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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
Antidepressants: Noradrenergic adn specific serotonergic antidepressants (NaSSAs)
Mirtazapine: 15-45mg/daily
26
Antidepressants, SNRIs ( serotonin-noradrenaline reuptake inhibitors)
Venlafaxine: 75-150mg/ daily Duloxetine: 60-120mg/ daily
27
Side effects of SSRI´s (6)
1. Insomnia 2. Nausea 3. Weight loss 4. headaches 5. anxiety 6. Sexual dysfunction
28
Indications for Venlafaxine
Major depressive disorder It has properties of tricyclics without the anticholinnergic side effects
29
Side effects of Venlafaxine
Hypertension in high doses
30
Indications for Clozapine
RX resistent schizophrenia | Intolerable EPSE or tardive dykinesia
31
Clozapine dose
starting dose 12.5/25mg, uptitrate by 25mg every 2-3 days
32
Life threatening side effects of clozapine
``` Myocarditis toxic megacolon seizures at high doses metabolic syndrome Orthostatic hypotension Agranulocytosis ```
33
Common side effects of clozapine
hypersalivation, weight gain and sedation
34
Examples of benzodiazepines
Diazepam Lorazepam Alprazolam Oxazepam
35
Uses for benzos
Anti-anxiety (use ones with longer half life) sedative properties ( use short acting ones) Alcohol withdrawel Anaesthetic induction
36
MOA of benzodiazepines
benzos are GABA agonists
37
Side effects of benzos
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
What do we give in benzo overdose
Flumazenil
39
Use of B-blockers in anxiety
Treat peripheral manifestations (sweating, palpitations and tremor) Also useful in akathisia (restlessness)
40
List mood stabalisers
Lithium carbonate Sodium Valproate Carbamazepine Lamotrigine Atypical antipsyhotic agents (olanzepine, risperidone, quietiapine)
41
Which drug to discontinue in bipolar mania
antidepressants
42
Which drug should one add to antidepressants in bipolar depression
Mood stabiliser
43
Where are carbamazepine and valproate used, other than bipolar
Impulse control disorders
44
Which drug is specifically useful in rapid cycling
Lamotrigine
45
Tests to perform before starting Lithium
Renal functions cardiac and thyroid status lithium has inhibitory effect on thyroid
46
Is Lithium safe to use in pregnancy
no. Contraindicated in first trimester
47
Other side effects of Lithium
acne | cardiac arrythmias
48
Therpeutic concentrations of Litium are
0.5-1.2mmol/L Toxicity usually above 1.5
49
Signs of Lithium toxicity ( to tell patient)
Nausea and vomiting Tremors Neuro signs(ataxia, disorientation, stupor, coma)
50
Important drug interactions of Lithium
Thiazide diuretics Anti-inflammatory agents Tetracyclines
51
Side effects of Valproate
``` Hepatotoxicity Weight gain gastric irritation hyperandrogenemia polycycstic ovaries leukopenia thrombocytopenia ``` usually dose related
52
Side effects of carbamazapine
Neuro side effect (sedation and diplopia) | Bone marrow supression
53
Which enzyme does carbamazapine induce
cytochrome P450 (smoking also induces this
54
NB side effects of lamotrigine
Toxic epidermal necrolyis Steven- Johnson syndrome Discontinue if rash appears
55
Is lamotrigine safe in pregnancy
Nope. contraindicated in first trimester
56
Which agents should be used for mood stabalisation during pregnancy
atypical antipsychotic agents
57
Cholinergic agents used in the treatment of alzheimers disease
Donepazil Rivastigmine Galantamine These agents are acetylicholinersterase inhibitors
58
Side effects of cholinergic agents
Nause, vom, diarrhoea Bradyarrythmias, GI bleeding Bronchospasm
59
Drugs used for treating acute dystonic reactions and parkinsonistic EPSE´s
Anticholinergic agents, Trihexyphenidyl Biperiden Orphenadrine
60
Side effects of anticholinergic agents
``` dry mouth urinary retention constipation aggravation of glaucoma Anticholinergic intoxication...(flushed skin, tachycardia, hypertension, hallucinationsm delirium and convulsions) ```
61
Which agents inhibit the cytochrome P450
Valproate and cimetidine | Fluoxetine and paroxetine
62
What causes serotonin syndrome
When MAOIs are given with SSRIs
63
Indications for ECT
Treatment resistent major depression Major depressive disorder with psychosis Treatment resistent manic episode Acute schizophrenia
64
Which 2 antiretroviral drugs are commonly associated with psychiatric side effects
efavirenz | zidovudine
65
Side effects of efavirenz
``` dizziness headaches confusion poor concentration agitation memory loss depersonalisation hallucinations insomnia ```
66
side effects of zidovudine
``` confusion agitation insomnia mania depression myalgia headaches ```
67
Does quetiapine cause hyperprolactinemia and EPSE
Rarely
68
How to treat treatment induced parkinsonism from typical antipsychotic like chlorpromazine
Anticholinergic agent: Biperiden: 2-5mg/ kg. IM repeat after 30min... max of 4 doses iin 24hr Orphenadrine
69
Buproprion:
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
Lamotrigine in psychiatry
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
Typical antipsychotic depot preparations
Modecate (Fluphenaxine) Fluanxol (Flupenthixol) Clopixol (zuclopenthixol)
72
Atypical antipsychotic depot preparations
Risperdal Consta | Xeplion (Paliperidone palmitate)

Psychiatry (4 decks)

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