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Psychiatric Drugs > Psychiatric Drugs 1 > Flashcards

Psychiatric Drugs 1 Flashcards

1
Q

Name 4 adrenergic side effects

A 
Sweating
Tremor
Headaches
Nausea
Dizziness
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2
Q

Name 4 muscarinic (ACh) side effects

A 
Dry mouth
Difficulty swallowing
Thirst
Difficulty urinating/urinary retention
Hot and flushed skin
Dry skin
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3
Q

Name 4 histamine side effects

A

Dry mouth
Drowsiness
Dizziness
Nausea and vomiting

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4
Q

Name 3 common side effects of SSRIs

A 
Weight changes
Sexual dysfunction 
Nausea and GI disturbance
Sense of restlessness
Headache
Suicidal ideation
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5
Q

Which SSRI is safest in cardiac disease?

A

Sertraline

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6
Q

Which SSRI can cause QTc prolongation?

A

Citalopram

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7
Q

Which SSRI can cause serotonin syndrome when being switched over to a different medication?

A

Fluoxetine

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8
Q

Above what dose of venlafaxine do you need to monitor BP?

A

225mgs

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9
Q

Mirtazapine is a unique class of antidepressant on its own. What type of antidepressant is it?

A

Noradrenergic and specific serotonergenic antidepressant - acts as a 5HT-2 and 5HT-3 antagonist.

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10
Q

What side effects fo mirtazapine may be used to their therapeutic advantage?

A

Sedation and weight gain

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11
Q

Why can TCA’s be fatal in overdose?

A

Cause QTc prolongation and arrhythmias

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12
Q

What do you need to do if changing an MAOI to another antidepressant?

A

A washout period of up to 6 weeks

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13
Q

MAOIs have potential for tyramine reactions leading to what?

A

Hypertensive crisis

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14
Q

What is the most common side effect of vortioxetine?

A

Nausea

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15
Q

Is a patient presents with new onset depression and major weight loss of difficulty sleeping, what antidepressant would you consider prescribing?

A

Mirtazapine

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16
Q

If a patient present with new onset depression and comorbid neuropathic pain, what antidepressant would you consider prescribing?

A

An SNRI eg duloxetine or venlafaxine

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17
Q

Name 3 symptoms caused by antidepressant discontinuation syndrome?

A 
Sweating
Shakes
Agitation
Insomnia
Headaches
Irritability
Nausea and vomiting
Paraesthesia
Clonus
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18
Q

What property of an antidepressant can make the discontinuation syndrome worse?

A

A shorter half-life - paroxetine and venlafaxine are the hardest to stop.

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19
Q

Give 3 symptoms of serotonin syndrome

A

Cognitive - headaches, agitation, hypomania, confusion, coma.
Autonomic - shivering, sweating, hyperthermia, tachycardia, nausea and diarrhoea.
Somatic - myoclonus, hyper-reflexia and tremour.

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20
Q

How is serotonin syndrome treated?

A

Supportive - fluids and monitoring

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21
Q

What receptors do antipsychotics works on?

A

D2 receptors (to reduce level of dopamine activity) in the mesocortical and mesolimbic pathways.

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22
Q

Antipsychotics acting on which two pathways leads to their unwanted effects?

A

Nigrostriatal (movement) and tuberoinfundibular (HPA axis)

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23
Q

Name 3 side effects of all antipsychotic medications

A 
Sedation
QTc prolongation 
Extrapyramidal side-effects (Parkinsonism, tardive dyskinesia, akathisia) - more likely to be caused by typical antipsychotics.
Weight gain
Diabetes
Dystopia
Oculogyric crisis
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24
Q

Name 2 typical antipsychotics

A

Haloperidol

Chlorpromazine

25
Q

Name 2 atypical antipsychotics

A 
Clozapine
Olanzapine
Risperidone
Quitiapine
Amisulpride
Aripriprazole
26
Q

What monitoring would you do for a patient on antipsychotics?

A 
FBC
Lipids
LFT
HbA1C
Weight
ECG
BP and HR
27
Q

Name 2 risk factors for neuroleptic malignant syndrome

A

High potency domaine antagonists (typical antipsychotics) in antipsychotic naive
High doses
Young men

28
Q

Name 3 symptoms of neuroleptic malignant syndrome

A 
Fever 
Confusion
Muscle rigidity
Sweating
Autonomic instability
Rhabdomyolysis
Renal failure
Seizures
29
Q

What will blood tests show in neuroleptic malignant syndrome

A

Raised CK

Raised WCC

30
Q

How would you treat neuroleptic malignant syndrome?

A 
Emergency referral to A&E
Stop antipsychotics
Give benzodiazepine
Fluid resuscitation
Cooling blankets
O2 if needed
Fluids and sodium bicarbonate to treat rhabdomyolysis
Dantrolene or lorazepam to relax muscles
31
Q

What medication can you use to treat the extra pyramidal side effects of psychiatric drugs?

A

Procyclidine (reduced acetylcholine activity)

32
Q

What are acute dystonias?

A

Sustained, often painful, muscular spasms causing twisting abnormal postures. Majority occur within 5 days of medication being commenced. Most commonly neck, tongue, jaw and oculogyric crisis.

33
Q

How would you treat an acute dystonia?

A

Stop antipsychotic.
Administer IM or IV anticholinergics eg procyclidine, continue 1-2days after dystonia and consider using long-term prophylactically.

34
Q

What is the criteria for using clozapine in schizophrenia?

A

Use after two other antipsychotics have not been effective.

35
Q

What significant side effects can clozapine cause?

A

Agranulocytosis (severe leukopenia).

Gastrointestinal hypo-mobility which can lead to potential fatal bowel obstruction.

36
Q

What monitoring/precautions are needed when using clozapine due to it’s potentially serious side-effects?

A

FBC weekly for first 18 weeks, then fortnightly up to a year, then monthly.
Dose titrate slowly upward over two weeks and vital signs monitored due to potential for autonomic dysregulation.

37
Q

How would you treat agranulocytosis caused by clozapine?

A

Stop clozapine, along with any other potentially bone marrow suppressing drugs eg sodium valproate.
Avoid other antipsychotics for a couple of weeks, if needed give aripiprazole.
Contact consultant haematologist as an emergency.
Avoid sources of infection and consider broad spectrum antibiotics.

38
Q

In what condition are beta-blockers contraindicated?

A

Asthma

39
Q

What receptors do benzodiazepines act on?

A

GABA

40
Q

For how long maximum should benzodiazepines be used for an anxious patient.

A

Cautiously and for no more than 6 weeks.

41
Q

How does pregabalin work?

A

Binds to voltage gated Ca2+ channels, increases GABA

42
Q

How should pregabalin be used in anxious patients?

A

Short term use, but often used indefinitely as less potential for misuse, dependence and tolerance than benzodiazepines.

43
Q

What are the 2 side effects of pregabalin?

A

Sedation

Weight gain

44
Q

How do the doses of SSRIs used in OCD differ from those used in depression and anxiety?

A

Higher dose in OCD.

45
Q

How long should sleeping tablets be used for?

A

2 weeks and take for only 5 out of 7 days a week to reduce potential for tolerance.

46
Q

How often should lithium levels be checked? Should they have any other monitoring?

A

Weekly after dose change until level stable, then 3 monthly once stable.
U&Es and TFTs every 6 months.

47
Q

Name 2 side effects of lithium and 2 longtime side effects.

A

SE: GI disturbance, metallic taste and/or dry mouth, fine tremor, polydipsia, polyuria, weight gain.
Long-term: hypothyroidism, renal impairment.

48
Q

Give 3 symptoms of lithium toxicity

A 
Confusion
Coarse tremor
Incontinence
Nausea and vomiting
Ataxia
Seizures
49
Q

How would you treat lithium toxicity?

A

Stop lithium

Supportive measures eg IV fluids, dialysis, benzodiazepines for seizures.

50
Q

What drug interactions can increase lithium levels?

A

NSAIDs
Loop diuretics
ACE inhibitors
Also dehydration - advise to drink a lot of water on a hot day

51
Q

What medication is first one treatment for bipolar disorder?

A

Quetiapine

52
Q

What anticonvulsant used as a mood stabiliser in bipolar can cause Stevens Johnson Syndrome?

A

Lamotrigine

53
Q

Name 2 side effects of anticonvulsants used as mood stabilisers

A

Sedation
Weight gain,
Thrombocytopenia (monitor FBC)

54
Q

What medication is used to treat ADD/ADHD

A

Methylphenidate

55
Q

What monitoring is needed for patients taking methylphenidate?

A

Weight
Height (in children)
Pulse

56
Q

What is tardive dyskinesia?

A

Disorder caused by antipsychotics and metoclopramide causing involuntary, repetitive body movements which may include grimacing, sticking out the tongue or smacking the lips.

57
Q

What conditions can sodium valproate be used to treat?

A

Schizophrenia
Epilepsy
Bipolar disorder
Migraine prophylaxis

58
Q

What is ECT used to treat?

A

Catalonia
Prolonged or severe manic episodes
Schizophrenia
Severe depression

59
Q

Name 2 contraindications for ECT

A

Brain tumour

Recent MI

Psychiatric Drugs (2 decks)

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