Psych (NEW) Flashcards
1
Q
SNRI’s
A
Venlefaxine/Desvenlefaxine/Duloxetine
MOA
-inhibits serotonin and noradrenaline reuptake
SE:
- ECG changes
- nausea
- constipation
- dry mouth
- diaphoresis/tremor
- dizziness
- insomnia
- sexual dysfunction
Precautions
- Serotonin syndrome
- > MOAI within 2 weeks
- > SNRI’s
- > St Johns wort
- > opioids
- > MDMA/amphetamines
- Increased suicide risk
- > probably only in teenagers
- Withdrawal
- > most common with venlafaxine
- Dose reduce in severe liver/kidney disease
- May provoke manic episode in bipolar
- May cause bleeding in those at high risk
- Heart disease
- > palpitations
- > orthostatic hypotension
- > tachycardia/HTN
- Generally safe in pregnancy/breastfeeding
2
Q
SSRI’s
A
MOA
- all SSRIs appear to treat depression by increasing serotonergic activity
- > decrease the action of presynaptic reuptake pump
- they have very little affinity for other types of receptors
SE
- nausea
- headache
- diarrhoea
- anxiety/agitation
- insomnia
- sexual dysfunction
- dry mouth
- drowsiness
- sweating/tremor
- rare
- > prolonged QT with cit/escitalopram/fluoxetine
- > tachycardia/hypotension
- > hyponatraemia in eldery
- > osteoporosis in elderly
Precautions
- CYP450 inhibition
- > most = fluoxetine and paraxetine
- > least = sertraline and cit/escitalopram
- Withdrawal
- > greatest risk with paroxetine (shortest half life)
- Increased suicide risk
- > probably only in teenagers
- Serotonin syndrome
- > MOAI within 2 weeks
- > SNRI’s
- > St Johns wort
- > opioids
- > MDMA/amphetamines
- Use lower dose in severe kidney/liver disease
- Use lower dose in elderly
- May provoke manic episode in bipolar
- May increase bleeding risk in those at high risk
- Generally safe in pregnancy/breastfeeding
3
Q
Mirtazepine
A
MOA:
- antagonises presynaptic alpha 2, increasing norepi and serotonin release
- antagonises post synaptic 5HT2 receptors, increasing 5HT1 receptor activity
- also has high affinity for H1 receptors = sedating
- no muscurinic or cholinergic affinity
SE:
- dry mouth
- drowsiness
- apetite increase
- weight gain
4
Q
Anti-psychotics
A
FGA
->chlorpromazine/fluphenazine/thioridazine/haloperidol
SGA
>aripiprazole/olanzepine/quetiapine/risperidone/clozepine
MOA
- All
- > post synaptic blockade of D2 receptors
- SGA
- > block pre-synaptic 5HT2 receptor (increase serotonin)
- Clozapine
- > selective for D2c receptor
- > D2a = nigrostriatal/D2c = mesolimbic
SE
- EPS
- > pseudoparkinsonism (tremor/rigidity/bradykinesia)
- > dyskinesias (torticolis/ocular gyrus/trismus/laryngospasm)
- > akathesia
- > tardive dyskinesia
- Hyperprolactinaemia
- > gynacomastea
- > galactorrhea
- > amenorrhoea
- > infertility
- Metabolic syndrome
- > hyperglycaemia
- > dyslipidaemia
- > weight gain
- Anticholinergic effects
- > hypotension
- > tachycardia
- Antimuscurinic
- > dry mouth
- > urinary retention and constipation
- > blurred vision
- > QT prolongation and torsades
- Neuroleptic malignant syndrome
- > fever
- > rigidity
- > autonomic instability
- > mental status change
- Other
- > dysphoria
- > sedation/anxiety/agitation
5
Q
Clozapine safety
A
Contraindications
- CNS depression of any cause
- Ileus
- Severe cardiac disease/shock
- Bone marrow disorders/neutropenia
- Severe renal impairment
- Severe liver impairment
SE
- Usual anti-psychotic side effects
- > less EPS
- > no tardive dyskinesia for clozapine
- > more metabolic effects
- Drowsiness
- Hypersalivation
- > aspiration pneumonia
- Urinary incontinence
- Constipation/bowel obstruction
- > more deaths than agranulocytosis
- Seizures
- Hyperthermia
- Hepatitis
- Myocarditis
- > early (6-8 weeks)
- Blood count
- > neutropenia in 2%
- > agranulocytosis in 1%
- > eosinophilia
Practice
- Laxatives for constipation
- CYP450 interactions
- > caffeine/nicotine affects dosing
- Baseline
- > BMI/waist circumference
- > BP
- > glucose/lipids
- > ECG + echo
- > prolactin
- > LFTs
- > eGFR
- > requires normal blood count
- Monitor
- > metabolic profile regularly
- > myocarditis (weekly trops/CRP for first month)
- > cell count (weekly for 18 then monthly)
- > echo annually
- > metabolic semi annually
