Psychiatric drugs Flashcards by John Darlington

What are the risks of SSRI use during pregnancy?

Cardiac malformations doubled (2% risk)

3-5x risk of pulmonary hypertension in new born

Neonatal adaption syndrome - 10%

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What are the methylphenidate medications used for ADHD, and what are their side effects?

Ritalin - fast acting 4 hours

Concerta - long acting - 12 hours

Side effects:

increased BP
headaches
insomnia
Appetite suppression
seizures

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What is an alternative drug to methylphenidate and how does it work?

Dexamphetamine

- Noradrenaline - dopamine reuptake inhibitor

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How does atomoxetine work? what are some side effects and name contraindication:

Noradrenaline reuptake inhibitor

Insomnia
Reduced appetite
Nausea
sexual dysfunction

Phaeochromocytoma

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Name some less common use medications for ADHD:

Clonidine: alpha agonist

Bupropion: DA and NA reuptake inhibitor

Modafinil: NA reuptake inhibitor

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What should be checked first before starting treatment for ADHD?

Baseline:

BP
Weight

**BP and HR need to checked 6 monthly

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Which drug is licenced for adolescents with depression, and why?

Fluoxetine

SSRI can induce thoughts of suicide, especially in younger people. Fluoxetine is least likely to do this.

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What are some of the common side effects of SSRIs?

G.I upset

Change in appetite

Hyponatraemia
- especially in elderly

Increased suicidal thoughts
- especially in young

Prolonged QT
- Citalopram

Bleeding
- effect 5HT3 uptake by platelets

Serotonin syndrome

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How long should SSRIs be used for? and what advice should you give the patient taking them?

A further 6 months on from when they start to feel better

Advice
- do not stop suddenly as will cause flu like symptoms.
Decrease gradually over 4 weeks

or 1 year for anxiety

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What are the two most common class of drugs prescribed for depression and what drug class do you need to be careful with?

SSRIs
SNRIs

TCAs can be fetal if overdosed on. As such should be avoided or given in low volume to those at risk of suicide.

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What are some important side effects of TCAs?

Urinary retention

QT prolongation
Arrhythmias
Postural hypotension

Weight gain

Mania - rare

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What are some of the major risk factors for suicide?

SAD PERSONS

Sex - Male
Age >40 years
Depression
Previous attempts
Ethanol
Rational thinking lost - psychosis
Social isolation
Organised plan - leaving notes, writing wills
No hobbies
Sickness (chronic pain)

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What screening tests/ monitoring should be done prior/ during lithium administration?

TFTs
- induces hypothyroidism

Parathyroid function
- can induce hyperparathyroidism

Renal function

induces diabetes insipidus (nephrogenic)
Reduces glomeruli filtration rate

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What warnings should be given to someone taking lithium?

Carry card explaining they are on lithium

Avoid dehydration
- leads to chronic accumulation

Avoid interactive drugs

NSAIDs
Diuretics

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What is the most common endocrinological side effect of lithium?

Hypothyroidism

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What antipsychotic provides the least side effect profile?

Aripiprazole

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What investigations or monitoring should be done for people on SSRIs?

FBC - G.I bleeding

U&Es - Hyponatraemia - SIADH

ECG
- if on citalopram - increased risk of QTc elongation

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What SSRI can increase QT length?

Citalopram

“in the Citi” there are long queues

Which SSRI should be used in someone with a previous M.I?

Sertraline

What are some important drug interaction with SSRIs:

NSAIDs and Aspirin - should be give PPI alongside

Triptans - increases risk of serotonin syndrome

Warfarin and heparin
- if needed recommended to be placed on mirtazapine

How do benzodiazepines works?

Bind to GABBA receptors and promote more of an influx of Cl- into the cell, hyperpolarising it.

induces calm
hypnotic effect
muscle relaxation as GABA are found in spinal cord

What are the common side effects of benzodiazepines? and what is the serious side effects with an overdose and how is it treated?

Impaired motor co-ordination
Drowsiness
Inability to concentrate

Serious:

respiratory arrest
coma

Flumazenil
*caution if suspected overdosed with other substances

How do Barbiturates work?

Prolong the opening of GABA receptors increasing Cl- influx

High doses can stimulate the GABA receptors.

causing strong CNS depression
phenobarbital

How long following doses of Clozapine will the dose need to be restarted again slowly?

48 hours

What are the common side effects of anti-psychotic drugs?

Within hours: - Acute dystonia (opisthotonus, Torticollis) * procyclidine management Within days: - Akathisia (unable to sit still) Within weeks/ months: - Parkinsonism Years: - Tardive dyskinesia involuntary facial movements Other important side effects: - weight gain - metabolic syndrome - QT prolongation (haloperidol) *increased DVT and stroke risk in elderly patients

Which anti-psychotic drugs are less likely to cause adverse effects such as tardive dyskinesia, acute dystonia etc?

Atypical/ second generation anti-psychotics: Risperidone Olanzapine Clozapine Quetiapine

After changing the dose of lithium, when will levels need to be rechecked?

1 week 12 hours after dose

What are the adverse effects of lithium?

Nausea and vomiting Nephrotoxicity / Diabetes insipidus Thyroid enlargement - hypothyroidism T wave flattening/ inversion Hyperparathyroidism - hypercalcaemia

What SSRIs are associated with increased risk in pregnancy?

Fluoxetine: 3rd trimester persistent pulmonary hypertension Paroxetine: 1st trimester - congenital heart defects

If a patient on lithium develops low mood, constipation, difficult concentrating and abdominal pain - why might this be?

Hyperparathyroidism | - hypercalcaemia

What are some important side effects of SSRIs?

Increased suicide idealisation when first starting - especially in <25 years G.I upset/ bleeding Hyponatremia Increased QT interval

List two SNRI:

Venlafaxine Duloxetine

name some TCAs and list some serious side effects:

- Amitriptyline - Clomipramine - Nortriptyline - Imipramine * drugs are anti-muscarinic and alpha antagonists. * expect side effects accordingly Side effects: - fatal arrhythmias - Urinary retention - Hypotension - sedation

In MAOIs what is the chemical which competes with it to cause hypertensive crisis?

Tyramine | - which induces wide spread vasoconstriction

What type of drug is mirtazapine?

Noradrenageric and specific serotonin antidepressant NaSSAs

What is the chronological order of how symptoms from antipsychotics begin?

Acute dystonic reactions Akathisia (inability to sit still, restless) - days to weeks Parkinsonism - weeks to months Tardive dyskinesia - months to years

Is procyclidine? and when is it used?

An anti-cholinergic drug | - used for acute dystonia

What are the side effects of hyper-prolactinaemia caused by second generation anti-psychotics?

``` Gynecomastia Galactorrhoea Infertility Osteoporosis Breast cancer ```

Outwith lithium, name some other mood stabilisers:

Carbamazepine Lamotrigine Sodium valproate

What are the indications for benzodiazepines?

``` Short term anxiety Alcohol detoxification Short term insomnia Sleep disorders Emergancy termination of seizures ```

What patients have a paradoxical reaction to benzodiazepines?

Lewy body dementia | - neuroleptic malignant syndrome risk

What is the course of ECT?

Twice weekly in a course of 6-12 treatments

What are some indications to ECT and some side effects?

Indications: - Unipolar depression - Bipolar depression - catatonia - mania - schizophrenia side effects: - most side effects are GA related - antegrade memory loss - headache - increased risk of suicide due to increased motivation to begin with