Psychiatric drugs Flashcards
Types of Antidepressants
Try MOA ASS
TCA
MAO inhibitors
Atypical antidepressants
SSRI
SNRI
TCA
MOA, Names, SE, USES, How long it takes to work,
MAO: inhibits reuptake of adrenaline and serotonin in the synaptic cleft.+ have affinity for cholinergic receptors and 5HT2
N: mitriptyline, clomipramine, dosulepin, doxepin, imipramine, lofepramine, nortriptyline, trimipramine.
SE:
- C–> cardiotoxicity, P. hypotension, long QT, arythmmias
- A–> Anticholinergic
- S–> sedation, seretonin syndrome
- T–> thrombocytopenia
- Hypersensitivity reactions–> urticarial, photosensitivity.
Uses: Migraine, Depression, peripheral neuropathy, OCD, Nocturnal anuerisis
time: takes 2-4 weeks to work (slow acting)
what is seratonin syndrome?
what drugs cause it?
Mx
is a rare but life-threatening complication of increased serotonin activity, usually rapidly occurring within minutes of taking the medication.
It is most commonly caused by SSRIs but can be caused by other drugs such as TCAs and lithium.
- Cognitiveeffects: headache, agitation, hypomania, confusion, hallucinations, and coma.
- Autonomic effects: shivering, sweating, hyperthermia, hypertension and tachycardia.
- neuromuscular excitation: (hyperreflexia, myoclonus, rigidity)
Management: involves stopping the offending drug and supportive measures.
- supportive including IV fluids
- benzodiazepines
- more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazin
SSRI’s
MOA, Names, SE, USES, CI, How long it takes to work,
N: sertraline, escitalopram, fluoxetine, fluvoxamine, Citalopram, paroxetine
MOA: increase serotonin activity by reducing the presynaptic reuptake of serotonin–> more seretonin chilling at junction–> down regulation of post-synaptic receptors
SE: GI symp, Insomnia, headache. sweating, diharrea, SIADH (HYPONATREMIA), FAT, sexual dysfunction, long QT, discontinuation sydrome, increase suicide risk
Uses: Depression, OCD, chronic anxiety, eating disorders, Panic disorders, social phobia
Caution: Hx of MANIA, women pregnant in first trimestersm careful with drugs that caus eupper GI bleed (NSAIDS & blood thinning)
CIx: Hx of MANIA
SSRI advice on drug
(starting, stoppping, monitoring)
- Access suicidal risk in 1 week–> those under 30
- Review patients after 2 weeks of prescribing SSRIs
- Takes for about 6 months if success–> reduce risk of relapse.
- If want to stop: reduce dose slowly in 4 weeks
which SSRI is safe in post MI? children and adolescents? can cause serotonin syndrome when switching? can cause long QT?
- Sertraline
- fluoxetine
- Fluoxetine
- Citalopram
SSRIs and pregnancy?
which drug is the most zag?
weigh up benefits and risk when deciding whether to use in pregnancy.
Is used during the first trimester –> small risk of congenital heart defects
Use during the third trimester —> can result in persistent pulmonary hypertension of the newborn
PAROXETINE has an increased risk of congenital malformations, particularly in the first trimester
what is Discontinuation syndrome ?
which drugs cause this?
range of symptoms that occur when SSRI or SNRI r STOPPED FAJ2A
Paroxetine and Venlafaxine
sweating, shakes, agitation, insomnia, headaches, irritability, nausea and vomiting, paraesthesia, clonus
Lithium
MAo, Uses, SE, excretion, Cautions, CI
NARROW therapuetic window!!!!!!!!!!!!
MAO: Mood stabilizer
SE: leucocytosis, Fine tremor, hypothyroidism, Metallic taste, Polyuria, Diabetes insipidous, ebstein’s anomlay, Weight gain
Excreted by: KIDNEY (watch out for renal impairment ppl)
Uses: Bipolar, Drug resistant depression
CI: renal impairment, breastfeedin/pregnant, congential heart defects, if taking ACE, NSAIDS, DIURETICS
Lithium Toxicity
causes, SE, treatment?
More than 1.5 mmol/L
precipitated by 4 D’s:
- Dehydration
- Drugs (ACE, NSAIDS, THIAZIDES)
- Diuretics (THIAZIDES)
- Depletion of sodium.
SE:
Confusion, Convulsions, Coma, Course tremor, N&V, Ataxia, Hyperreflexia,
Mx:
- STOP lithium
- mild-moderate –> FLUIDS
- SEVERE: haemodialysis
- sodium bicarbonate is sometimes used but there is limited evidence to support this. By increasing the alkalinity of the urine it promotes lithium excretion
Lithium Monitoring, how long should u take it for?
(b4 and after taking)
is u changed the ptx dose of lithium, when do u re check it?
B4: U&Es and eGFR, TFTs, pregnancy status and baseline ECG should be checked.
take for at least 18 months for clear benefit. Starting dose 400 mg at night
- check lithium levels after 12 hrs of taking, after 1 week, every 3 months
- U&E’s–> every 6 months
- TFT’s–> every 12 months
after a CHANGE in dose, lithium levels should be taken ONE WEEK later and then weekly until the levels are stable.
if someone cant take lithium, what do u give second line?
Sodium Valproate
What is ECT and what is it used for.
how many sessions a week?
Electro convulsive therapy An electric current is used to induce seizures for 30 seconds
E Euphoric symptoms like severe mania
C Catatonia.
T Tearful
- Suicidal risk
- Severe depression where patient is not eating or drinking
- Treatment resistant depression.
Name for contra indications to ECT?
Myocardial infarction
Aneurysm
Raised ICP → absolute contraindication
stroke
Side-effects of ECT
Short term PC DAMS
P Peripheral nerve palsy
C Confusion
D Dental trauma
A Arrhythmias, Anaesthetic problems
M Muscular aches and headaches
S Short-term memory loss, Status epilepticus
long term
Amnesia (anterograde and retrograde) worse with BILAT ECT
MAO
names, uses, MAO, SE, CI
which one is more dangerous and why?
what if u wanted to change to another antidepressent?
phenelzine, isocarboxazid, moclobamide, tranylcrypomine
USES: 3rd line for depression: atypical or tx resistant depression and social phobia
MAO: block MAO in nerve terminals, this increases the availbility of NA or SE for neruotransmission, type A and B
SE: CVS (postural hypotension, aryhtmmias), sedation/insomnia, headache, increase apetite, weight gain
CI: pheochromocytoma, acute confusional state, avoid
CAUTION: avoid with Tyramine-rich foods that can lead to hypertensive CRISIS, (sausages, salami, red wine, cheese)
NEED A WASHOUT PERIOD (UP TO 6 WKS)
when do we give mirtazipine? what is it
atypical antidepressent
acys on 5HT-2 and 5HT-3 antagonist
STRONG histamine activity!–> sedation and weight gain
goals for those who wanna gain weight and sleep,
used if 2 SSRI has not worked
antipsychotic monitoring
U&E, FBC, LFT: start of therpay and annually
BM: basline line then in 4-6 mnths, then annually, but olanzipine and clozapine u check igt again after one month of taking it
Lipids: baseline, 3 mnths, annually
ECG: baseline
BP: before
Prolactin: start then 6 mnths
weight: basleine. every 3mnths, then annaully
CK: baseline
7 side effects of clozapine
hypersalivation
sedation
weight gain
diabetes
agranulocytosis
fatal bowl obstruction
seizures
how often to u check FBC for clozapine?
which 3 atypical antipsychotics can be given as a depot?
olanzipine, risperidone, aripiprizole
