Psychiatric drugs Flashcards
Mechanism of action of SSRIs
Inhibit the uptake of serotonin by neurones. So increasing the duration its in the synaptic cleft.
Improves mood and physical symptoms.
SSRIs are first line for?
Moderate / severe depression
Cautions for SSRIs (2)
Epilepsy
Peptic ulcer disease
Why should SSRIs be used with caution in the young?
Can be associated with increased risk of self harm / suicidal thoughts.
2 contraindications for SSRIs?
Bipolar disorder
Mania phase
6 SE of SSRIs
GI upset - N&V and diarrhoea
Decreased appetite
Weight gain / loss
Hyponatraemia esp. in the elderly.
Rarely increase in suicidal thoughts and behaviours
Sexual dysfunction
3 common SSRIs
Citalopram
Sertraline
Fluoxetine
SSRIs interact specifically with?
MOIs
SSRIs should be used in caution …..(4)
Epilepsy (lowers the seizure threshold)
Young patient
Peptic ulcer disease
Hepatic impairment
Normal starting does for SSRI
20mg tablet OD
How long do SSRIs take to start working?
few weeks
How long should SSRIs be taken for as a minimum?
6 months once symptoms improve
What happens if you stop SSRIs suddenly?
GI upset
flu like withdrawl symptoms
Sleeplessness
Antipsychotics mainly target which symptoms of psychosis?
+ve
What is the mechanism of action of antipsychotics?
Antagnoise D2 receptors
Difference between first and second generation antipsychotics
improved efficiency in treatment resistant schizophrenia
Works against -ve symptoms more
Lower risk of extra-pyramidal SE
What are patients especially at risk of with second generation APs?
Metabolic syndrome - weight gain, DM and lipid changes
What happens as a result of APs targeting the nigrostriatal pathway?
Extrapyramidal SE
- Parkinsonian symptoms
- Actue dystonia
- Akathisia
- Neuroleptic malignant syndrome
What hormones does dopamine inhibit the release of?
Prolactin
Hyperprolactinaemia symptoms produced by APs (3)
Galatorrhoea
Amenotrhea
Sexual dysfunction
Anticholinergic SE caused by APs (4)
Dry mouth
Constipation
Urinary retention
Blurred vision
Why can APs cause arrhythmias?
Prolong the QT interval
What causes postrural hypotension in APs?
Alpha adrenergic receptor blockade
Histamine blockade in APs lead to?
Sedation and weight gain
Caution for AP
CV disease
3 serious SE of clozapine
Agranulocytosis
Myositis
Cardiomyopathy
2 contraindications of APs
Severe HD
History of neutropenia
2 uses of APs in psychosis
Acute and prophylactically
2 possible methods of administration of APs
Daily oral treatment
Slow release IM injections
What time is it best to take APs?
bedtime
What should be done on patients on APs each year?
Annual health screen
Mechanism of action of tricyclic AD?
inhibit uptake of serotonin and noradrenaline at the synapse.
Tricyclic AD second line for?
Moderate / severe AD
4 types of receptors blocked by tricyclic AD?
H1
Alpha
Muscarinic
Dopamine
4 symptoms of blocking antimuscarinic receptors -
Dry mouth
Urinary retenion
Constipation
Blurred vision
Blockade of H1 receptors in Tricyclic AD leads to -
Sedation
Tricyclic AD blocking alpha receptors leads to -
postural hypotension
What problems can Tricyclic AD cause on the heart?
Arrhythmia’s and ECG changes
How may tricyclic AD cause changes to the brain? (3)
Convulsions
Hallucinations
Mania
Blocking of dopamine receptors causes what in tricylic AD?
Sexual dysfunction
Breast changes
What should tricyclic AD not be prescribed with?
MOI
s
Two preparations of tricyclic AD -
Tablet / oral solution
How long do tricyclic AD take to work?
2 weeks
How long should patients take tricyclic AD?
at least 6m after symptoms improve
Sudden withdrawl of tricyclic AD can lead to? (4)
GI upset
Influenza symptoms
Neuro symptoms and Sleep disturbance
Clozapine monitoring
every week for 18 weeks
then every 2 weeks
then @ at a year - monthly
