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Psychiatry > psych pharmacology > Flashcards

psych pharmacology Flashcards

1
Q

List Extrapyramidal side effects

A

Acute dystonia
Parkinsonism
Akathisia
Tardive dykinesia

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2
Q

Side effects of antipsychotics other than EPSE

A 
Metabolic disturbances (diabetes, weight gain, dylipidemia)
Hyperprolactinemia
Anti.cholinergic side effects
QT prolongation 
Seizures
Agranulocytosis
Tardive dykinesia
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3
Q

Name 2 atypicals that cause prolactin elevation

A

Risperidone

Amisulpride

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4
Q

Name uses of tricyclic antidepressants, and drugs specific for certain conditions

A

Mainly for Major depressive disorder

Takes 10-21 days for response

Panic disorder (imipramine)
Posttraumatic stress disorder ( imipramine, amitriptyline) 
Obsessive compulsive D (Clomipramine)
Enuresis (imipramine) 
Chronic pain syndrome (Amitriptyline)
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5
Q

Side effects of Tricyclic antidepressants

A
  1. Anticholinergic side- effects: Dry mouth, blurred vision, urinary retention, constipation
  2. Postural hypotension (alpha-1- blockage)
  3. Sedation ( antihistamine effects)
  4. Cardiotoxic (arrhythmias)… very dangerous in overdose
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6
Q

Side effects of Mirtazapine

A

weight gain and sedation

fewer sexual side effects

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7
Q

Trazodone side effects

A

Priapism

sedative ( may be an advantage )

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8
Q

Antidepressants: Noradrenergic reuptake inhibitors (NRIs)

A

Reboxetine: 8-12mg/daily

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9
Q

Side effects of bupropion

A
  1. Headache
  2. nausea
  3. dry mouth
  4. weight loss
  5. insomnia
  6. agitation
  7. dizziness
  8. pharyngitis
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10
Q

Side effects of Reboxetine (NRI)

A 
Dry mouth 
tachy
hypotension
sweating
urinary urgency/ incontinence
constipation 
insomnia
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11
Q

Antidepressants: Serotonin antagonists and reuptake inhibitors

A

Trazodone: 150mg/daily

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12
Q

Antidepressants: Norepineprine and dopamine reuptake inhibitors (NRDIs)

A

Antidepressants: Norepineprine and dopamine reuptake inhibitors (NRDIs)
Bupropion 300mg/ day given in 2 doses of 150mg

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13
Q

Antidepressants, Tricyclic antidepressants

A

Amitriptyline: 50-200mg/daily

Imipramine: 50-200mg/daily

Clomipramine: 50-200mg/daily

Lofepramine: 70mg-210mg/daily

nb: all end in ine

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14
Q

Name 3 first gen/ typical antipsychotics

A

Haloperidol: 0.5-15mg

Chlorpromazine: 200-800mg

Trifluoperazine: 2-15mg

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15
Q

MOA. Tricyclics

A

Block noradrenaline & serotonin at presynaptic membrane

Therefore increased noradrenergic and serotonergic activity

Also Block cholinergic (muscarinic), alpha-1-adrenergic and histamine receptors

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16
Q

Name second gen/ atypical antipsychotics

A

Rispiridone: 1-8mg

Olanzapine: 5-20mg

Quietiapine: 300-800mg

Clozapine: 100-800mg

Paliperidone

Amisulpride

Sulpiride

Ziprasidone

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17
Q

Antidepressants: SSRI

A

Fluoxetine: 20-60mg/day

Paroxetine: 20mg/day

Fluvoxamine: 50mg/day

Citalopram: 20mg/day

Sertraline: 50mg/day

Escitalopram: 10mg/day

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18
Q

Antipsychotic depot preparations

A

Fluanxol
Modecate
Clopixol

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19
Q

When to use SSRI´s (7 conditions )

A 
Antidepressents
Panic disorder
Obessesive-compulsive disorder
Posttraumatic stress disorder
Generalised anxiety disorder
Social anxiety disorder 
Bulemia
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20
Q

Antidepressants: monoamine oxidase inhibitors

A

Tranylcypramine: 10-30mg/ daily

Phenelzine: 10- 30mg/ daily

RIMAs: moclobemide: 300-600mg/ dail

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21
Q

Side effects of Agomelatine

A

Dizzy
abdo pain
abnormal changes in liver function tests

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22
Q

When do we use Monoamine oxidase inhibitors

A

Treatment resistent major depression and social phobia

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23
Q

Antidepressants with novel mechanisms of action

A

Agomelatine

increases levels of dopamine and noradrenaline in areas of the brain involved in mood control

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24
Q

Side effects of monoamine oxidase inhibitors

A
  1. hypertensive crisis, when ingested with tyramine- containing foods such as meat and cheese, and medication such as pethidine.
  2. insomnia
  3. irritability
  4. restlessness
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25
Q

Antidepressants: Noradrenergic adn specific serotonergic antidepressants (NaSSAs)

A

Mirtazapine: 15-45mg/daily

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26
Q

Antidepressants, SNRIs ( serotonin-noradrenaline reuptake inhibitors)

A

Venlafaxine: 75-150mg/ daily

Duloxetine: 60-120mg/ daily

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27
Q

Side effects of SSRI´s (6)

A
  1. Insomnia
  2. Nausea
  3. Weight loss
  4. headaches
  5. anxiety
  6. Sexual dysfunction
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28
Q

Indications for Venlafaxine

A

Major depressive disorder

It has properties of tricyclics without the anticholinnergic side effects

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29
Q

Side effects of Venlafaxine

A

Hypertension in high doses

30
Q

Indications for Clozapine

A

RX resistent schizophrenia

Intolerable EPSE or tardive dykinesia

31
Q

Clozapine dose

A

starting dose 12.5/25mg, uptitrate by 25mg every 2-3 days

32
Q

Life threatening side effects of clozapine

A 
Myocarditis 
toxic megacolon
seizures at high doses
metabolic syndrome 
Orthostatic hypotension 
Agranulocytosis
33
Q

Common side effects of clozapine

A

hypersalivation, weight gain and sedation

34
Q

Examples of benzodiazepines

A

Diazepam
Lorazepam
Alprazolam
Oxazepam

35
Q

Uses for benzos

A

Anti-anxiety (use ones with longer half life)
sedative properties ( use short acting ones)
Alcohol withdrawel
Anaesthetic induction

36
Q

MOA of benzodiazepines

A

benzos are GABA agonists

37
Q

Side effects of benzos

A
  1. may cause dependence
  2. mild withdrawel symptoms (anxiety, irritability, insomnia)
  3. Reversible cognitive impairment
  4. Drowsiness ( no operating of machinary or driving)
  5. Potentiate effects of alcohol
38
Q

What do we give in benzo overdose

A

Flumazenil

39
Q

Use of B-blockers in anxiety

A

Treat peripheral manifestations (sweating, palpitations and tremor)
Also useful in akathisia (restlessness)

40
Q

List mood stabalisers

A

Lithium carbonate
Sodium Valproate
Carbamazepine
Lamotrigine

Atypical antipsyhotic agents (olanzepine, risperidone, quietiapine)

41
Q

Which drug to discontinue in bipolar mania

A

antidepressants

42
Q

Which drug should one add to antidepressants in bipolar depression

A

Mood stabiliser

43
Q

Where are carbamazepine and valproate used, other than bipolar

A

Impulse control disorders

44
Q

Which drug is specifically useful in rapid cycling

A

Lamotrigine

45
Q

Tests to perform before starting Lithium

A

Renal functions
cardiac and thyroid status

lithium has inhibitory effect on thyroid

46
Q

Is Lithium safe to use in pregnancy

A

no. Contraindicated in first trimester

47
Q

Other side effects of Lithium

A

acne

cardiac arrythmias

48
Q

Therpeutic concentrations of Litium are

A

0.5-1.2mmol/L

Toxicity usually above 1.5

49
Q

Signs of Lithium toxicity ( to tell patient)

A

Nausea and vomiting
Tremors
Neuro signs(ataxia, disorientation, stupor, coma)

50
Q

Important drug interactions of Lithium

A

Thiazide diuretics
Anti-inflammatory agents
Tetracyclines

51
Q

Side effects of Valproate

A 
Hepatotoxicity 
Weight gain 
gastric irritation 
hyperandrogenemia
polycycstic ovaries
leukopenia
thrombocytopenia

usually dose related

52
Q

Side effects of carbamazapine

A

Neuro side effect (sedation and diplopia)

Bone marrow supression

53
Q

Which enzyme does carbamazapine induce

A

cytochrome P450

(smoking also induces this

54
Q

NB side effects of lamotrigine

A

Toxic epidermal necrolyis
Steven- Johnson syndrome

Discontinue if rash appears

55
Q

Is lamotrigine safe in pregnancy

A

Nope. contraindicated in first trimester

56
Q

Which agents should be used for mood stabalisation during pregnancy

A

atypical antipsychotic agents

57
Q

Cholinergic agents used in the treatment of alzheimers disease

A

Donepazil
Rivastigmine
Galantamine

These agents are acetylicholinersterase inhibitors

58
Q

Side effects of cholinergic agents

A

Nause, vom, diarrhoea
Bradyarrythmias, GI bleeding
Bronchospasm

59
Q

Drugs used for treating acute dystonic reactions and parkinsonistic EPSE´s

A

Anticholinergic agents,

Trihexyphenidyl
Biperiden
Orphenadrine

60
Q

Side effects of anticholinergic agents

A 
dry mouth 
urinary retention 
constipation 
aggravation of glaucoma
Anticholinergic intoxication...(flushed skin, tachycardia, hypertension, hallucinationsm delirium and convulsions)
61
Q

Which agents inhibit the cytochrome P450

A

Valproate and cimetidine

Fluoxetine and paroxetine

62
Q

What causes serotonin syndrome

A

When MAOIs are given with SSRIs

63
Q

Indications for ECT

A

Treatment resistent major depression
Major depressive disorder with psychosis
Treatment resistent manic episode
Acute schizophrenia

64
Q

Which 2 antiretroviral drugs are commonly associated with psychiatric side effects

A

efavirenz

zidovudine

65
Q

Side effects of efavirenz

A 
dizziness
headaches
confusion 
poor concentration 
agitation 
memory loss
depersonalisation 
hallucinations 
insomnia
66
Q

side effects of zidovudine

A 
confusion 
agitation 
insomnia 
mania 
depression 
myalgia 
headaches
67
Q

Does quetiapine cause hyperprolactinemia and EPSE

A

Rarely

68
Q

How to treat treatment induced parkinsonism from typical antipsychotic like chlorpromazine

A

Anticholinergic agent:
Biperiden: 2-5mg/ kg. IM
repeat after 30min… max of 4 doses iin 24hr

Orphenadrine

69
Q

Buproprion:

A

Antidepressant drug used in smoking cessasation:
MOA: increases dopamine and noradrenaline levels

Side effects: sleep disturbances
dry mouth
seizures
dose: 300mg/ daily given in two 150mg doses

70
Q

Lamotrigine in psychiatry

A

Anticonvulsant medication used as mood stabiliser

MOA Of lamotrigine
Blocks sodium channel and thus modulates the release of glutamate and aspartate

Side effects:
Toxic epidermal necrolysis
Steven Johnson syndrome

discontinue if rash appears

dose: starting dose is 25mg, once daily…uptitrate every 2 weeks. (50, 100, 200)
Maintainence dose is 200mg/ day

71
Q

Typical antipsychotic depot preparations

A

Modecate (Fluphenaxine)
Fluanxol (Flupenthixol)
Clopixol (zuclopenthixol)

72
Q

Atypical antipsychotic depot preparations

A

Risperdal Consta

Xeplion (Paliperidone palmitate)

Psychiatry (4 decks)

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