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Phase 3a > Psych Pharmacy > Flashcards

Psych Pharmacy Flashcards

1
Q

What are hypnotics?

A

Sleeping pills

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2
Q

3 types of hypnotics

A

Benzodiazepines
Non-benzodiazepines (zdrugs)
Melatonin

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3
Q

How do benzodiazepines works?

A

Enhance the mechanisms of GABA

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4
Q

Name 2 benzodiazepines used as hypnotics. And state their different uses.

A

Temazepam - short acting

Nitrazepam - long acting

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5
Q

Common indications of benzodiazepines:

A
  1. First line management of seizures and status epilepticus
  2. First line for alcohol withdrawal
  3. Short term treatment of extreme anxiety
  4. Short term treatment of extreme insomnia
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6
Q

Side effects of benzos

A
  • drowsiness
  • sedation
  • coma
  • loss of airway reflexes - obstruction - death
  • can lead to dépendance
  • abrupt cessation can lead to withdrawal similar to alcohol
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7
Q

What to monitor with benzodiazepines?

A

After IV or high dose clinical signs and vitals are key to monitor.

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8
Q

What is the action of Z drugs?

A

Bind to benzo receptors and are clinically the same as benzos but different structure.

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9
Q

Give an example of a Z drug.

A

Zopiclone

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10
Q

Adverse effects of Zdrugs

A
  • day time sleepiness
  • rebound insomnia when drugs are stopped.
  • CnS effects : headache, confusion, nightmares
  • taste disturbance (zopiclone)
  • gi upset (zolpilem)
  • possible to overdose - respdepression, coma
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11
Q

When would melatonin be used?

A

Only licenced in over 55y but also used off licence in children.

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12
Q

What is an anxiolytic?

A

An anxiety reducer.

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13
Q

Give 2 drug types used in the treatment of anxiety.

A

Benzodiazepenes and beta-blockers

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14
Q

Give 2 examples of benzodiapepenes used in the treatment of anxiety.

A

Lorazepam - shorter acting

Diazepam - longer acting

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15
Q

Give the reasons for use of beta-blockers in anxiolytics and which beta-blockers used.

A

Propanolol.
Works on autonomic symptoms (tachycardia, sweating, , SOB etc.)
May have indirect effect on anxiety by reducing autonomic sx which may be contributing to anxiety.

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16
Q

Give 5 types of antidepressants.

A
  • SSRIs
  • SNRIs
  • Noradrenergic and specific seretonin reuptake inhibitors
  • Tricyclic antidepressants
  • Monoamine oxidase inhibitor
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17
Q

What is the first line treatment for depression? and why?

A

SSRIs because they are better tolerated in general and safer in overdose.

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18
Q

Give 3 examples of SSRIs.

A

Citalopram, sertraline, fluoexitine.

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19
Q

Give some notable risks of ssris.

A
  • Increase risk of bleeding (GI)
  • Hyponatraemia ( especially in elderly patients)
  • Increased risk of suicide and suicidal thoughts (mainly in younger patients)
  • Risk of seretonin syndrome.
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20
Q

What is seretonin syndrome?

A 
Often occurs when 2 or more ssris are used together leads to autonomic hyperactivity.
Physical signs : 
-tachycardia
-HTN
-hyperthermia
-agitation
-altered mental state
-dilated pupils
-slow horizontal eye movements
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21
Q

What is the management of seretonin syndrome?

A
  • Mainly supportive
  • stop seretonergic agents
  • benzos to help agitation
  • cardiac monitoring
  • IV fluids/o2
  • cooling for hyperthermia.
22
Q

Give 2 examples of serotonin noradrenergic reuptake inhibitors.

A

Duloxetine

venlofaxine

23
Q

When would serotonin noradrenergic reuptake inhibitors be indicated?

A

When dual therapy ssris have been trialled with no success

24
Q

What are the side effects of snris?

A
  • Postural hypotension
  • HTN
  • tachycardia
  • GI upset
25
Q

Give an example of a noradrenergic and specific serotonin antidepressant.

A

Mirtazepine.

26
Q

When would you give an NaSSA?

A

As second line treatment for depression. Also good if INSOMNIA is present .

27
Q

What are the notable side effects of NaSSAs (mirtazapine)

A

Weight gain, sedation.

28
Q

Name 2 tricyclic antidepressants.

A

amitriptyline

imipramine

29
Q

When are tricyclic antidepressants indicated and why aren’t they prescribed as much any more?

A

Sometimes used in insomnia and neuropathic pain

Aren’t really prescribed anymore because they can be fatal in overdose.

30
Q

Give some side effects of tricyclic antidepressants.

A

Antimuscarinic:

  • constipation, urinary retention, blurred vision, dry mouth (drying up)
  • sedation
  • hypotension
  • QT prolongation
  • convulsions
  • hallucinations
  • mania
  • decreased sexual function
  • extrapyramidal
31
Q

What can occur in a tricyclic overdose?

A

arrhythmias, cardiac event, seizures, death.

32
Q

Give a caution of using monoamine-oxidase inhibitors.

A

hypertensive reaction in tyramine rich foods
(tyramine causes a release of monoamine from presynaptic vesicles but is usually metabolised in the gut by monoamine-oxidases.

33
Q

Give an example of a monoamine-oxidase inhibitor.

A

Phenelzine

34
Q

Give 3 first generation antipsychotics.

A

Haloperidol, chlorpromazine, zuclopenthixol (clopixol), flupentixol ( depixol)

35
Q

How do first generation (typical) antipsychotics work in general?

A

By blocking D2 receptors.

36
Q

What are the indications for first line antipsychotics?

A
  • Psychomotor agiation
  • Schizophrenia
  • Bipolar disorder (mania/hypomania)
37
Q

Give the main side effects of first line antipsychotics.

A

Extrapyramidal effects: Dystonia/muscle jerks, akathisia, neuroleptic malignant syndrome

  • decreased blood pressure
  • QT prolongation
  • Erectile dysfunction.
38
Q

What is the difference between 1st and 2nd generation antipsychotics?

A

2nd generation antipsychotics work on a greater range of receptors in addition to the dopamine receptors. Range includes : serotonin, muscarinic, histamine.

39
Q

Give 4 examples of 2nd generation antipsychotics.

A 
Olanzipine, 
quetiapine
Risperidone
Aripiprazole (partial d2 agonist)
Clozapine
40
Q

What is the difference between clozapine and the other 2nd generation antipsychotics?

A

It is the only one shown to be more effective. Must have trialled at least 2 other antipsychotics before starting.

41
Q

What are the side effects of 2nd generation antipsychotics?

A
  • Extrapyramidal,
  • Metabolic disturbance : wt gain, diabetes, hyperglycaemia
  • QT prolongation
42
Q

What are the specific side effects of clozapine?

A

Myocarditis - monitor with regular ECGs ( QT prolongation and inverted T waves)

  • Agranularcytosis (destruction of neutrophils) - Monitor by regular blood tests WCC
  • Constipation - stool monitoring (laxitaves movicol)
43
Q

What is the upper limit of QTC?

A

F :470

M:440

44
Q

Give 3 types of mood stabilisers.

A

Antipsychotics
Lithium
Antiepileptics

45
Q

What antipsychotics may be prescribed as mood stabilisers?

A

Haloperidol, olanzapine, quetiapine, riperidone.

46
Q

How does lithium work?

A

Decreased release of neurotransmitters and blocks actions of hormones and neurotransmitters.

47
Q

When is lithium used?

A

first line treatment in bipolar affective disorder.

48
Q

What are the cautions of lithium?

A

It has a very narrow therapeutic range and needs to be carefully monitored.
Also very nephrotoxic - needs to be monitored with regular blood test for kidney function.
Also teratogenic.

49
Q

What are the signs of lithium toxicity?

A
  • Gi upset
  • tremor
  • polyuria
  • weakness
  • visual disturbance
  • confusion
  • drowsieness
  • abnormal reflexes
  • arrhythmias
  • seizures
  • coma
  • death
50
Q

Give 3 antiepileptics that may be used in mood stabilisation and when might they be used.

A

Sodium valproate
Lamotrigine - better for more depressive symptoms
Carbamazepine - if unresponsive to other drugs

51
Q

What are the cautions with antiepileptics?

A

Very teratogenic.

Phase 3a (2 decks)

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