Psychiatric Drugs Flashcards by Molly Harby

Give 4 generic side effects of adrenergic receptor drugs

Sweating, tremor, headaches, nausea, dizziness

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Give 4 generic side effects of muscarinic receptor drugs

Dry mouth, dysphagia, thirst, urinary retention, hot and flushed skin

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Give 4 generic side effects of histamine receptor drugs

Dry mouth, drowsiness, dizziness, nausea, vomiting

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Give the 4 main extrapyramidal side effects

Parkinsonism (cogwheel rigidity, bradykinesia, tremor)
Akathisia (restlessness, inability to stay still)
Dystonia (muscle spasms)
Tardive dyskinesia (involuntary movements of the tongue lips and face)

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What are antidepressants?

Medications used to treat depression. They mainly work on increasing the activity of serotonin at postsynaptic receptors.

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Give 4 examples of SSRIs

Sertraline
Citalopram
Fluoxetine
Paroxetine

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How do SSRIs work?

Reduce the presynaptic reuptake of serotonin after its release

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Give 5 side effects of SSRIs

Restlessness, agitation, increased anxiety, nausea, GI disturbance, headaches, weight changes, sexual dysfunction, GI bleeding, suicidal ideation

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Give examples of 3 DDIs with SSRIs

Aspirin
Warfarin
NSAIDs
Triptans

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Which SSRI is given in paediatric depression?

Fluoxitine

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Which SSRI is given as 1st line treatment?

Sertraline

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Which SSRI is the safest in cardiac disease?

Sertraline

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How do TCAs work?

Inhibiting the reuptake of adrenaline and serotonin in the synaptic cleft

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Give 4 potential side effects from TCAs

Tachycardia, hypotension, fine tremor, weight gain, dry mouth, urinary retention, dizziness, thirst, N&V

Fatal in overdose (QTc elongation)

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Give 3 examples of TCAs

Amitriptyline
Dosulepin
Clomipramine
Lofepramine

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Give the only example of an NaSSAntidepressant

Mirtazapine

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Give 2 side effects of Mirtazapine

Sedation, weight gain, dry mouth

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What is the mechanism of action of Reboxetine?

Prevents the reuptake of noradrenaline (NARI)

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What is a SNRI?

Serotonin and noradrenaline reuptake inhibitor –> stops serotonin and noradrenaline from re-entering the presynaptic membrane.

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Give 2 examples of SNRIs

Duloxetine

Venlafaxine

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Give 4 potential side effects of SNRIs

Nausea, dry mouth, headache, dizziness, sexual dysfunction

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When should Venlafaxine be used cautiously?

Heart disease patients –> changes in blood pressure

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When might a MAOI be prescribed?

Atypical depression

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What foods must a person on an MAOI avoid?

Foods high in tyramine

Cheese, wine, pickled meats

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Give 2 examples of MAOIs

Phenelzine Isocarboxazid Moclobemide Tranylcypromine

How long should a patient stay on an antidepressant?

6 months after they feel better

What is discontinuation syndrome?

When a patient comes off antidepressants very quickly | Symptoms include sweating, shakes, agitation, insomnia, headaches, irritability, nausea, vomiting, paraesthesia, clonus

What is serotonin syndrome?

Too much serotonin in the body from antidepressant use

What are the symptoms of serotonin syndrome?

Headaches, agitation, hypomania, confusion, shivering, sweating, hyperthermia, tachycardia, nausea, myoclonus, hyperreflexia, tremor

What are antipsychotics?

Drugs given to patients who have psychotic symptoms such as in schizophrenia and psychotic depression.

What is the main aim of antipsychotics?

Reduce dopamine activity in the mesocortical and mesolimbic brain pathways

Which receptors do typical antipsychotics work on?

Muscarinic and histamine

Give 5 common side effects of typical antipsychotics

``` Bradycardia Muscle stiffness Parkinsonism Tardive dyskinesia Akathisia Dizziness Sexual dysfunction Acute dystonia (torticollis, oculogyric crisis) ```

Give 2 examples of typical antipsychotics

``` Haloperidol Flupenthixol Zuclopenthixol Chlorpromazine Sulpiride ```

Give 3 side effects of atypical antipsychotics

Weight gain Dyslipidemia Diabetes Increased risk of VTE

Give 4 examples of atypical antipsychotics

``` Clozapine Olanzapine Risperidone Quetiapine Amisulpride Aripiprazole ```

When should Clozapine be prescribed?

After 2 antipsychotics have been tried

What is the main risk of being on Clozapine?

Agranulocytosis

Give 4 side effects of Clozapine (not agranulocytosis)

GI hypomotility, bowel obstruction, hypersalivation, urinary incontinence

What is Neuroleptic Malignant Syndrome?

Rare, life-threatening reaction to antipsychotics causing fever, confusion, muscle rigidity, sweating and autonomic instability.

Why are anticholinergics sometimes taken alongside antipsychotics?

To reduce the extrapyramidal side effects

Give an example of an anticholinergic

Procyclidine

What are anxiolytics?

Drugs which are used to help reduce anxiety.

Why are beta blockers used as anxiolytics?

Reduce autonomic nervous system activation so relieve autonomic symptoms of anxiety.

What receptors do Benzodiazepines work on?

GABA-A receptors to potentiate the effect of GABA and reduce the excitability of neurons.

Give 4 side effects of Benzodiazepines

Drowsiness, lightheadedness, ataxia, confusion, amnesia

Give 4 effects of a Benzodiazepine overdose

Ataxia, dysarthria, nystagmus, coma, respiratory depression

Give 3 examples of benzodiazepines

Diazepam Lorazepam Temazepam Zopiclone

What is the mechanism of action of Pregabalin?

Inhibitor of glutamate, noradrenaline and substance P

Give 3 side effects of Pregabalin

``` Dizziness Blurred vision Diplopia Confusion Vivid dreams ```

Give examples of drugs which can work as hypnotics

Benzodiazepines Trazodone Low dose amitriptyline Z drugs

What are the Z drugs?

Zopiclone, Zolpidem, Zaleplon | Used as hypnotics and act like benzodiazepines

What are acetylcholinesterase inhibitors?

Drugs used in Alzheimers Disease to inhibit the breakdown of acetylcholine and therefore increase the amount of acetylcholine in the brain.

Give 4 side effects of ACh-esterase inhibitors

Nausea, vomiting, insomnia, fatigue, muscle cramps, syncope

Who are ACh-esterase inhibitors contraindicated in?

``` Patients with a heart rate less than 50 Supraventricular arrhythmias Peptic ulcers Asthma COPD ```

Give 3 examples of ACh-esterase inhibitors

Donepezil Galantamine Rivastigmine

What is Memantine?

Glutamine receptor agonist which leads to lower neuronal excitability. It is mainly given to patients with dementia behavioural issues.

What medications can be given in alcohol dependence?

Acamprosate and Naltrexone to reduce cravings | Disulfiram to induce severe hangovers

What are mood stabilising drugs?

Drugs used to treat bipolar disorder

Which 3 antipsychotics are commonly used in psychotic bipolar?

Haloperidol Olanzapine Quetiapine

Why should bipolar patients not be given an antidepressant when they are in a low episode?

They can induce a manic episode

Why must bloods be taken every week when a patient is initially started on Lithium?

Narrow therapeutic window

Which bloods should be done every 6 months for patients on long term lithium?

U&Es | TFT

What ECG changes may be seen in a patient on Lithium?

T wave flattening | Widening of the QRS

Give 5 side effects of lithium

Polyuria, polydipsia, nausea, metallic taste, GI disturbance, weight gain, renal impairment, fine tremor, hypothyroidism, leukocytosis, oedema

Give 5 effects of lithium toxicity

Coarse tremor, ataxia, dysarthria, reduced consciousness, convulsions, coma, death

Give 3 types of drugs which interact with lithium

NSAIDs, Loop diuretics, ACE inhibitors

Which 2 antiepileptic drugs can also be used as mood stabilisers?

Sodium valproate | Carbamazepine

What blood checks need to be done when a patient is taking sodium valproate?

LFTs, FBC every 6 months, TFTs every year

Give 5 side effects of sodium valproate

Tremor, sedation, anorexia, nausea, vomiting, diarrhoea, headache, sedation, thrombocytopenia, hair loss

What blood checks need to be done when a patient is taking carbamazepine?

Serum levels, LFTs, U&Es, FBC every 6 months | TFTs every year

When is carbamazepine most effective in bipolar?

When the mood cycles are very rapid

What are the side effects of carbamazepine?

Dizziness, drowsiness, ataxia, headache, hyponatraemia, oedema, anorexia, constipation, leukopenia, agranulocytosis, rash

What is the main drug used in treatment of ADHD?

Methylphenidate

Give 4 side effects of methyphenidate

``` GI disturbance Hypertension Tachycardia Palpitations Insomnia Nervousness ```