsychotics mechanism + indication + examples

D2 AND serotonin antagonist (better efficacy in negative symptoms) schizophrenia, mania in bipolar Quetiapine, arpiprazole, olanzapine, clozapine, risperidone

Atypical antipsychotics side effects

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

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

treatment resistant schizophrenia | Hyoscine to stop excessive drooling

Benzodiazepines mechanism + indication + examples

Allosteric modulators at GABA receptors --> enhances it (=increased inhibition in CNS) alcohol dependence, seizures, anxiety disorders, insomnia Lorazepam, diazepam, chlordiazepoxide

Side effects of benzodiazepines

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

side effects of benzodiazepine rapid withdrawal

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

Med management of ADHD

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

What is given in alcohol withdrawal?

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

1st line alcohol relapse prevention drug

Naltrexone

OCD treatment

CBT + ERP, SSRI, Clomipramine (TCA)

Mild-moderate Alzheimer's

``` Cholinesterase Inhibitors (rivastigimine, donepezil) increase ACh ```

Moderate - Severe Alzheimer's

Memantine (blocks glutamate so dampens neurotoxicity)