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Core Formulary > Psychiatric drugs > Flashcards

Psychiatric drugs Flashcards

1
Q

What are examples of BZDs?

A

Diazepam
Flurazepam
Chlordiazepoxide

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2
Q

What is the antidote for BZDs?

A

Flumazenil

Note may provoke seizures in mixed overdoses (as take away BZD’s anticonvulsant role)

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3
Q

What are the indications for BZDs?

A
  1. Induction and maintenance of sleep
  2. Anxiety disorders
  3. Alcohol withdrawal, pre-operation and muscle spasms
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4
Q

What is the MOA of BZDs?

A

Open Cl- channels

Hyperpolarisation and inhibition of GABA

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5
Q

What are ADRs of BZDs?

A

Dependence and memory loss

Respiratory function effect potentially if IV

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6
Q

What is important with BZD withdrawal?

A

45% get anxiety and perceptual disturbances
Need to monitor
Gradual decrease over 4-16 weeks

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7
Q

How should BZDs be dosed?

A

Lowest dose for shortest time

Warn about side effects - tolerance and dependence!

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8
Q

What are indications for use of Pregabalin?

A

General Anxiety Disorder
Social phobia
Epilepsy
Neuropathic pain and fibromyalgia

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9
Q

What is the MOA of Pregabalin?

A

Binds to subunit of voltage gated Ca2+ channels
Reduces effects of excitatory NTs –>glutamate
Attenuates amygdala response to emotional visual stimuli

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10
Q

What are ADRs of Pregabalin?

A

Dizziness
Vertigo
Weight gain
Dependence and abusive potential (1-10% experience euphoria)
Discontinuation
Rarely cause oedema, deranged LFTs and AV block

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11
Q

What are examples of Tricyclic Antidepressants?

A

Amitriptyline
Imipramine
Clomipramine

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12
Q

What is important to think about with TCAs?

A

Titrating dose as cardiac toxicity

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13
Q

What is the MOA of TCAs?

A

Block mACh, H1 and a-1-adrenergic receptors

Inhibit serotonin and NA uptake

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14
Q

When are TCAs indicated?

A

Depression

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15
Q

What interactions doe TCAs have?

A 
Interactions with CYP450 metabolised drugs
SSRIs
MAOIs
Cimetidine 
Warfarin 
Haloperidol 
Alcohol
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16
Q

What are contraindications for TCAs?

A

Heart block, arrhythmias and recent MIs
Hypomania and mania
Acute porphyria

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17
Q

What are ADRs of TCAs?

A 
Anticholinergic:
Dry mouth 
Blurred vision 
Constipation 
Urinary retention

Antihistaminergic:
Weight gain
Sedation

a-1-adrenergic:
Postural hypotension
Dizziness
Sedation

5HT2 blockade: Weight gain (Amitriptyline)

Cardiotoxic:
Arrhythmias
QTc prolongation
(+STEMI)

Neurotoxic:
Delirium
Seizures
Coma

Manic switch

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18
Q

What are examples of NRIs?

A

Reboxetine

Atomoxetine

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19
Q

What is Reboxetine indicated for?

A

Major depression

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20
Q

What is Atomoxetine indicated for?

A

ADHD

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21
Q

When should NRIs be used with caution?

A

BAD

Epilepsy

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22
Q

What is the MOA of NRIs?

A

Inhibits NA re-uptake

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23
Q

What are the ADRs of NRIs?

A

Hand tremors
Increased HR and BP
Note QTc prolongation and arrhythmias
Anxiety

Anticholinergic effects:
Dry mouth 
Constipation 
Urinary retention 
Blurred vision
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24
Q

What are examples of SNRIs?

A

Venlafaxine

Duloxetine

25
Q

When are SNRIs indicated?

A

MDD
Neuropathy
GAD

Used in px with depression not responding to SSRIs

26
Q

What are ADRs of SNRIs?

A 
Increase BP and HR 
Tremors 
Anticholinergic effects 
Increased risk of seizures 
Anxiety
27
Q

When are SNRIs contraindicated?

A

Should be avoided if hepatic impairment
Arrhythmias
QTc prolongation

28
Q

What are examples of SSRIs?

A 
Citalopram 
Fluoxetine 
Fluvoxamine
Paratexetine 
Sertraline
29
Q

When are SSRIs indicated?

A

First line treatment against anxiety and depression

Used in treatment of premature ejaculation

30
Q

What is the MOA of SSRIs?

A

Inhibit serotonin transporter

Increases serotonin in synapse

31
Q

What are ADRs of SSRIs?

A 
GI effects (5HT3)
Sedation and dizziness
Sexual dysfunction (5HT2a)
Hyponatraemia 
Increased risk of bleeding 
Weight gain 
Nausea and vomiting (5HT3)
32
Q

What drugs are metabolised slower due to SSRIs?

A

Codeine
BZDs
Erythromycin

33
Q

What can be combined with NaSSAs?

A

SSRIs

SNRIs

34
Q

When are NaSSAs indicated?

A

Depression

35
Q

What is the MOA of NaSSAs?

A

Antagonist of a-2, 5HT2, 5HT3 and H1 receptors
No reuptake
a-2 blocks negative feedback of inhibitory autoreceptors so enhances NA and serotonin
Increase dopamine release in PFC

36
Q

What are ADRs of NaSSAs?

A

Weight gain
Sedation
Blood dyscrasias

37
Q

Bupropion

A

Atypical antidepressant

Inhibits DA re-uptake

38
Q

Mirtazapine

A

Atypical antidepressant
Sometimes used in anxiety and OCD

Antagonist of a-2, 5HT2 and 5HT3 receptors

39
Q

When are MAOIs indicated?

A

3rd line! and specialist use
Severe depression
Treatment resistant depression
Atypical

40
Q

What is the MOA of MAOIs?

A

Inhibit breakdown of monoamines
MAO-A: adrenergic and dopaminergic neurones –> antidepressive
MAO-B :serotonergic and histaminergic –> Parkinson’s
Increase storage and release of serotonin and NA

41
Q

What are examples of MAOIs?

A 
Rasagiline 
Segelinine 
Isocarboxazid 
Phenelzine 
Tranylcypromine
42
Q

What needs to be noted with MAOIs?

A

Last 2 weeks
Need to give time when switching drugs

CHEESE effect

43
Q

What are ADRs of MAOIs?

A 
Nausea and dizziness
Restlessness
Sweating 
Tremor 
Insomnia 
Postural hypotension 
Peripheral oedema 
Sexual dysfunction
44
Q

What interactions do MAOIs have?

A 
Other antidepressants
Insulin 
Alcohol 
Anti-epileptics 
Sympathomimetics 
Dobutamine
45
Q

When are MAOIs contraindicated?

A

CVS
Pheochromocytoma
Cerebral vascular disease
Delirium

46
Q

What are examples of antipsychotics?

A

Typical:
Haloperidol
Chlorpromazine

Atypical:
Clozapine

Risperidone
Quetiapine
Olanzapine

47
Q

Haloperidol

A

Antagonise D receptors

48
Q

Chlorpromazine

A

EPSEs - D2 blockage

Negative symptoms

49
Q

Clozapine

A

Block D2, serotonin and other MA
D2 = ESPEs

Sedation and weight gain

Decreased craving for illegal drugs and alcohol

Take week to days to work

50
Q

What are EPSEs?

A
  • Dystonias
  • Parkinsonism
  • Akathesia
  • Tardive dyskinesia
51
Q

Risperidone
Quetiapine
Olanzapine

A

5HT2A and D2 receptors

Decreased EPSEs and better with negative symptoms

Improve cognitive function
May improve social impairments
No bone marrow suppression

52
Q

What are the results of elevated prolactin (due to dopamine blockade)?

A 
Ammenorrhoea 
Gynaecomastia 
Galactorrhoea 
Sexual dysfunction 
Hypogonadism
53
Q

Procyclidine

A

Used in treatment of dystonias and Parkinsonism

mACh antagonist

54
Q

What can BZDs also be used for?

A

Treatment of tardive dyskinesia

Treatment of akathesia

55
Q

Dantrolene

A

Anti spasmodic

Used in treatment of neuroleptic malignant syndrome

56
Q

Bromocriptine

A

DA receptor antagonist

Used in treatment of neuroleptic malignant syndrome

57
Q

Stopping smoking (+psychosis / schizophrenia)

A

Nicotine replacement therapy
Bupropion (Schizophrenia)
Varenicline

58
Q

What is to be noted with Clozapine?

A

Nicotine is enzyme inhibitor

Dramatic smoking reduction may mean increase in toxicity

59
Q

What needs to be measured early on in treatment?

A

Height, weight and BMI
BP
Fasting plasma glucose
Fasting plasma lipids

+ smoking, physical activity and diet

Core Formulary (11 decks)

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