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Phase 3a > Psych pharmacology and treatments > Flashcards

Psych pharmacology and treatments Flashcards

1
Q

what are the different types of SSRI?

A
  • Citalopram
  • Escitalopram
  • Fluoxetine
  • Paroxetine
  • Sertraline
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2
Q

what can SSRIs be used for?

A

first line treatment for depression
post traumatic stress disorder
OCD

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3
Q

what SSRI is useful post MI?

A

Sertraline

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4
Q

what SSRI is the one of choice in children and adolescents?

A

Fluoxetine

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5
Q

what are the side effects of SSRIs?

A
  • most common is GI symptoms
  • increased risk of GI bleeding, if patient is taking NSAIDs and SSRI a PPI should also be prescribed
  • citalopram can cause a dose-dependent QT interval prolongation
  • insomnia, increased anxiety and irritability
  • sexual side effects - ED
  • nausea, vomiting and diarrhoea
  • hyponatraemia (SIADH)
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6
Q

what drugs do SSRIs interact with?

A

NSAIDs: NICE guidelines advise ‘do not normally offer SSRIs’, but if given co-prescribe a proton pump inhibitor
warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine
aspirin: GI problems
triptans: avoid SSRIs
monoamine oxidase inhibitors (MAOIs) - risk of serotonin syndrome

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7
Q

how long should a patient take an SSRI after remission?

A

at least 6 months to reduce the risk of relapse

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8
Q

how should patients stop taking SSRIs?

A

gradually over a 4 week period
(not necessary with fluoxetine)
paroxetine has higher incidence of discontinuation symptoms

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9
Q

what symptoms should make you stop taking SSRI?

A 
increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
paraesthesia
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10
Q

can women take SSRI during pregnancy?

A
  • BNF says to weigh up benefits and risk when deciding whether to use in pregnancy.
  • Use during the first trimester gives a small increased risk of congenital heart defects
  • Use during the third trimester can result in persistent pulmonary hypertension of the newborn
  • Paroxetine has an increased risk of congenital malformations, particularly in the first trimester
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11
Q

what are SNRIs?

A

serotonin-norepinephrine reuptake Inhibitor

Venlafaxine
desvenlafaxine
duloxetine

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12
Q

what can SNRI be used for?

A

depression
anxiety
panic disorder
effective in reducing pain associated with fibromyalgia and pain caused by neuropathy

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13
Q

what are the side effects of SNRIs?

A

same as SSRI

may increase blood pressure and heart rate

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14
Q

what are TCAs?

A

tricyclic antidepressants
amitriptyline
clomipramine
imipramine

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15
Q

what can TCAs be used for?

A

depression
can also be used in migraine prevention and treatment of neuropathic pain
insomnia

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16
Q

what are the side effects of TCAs?

A 
hypotension 
dizziness 
sedation 
blurred vision 
dry mouth 
constipation 
urinary retention 
cardiac conduction abnormalities 
cardiotoxicity and QT prolongation
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17
Q

what are MAOIs?

A

Monoamine oxidase inhibitors

two types A and B
(type a preferentially metabolises serotonin)
(type B preferentially metabolised dopamine)

Isocarboxazid
phenelzine

selegiline (specifically type B - good for Parkinson’s)

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18
Q

what are MAOIs used for?

A

depression

19
Q

what are the the side effects of MAOIs?

A

drug drug interactions
drug food interactions - avoid tyramine rich food (cheese, cured or smoked meats/fish, some overripe fruits) as they can cause hypertensive crisis and potentially a stoke

other side effects include dry mouth, nausea, diarrhoea, constipation, headache, drowsiness, insomnia

20
Q

how should SSRIs be monitored?

A

MONITOR 1-2 weeks (after 1 week if under 30/increased risk of suicide) after starting - agitation and SUICIDAL IDEATION initially - since have more energy but mood hasn’t improved yet

*requires 2-4 weeks to become effective

21
Q

what is serotonin syndrome?

A

too much serotonin = restless, fever, tremor, myoclonus, confusion, fits

22
Q

what is a contraindication to SNRIs?

A

chronic alcoholic liver

23
Q

what is an atypical antidepressant and when is it indicated?

A
  • Mirtazapine

- Indicated for depression where sedation or increased oral intake is desirable also indicated for PTSD

24
Q

what are the side effects of mirtazapine ?

A

weight gain and sedation

25
Q

when is lithium used?

A
  • Acute treatment of mania
  • Bipolar relapse prevention
  • Treatment resistant depression
26
Q

why does lithium need monitoring?

how is it monitored?

A

because it is very toxic and has very narrow therapeutic window (avoid in those who have risk of suicide)
TFT - hypothyroid can manifest 6-18 months after
FBC
pregnancy test
kidney function test s

27
Q

what are the side effects of lithium?

A

leucocytosis
early side effects - fine tremor, dry mouth, metallic taste, mild diuresis, sick

Late - weight gain, hypothyroidism, hypokalaemia, oedema, teratogenic, diabetes insupidus

  • LITHIUM
  • Level - 0.6-1 mmol/L, Leukocytosis
  • Insipidus - Nephrogenic Diabetes (Increase ADH) • Tremors - mild (ok), coarse? (TOXICITY)
  • Hydration - Dry mouth, diarrhoea, thirsty
  • Increased - GI, Skin, memory problems
  • Under active thyroid (decreased TSH)
  • Metallic taste, mum beware - Ebstein anoma
28
Q

when does lithium toxicity occur?
what can it be caused by
what are the symptoms
and how is it managed?

A

• Occurs when levels are GREATER than 1.0-1.5mmol/L • Can be caused by:
- Fluid depletion (vomiting, diarrhoea, dehydration)
- Changes in salt level in diet
- Reduced renal function
- Certain medications e.g. diuretics, NSAIDs, blood pressure medication
- Change in brand of lithium • Onset usually sudden
• Symptoms:
- Coarse tremor, hyperreflexia, seizures, heart block - Muscle weakness, ataxia, coma
- Dysarthria, dysphasia
• Management:
- STOP LITHIUM & TREAT cause - Give fluids
- Haemodialysis (if severe)

29
Q

what can antipsychotics be used for?

A
  • Relieve positive symptoms i.e. hallucinations, thought disorder, delusions
  • Treat schizophrenia
  • Control acute mania
  • Provide rapid tranquillisation
  • Treat psychotic depression
30
Q

what can antipsychotics not do?

A
  • Relieve negative symptoms i.e. blunted emotions, apathy
  • Change personalities

apart from clozapine

31
Q

before starting antipsychotics what tests need to be performed?

A
  • Bloods - FBC, U&E, LFT, lipids, BM, cholesterol, prolactin
  • Physical - weight, BP, pulse
  • ECG - Risk of prolonged QT syndrome/arrhythmias
32
Q

what are some first generation/typical anti-psychotic?

A

Haloperidol

Chlorpromazine

33
Q

what are the side effects of first generation antipsychotics?

A

worsening negative symptoms
extrapyramidal side effects (acute dystonic reaction, Parkinsonism, akathisia, tardive dyskinesia (involuntary, repetitive body movements))
anticholinergic side effects - dry mouth, constipation, blurred vision, urinary retention
antiadrenergic - postural HTN
antihistaminergic - sedation and weight gain
prolactinaemia and gynocomastia in men

34
Q

what are some examples of second generation/atypical antipsychotics?

A

Olanzapine, Clozapine, Risperidone, Quetiapine

35
Q

what are the side effects of 2nd gen antipsychotics?

A
  • Metabolic - weight gain, hyperglycaemia and dyslipidemia

* Hyperprolactinaemia

36
Q

when is clozapine used?

A

in treatment resistant schizophrenia

used when 2 other treatments have networked

37
Q

what are the side effects of clozapine?

A

Agranulocytosis (bone marrow suppression)
neutropenia, myocarditis, cardiomyopathy, constipation)

  • requires regular blood test for neutropenia
  • staring/stoping smoking can alter the drug metabolism
38
Q

what is the neuroleptic malignant syndrome?

A

Rare life threatening reaction to antipsychotics (both typical and atypical)
Carries a mortality of 10%
More common in young male patients Features:
• Onset usually in first 10 days of treatment or after increasing dose • Pyrexia, rigidity, tachycardia
• Severe motor/mental/autonomic dysfunction
• Increased sweating, dysphagia, urinary incontinence
• Raised creatine kinase in most cases
- AKI (secondary to rhabdomyolysis) may develop in severe
cases

39
Q

how is neuroleptic malignant syndrome managed?

A

stop antipsychotic
IV fluids to prevent renal failure
Bromocriptine may be used

40
Q

what can sodium valproate be used for?

A

epilepsy
acute mania
bipolar

41
Q

what are the side effects of sodium valproate?

A 
VALPROATE:
 • Vomiting
• Ataxia
• Liver toxicity
• Pancreatitis
• Tremor
• Extra weight-gain
42
Q

what can carbamazepine be used for?

A

epilepsy

2nd line for bipolar prophylaxis

43
Q

what are some examples of anxiolytics and hypnotics?

A

Benzodiazepines e.g. Diazepam and ‘z’ drugs (zopiclone, zolpiden, zaleplon)

44
Q

what are the side effects of anxiolytics and hypnotics?

and how is an overdose managed?

A
  • ALL result in TOLERANCE, DEPENDENCE and WITHDRAWAL - When used in combination with alcohol can become addictive - Respiratory depression when used with alcohol or opiates
  • Overdose management:
    • Flumazenil - an antagonist of benzodiazepine receptor -> reverses effects

Phase 3a (41 decks)

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