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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
Name 2 atypical antipsychotics
``` Clozapine Olanzapine Risperidone Quitiapine Amisulpride Aripriprazole ```
26
What monitoring would you do for a patient on antipsychotics?
``` FBC Lipids LFT HbA1C Weight ECG BP and HR ```
27
Name 2 risk factors for neuroleptic malignant syndrome
High potency domaine antagonists (typical antipsychotics) in antipsychotic naive High doses Young men
28
Name 3 symptoms of neuroleptic malignant syndrome
``` Fever Confusion Muscle rigidity Sweating Autonomic instability Rhabdomyolysis Renal failure Seizures ```
29
What will blood tests show in neuroleptic malignant syndrome
Raised CK | Raised WCC
30
How would you treat neuroleptic malignant syndrome?
``` 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
What medication can you use to treat the extra pyramidal side effects of psychiatric drugs?
Procyclidine (reduced acetylcholine activity)
32
What are acute dystonias?
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
How would you treat an acute dystonia?
Stop antipsychotic. Administer IM or IV anticholinergics eg procyclidine, continue 1-2days after dystonia and consider using long-term prophylactically.
34
What is the criteria for using clozapine in schizophrenia?
Use after two other antipsychotics have not been effective.
35
What significant side effects can clozapine cause?
Agranulocytosis (severe leukopenia). | Gastrointestinal hypo-mobility which can lead to potential fatal bowel obstruction.
36
What monitoring/precautions are needed when using clozapine due to it’s potentially serious side-effects?
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
How would you treat agranulocytosis caused by clozapine?
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
In what condition are beta-blockers contraindicated?
Asthma
39
What receptors do benzodiazepines act on?
GABA
40
For how long maximum should benzodiazepines be used for an anxious patient.
Cautiously and for no more than 6 weeks.
41
How does pregabalin work?
Binds to voltage gated Ca2+ channels, increases GABA
42
How should pregabalin be used in anxious patients?
Short term use, but often used indefinitely as less potential for misuse, dependence and tolerance than benzodiazepines.
43
What are the 2 side effects of pregabalin?
Sedation | Weight gain
44
How do the doses of SSRIs used in OCD differ from those used in depression and anxiety?
Higher dose in OCD.
45
How long should sleeping tablets be used for?
2 weeks and take for only 5 out of 7 days a week to reduce potential for tolerance.
46
How often should lithium levels be checked? Should they have any other monitoring?
Weekly after dose change until level stable, then 3 monthly once stable. U&Es and TFTs every 6 months.
47
Name 2 side effects of lithium and 2 longtime side effects.
SE: GI disturbance, metallic taste and/or dry mouth, fine tremor, polydipsia, polyuria, weight gain. Long-term: hypothyroidism, renal impairment.
48
Give 3 symptoms of lithium toxicity
``` Confusion Coarse tremor Incontinence Nausea and vomiting Ataxia Seizures ```
49
How would you treat lithium toxicity?
Stop lithium | Supportive measures eg IV fluids, dialysis, benzodiazepines for seizures.
50
What drug interactions can increase lithium levels?
NSAIDs Loop diuretics ACE inhibitors Also dehydration - advise to drink a lot of water on a hot day
51
What medication is first one treatment for bipolar disorder?
Quetiapine
52
What anticonvulsant used as a mood stabiliser in bipolar can cause Stevens Johnson Syndrome?
Lamotrigine
53
Name 2 side effects of anticonvulsants used as mood stabilisers
Sedation Weight gain, Thrombocytopenia (monitor FBC)
54
What medication is used to treat ADD/ADHD
Methylphenidate
55
What monitoring is needed for patients taking methylphenidate?
Weight Height (in children) Pulse
56
What is tardive dyskinesia?
Disorder caused by antipsychotics and metoclopramide causing involuntary, repetitive body movements which may include grimacing, sticking out the tongue or smacking the lips.
57
What conditions can sodium valproate be used to treat?
Schizophrenia Epilepsy Bipolar disorder Migraine prophylaxis
58
What is ECT used to treat?
Catalonia Prolonged or severe manic episodes Schizophrenia Severe depression
59
Name 2 contraindications for ECT
Brain tumour | Recent MI

Psychiatric Drugs (2 decks)

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