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Year 4 - Psych > Psychiatric Medications > Flashcards

Psychiatric Medications Flashcards

1
Q

Anti-depressants
- Common mechanism of action
- Common time needed

A

Anti-depressants
- Common mechanism of action
- Common time needed

  1. Serotonin activity
    - increase activity at post-synaptic receptor
  2. 2-3 weeks
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2
Q

SSRIs
- Mechanism

A

SSRIs
- Mechanism

  1. Reduce pre-synaptic uptake
  2. Increased junction serotonin
  3. Down-regulation of post-synaptic receptors
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3
Q

SSRIs
- ADRs

  1. Short term
  2. Sensitive
  3. Uncommon
A

SSRIs
- ADRs

  1. Short term
    - restlessness/agitation
    - GI/Nausea
    - Headache
  2. Weight change
  3. Sexual dysfunction
    - low libido
    - failure to orgasm
  4. Less common
    - Bleeding (eg. PPI with aspirin)
    - Suicidal ideation
    (Young men, first few weeks)
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4
Q

SSRIs
- 4 commonest (dose)
- Choosing

A

SSRIs
- Commonest & Use

  1. Sertraline (50-200)
    - Safe in heart disease
  2. Citalopram (20-40)
    - QTc prolongation
    - Escitalopram (10-20)
  3. Fluoxetine (20-60) (prozac)
    - Serotonin syndrome when switching
  4. Paroxetine (20-60)
    - Discontinuation syndrome
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5
Q

SNRIs
- Mechanism
- Uses

A

SNRIs

  • Mechanism
    1. Reduce pre-synaptic uptake
    2. Increased junction serotonin (and NA)
    3. Down-regulation of post-synaptic receptors
  • Uses
    1. Evidence for neuropathic pain
    2. Similar to SSRIs
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6
Q

SSRIs vs SNRIs
- Effects

A

SSRIs vs SNRIs
- Effects

SNRI
1. Greater sedation
2. Greater Nausea
3. Greater Sexual dysfunction

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7
Q

SNRIs
- 2 examples (doses)
- ADRs

A

SNRIs
- 2 examples (doses)
- ADRs

  1. Duloxetine (60-120mg)
  2. Venlafaxine (75-375mg)
    - More efficacious
    - Higher dose tolerated
    - Caution in heart disease (BP)
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8
Q

Mirtazepine
- Mechanism
- Activity and ADRs

A

Mirtazepine

  • Mechanism
    1. NaSSA
  • NA and Serotonin
    2. 5HT-2 and 5HT-3 antagonist
  • Activity and ADRs
    1. Strong H1 activity
  • sedation
  1. Weight gain
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9
Q

Tricyclic Antidepressants
- ADRs

A

Tricyclic Antidepressants
- ADRs

  1. Muscarinic
  2. Histaminic
  3. Overdose
    - QTc prolongation
    - Arrythmias
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10
Q

MAOIs
- Types
- Examples (reversible/irreversible)
- ADRs

A

MAOIs

  • Types
    1. MAOi - A
  • More serotonin
    2. MAOi - B
  • More on dopamine
  • Examples
    1. Reversible
  • Moclobamide
  • Tranylcypromine
  1. Irreversible
    - Phenelzine
    - Isocarboxazid
  • ADRs
    1. Serious interactions
  1. Tyramine reaction
    - HTN crisis
    - Avoid tyramine foods (cheese, pickled meats, wine)
  2. 6 week washout period before new AD
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11
Q

Vortioxetine
- Effects
- ADRs

A

Vortioxetine

  • Effects
    1. Serotonergic
    2. Antagonism and agonism
  • ADRs
    1. Few side effects
    2. Less nausea
    3. Less cognitive symptoms
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12
Q

ADs
- Dose changing

A

ADs
- Dose changing

  1. Depression
    - If no effect, switch, don’t increase
  2. Anxiety
    - If no effect, consider increasing
  3. ADRs
    - May improve in 2 weeks
    - Consider switching if problem
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13
Q

Discontinuation syndrome
- Character
- Causes

A

Discontinuation syndrome

  • Character
    1. Shakes,
    2. Agitation, insomnia
    3. Headaches, N&V
    4. Paresthesia, clonus
  • Causes
    1. Short half lives
    2. Paroxetine & Venlafaxine
  • Slow taper
  • Consider Fluoxetine cover
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14
Q

Serotonin syndrome
- Cognitive
- Autonomic
- Somatic
- Treatment

A

Serotonin syndrome

  • Cognitive
    1. Headaches, agitation
    2. Hypomania, confusion
    3. Coma
  • Autonomic
    1. Shivering, sweating
    2. Hyperthermia, tachycardia
    3. N&D
  • Somatic
    1. Myoclonus, hyper-reflexia
    2. Tremor
  • Treatment
    0. Stop treatment
    1. Fluids
    2. Monitoring
    3. Seizure Meds
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15
Q

Antipsychotics
- Effects
- Pathways
- Unwanted pathways
- ADRs

A

Antipsychotics

  • Effects
    1. D2 receptors
  • Pathways
    1. Mesocortical
    2. Mesolimbic
  • Unwanted pathways
    1. Nigrostriatal
    2. Tuberoinfundibular (HPA)
  • ADRs
    1. Sedation
    2. Extra-pyramidal
    3. Weight gain
  1. Acurte dystonia
  2. Oculogyric crisis
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16
Q

Antipsychotics
- Typical vs Atypical
- ADRs, receptors

A

Antipsychotics

  • Typical
    1. Extrapyramidal
    2. Muscarinic
    3. Histaminic
  • Atypical
    1. Serotenergic
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17
Q

Antipsychotics
- 5 Typicals
- 5 Atypicals

A

Antipsychotics
- 3 Typicals

  1. Haloperidol
  2. Chlorpromazine
  3. Flupenthixol
  • 5 Atypicals
    1. Clozapine
    2. Olanzapine
    3. Risperidone
    4. Quetiapine
    5. Aripiprazole
  • D2 partial agonist
  • No QTC
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18
Q

Tardive dyskinesia
- Signs

A

Tardive dyskinesia
- Signs

  1. Involuntary mouth movements
    - Chewing
    - Tongue movements
  2. Sometimes throat
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19
Q

Akathisia
- Signs

A

Akathisia
- Signs

  1. Involuntary movements
  2. Especially leg movements
20
Q

Antipsychotic monitoring

  1. Baseline
  2. Weekly
  3. Three months
  4. Yearly
A

Antipsychotic monitoring

  1. Baseline
    - HR & BP
    - Weight, ECG
    - FBC, Lipids, LFT, HbA1C
  2. Weekly
    - Weight
  3. Three months
    - As baseline
  4. Yearly
    - As baseline
21
Q

Clozapine
- Discovery
- Withdrawal
- Mechanism

A

Clozapine

1.Discovery
- 1958, used 60s

  1. Withdrawal
    - 1975
  2. Mechanism
    - D2, 5HT-2 antagonist
22
Q

Clozapine
- Indication
- ADRs
- Monitoring

A

Clozapine

  • Indication
    1. Schizophrenia
    2. After 2 others
  • ADRs
    1. Agranulocytosis 1%
  • 3% neutropenia
    2. Gastrointestinal hypomobility
  • Valproate
    3. Seizures
  • Baseline
    0. BMI, ECG, HR, BP
    1. FBCs
    2. U&E, LFT, Trop, and Prolactin
  • FBC
    1. Weekly to 18 weeks
    2. Fortnightly from 18 weeks
    3. Monthly from 1 year
23
Q

Neuroleptic malignant syndrome
1. Trigger
2. S&S
3. Mx

A

Neuroleptic malignant syndrome

  1. Trigger
    - High potency antipsychotics
    - Antipsychotic naive
    - High dose
  2. S&S
    - Fever, sweating
    - Confusion
    - Muscle rigidity
    - Autonomic instability
    - Rhabdo/renal failure, seizures
  3. Mx
    - ED
    - Stop antipsychotics
    - Fluids, anti-pyrexial
24
Q

Extra-pyramidal ADRs
- Mx
- Dx ADRs

A

Extra-pyramidal ADRs
- Mx

  1. Nigrostriatal pathway
    - Dopamine: ACh
  2. Anticholinergics
    - Procyclidine

(Benzatropine/trihexphenidyl)

  1. ADRs of Tx
    - Tardive dyskinesia
25
Q

Anxiety
- Tx (Drugs)

A

Anxiety
- Tx (Drugs)

  1. Beta blockers
  2. Benzos
  3. ADs
  4. Pregabalin
26
Q

Benzos
- Common half lives
- Mechanism
- Max use

A

Benzos

  • Common half lives
    1. Longer - Diazepam
    2. Shorter - Lorazepam
  • Mechanism
    1. Positive allosteric modulator of GABA
    2. Bind to receptor and reduce excitability
  • Max use
    1. 6 Weeks
27
Q

Paradoxical disinhibition
- Drug
- Effect

A

Paradoxical disinhibition

  1. Drug
    - Benzos
  2. Effect
    - Increased agitation
    - At low doses
28
Q

Pregabalin
- Mechanism
- Indications
- Abuse

A

Pregabalin

  • Mechanism
    1. GABA synthesis catalyst
  • Indications
    1. Anxiety
    2. Neuropathic pain
    3. Epilepsy
  • Abuse
    1. Dependence
    2. Sedation
    3. CNS depressant
29
Q

ADs in Anxiety
- Groups
- OCD

A

ADs in Anxiety
- Groups
1. SSRIs

  • OCD
    2. High doses required
30
Q

Psych Hypnotics
- Types
- Use

A

Psych Hypnotics

  • Types
    1. Benzos (potent)
  • Temazepam
  • Lormatazepam
  • Nitrazepam
  1. Non-benzos
    - Z Drugs
    - Zopiclone, Zolpidem
  • Use
    1. 5-7 days
    2. Two weeks only
  • Rebound insomnia
31
Q

Lithium

  • Mechanism
  • Monitoring
  • Indication
  • Instructions
  • Common ADRs
A

Lithium

  • Mechanism
    1. Unknown
    2. NA release reduced
    3. Serotonin synthesis
  • Monitoring
    1. Narrow window
    2. Kidney excretion
  • Indication
    1. Mood stabilisation
    2. Augment ADs

-Instructions
1. Plenty of water
2. Same time daily
- better at night
- record in book
3. Don’t stop suddenly
- Talk to doctor about changing dose
4. Leave missed dose

  • Common ADRs
    1. Polydipsia/polyuria
    2. Fatigue
    3. Weight gain
    4. Fine tremor
32
Q

Lithium
- ADRs

A

Lithium
- ADRs

SEs
1. GI
2. Taste
3. Fine tremor
4. Polydipsia/polyuria
5. Weight gain

Long-term
1. Hypothyroid
- Anual TFTs
2. Renal
- Irreversible impairment
- Anual U&Es

33
Q

Lithium
- Toxicity
- Interactions
- Mx

A

Lithium

  • Toxicity
    0. Dehydration
    1. Confusion, coarse tremor
    2. N&V
    3. Ataxia and seizures
  • Interactions
    1. NSAIDs
    2. Loop Ds
    3. ACEis
  • Mx
    1. Hydration
    2. Fluids
    3. Dialysis
34
Q

Bipolar
- Use of S-G APs

A

Bipolar
- Use of S-G APs

  1. Quetiapine First Line
    - Better SE profile than Li
  2. FGAs have effect too
35
Q

AEDs as mood stabilisiers

  • Action
  • Common choices
  • ADR and monitoring
A

AEDs as mood stabilisiers

  • Action
    1. GABA
    2. Ca&Na
  • Common choices
    1. Valproate (LFTs)
    2. Carbamazepine
    3. Lamotrigine (SJS)
    4. Pregabalin
  • ADR and monitoring
    1. Thrombocytopenia (FBC)
    2. Sedation
    3. Weight gain
36
Q

Dementia
- Types
- Drugs
- ADRs

A

Dementia
- Pharmacy

  • Acetylcholinesterase
  1. Donepezil
  2. Galantamine
  3. Rivastigmine
  4. Good for apathy
    - Mild to moderate only
  5. ADRs
    - DNV, cramps
    - Insomnia, anorexia,
  • NMDA antagonist (glutamine)
    1. Memantine
  • Moderate-severe Alzheimers
    2. Agitated behaviour
    3. ADRs
  • Headache, nausea
  • Drowsiness, insomnia
37
Q

ADD and ADHD
- Classes
- ADRs

A

ADD and ADHD

  • Stimulants
    1. Methylphenidate
    2. Dextroamphetamine
    3. Monitor weight and height
  • NA re-uptake inhibitor
    1. Atomoxetine
    2. Used in previous dependence
38
Q

Depression first line meds
- CAMHS
- Adult
- Older persons

A

Depression first line meds

  • CAMHS
    1. Fluoxetine
  • Adult
    2. SSRIs
  • Older persons
    3. SSRIs and monitor sodium
39
Q

Clozapine counseling
- Common side effects

A

Clozapine counseling
- Common side effects

  1. Sedation
    - May improve with time
    - Consider night time dosing
  2. Constipation
    - Bowel monitoring
    - High fibre
    - Stimulant laxatives
  3. Tachycardia
    - Cardiology advice/ BBs
  4. Weight gain
    - Dietary advice/Metformin
  5. Hypersalivation
    - Improve with time
    - Hyoscine
  6. BP (either)
  7. Hyperglycaemia
    - Tablets or insulin
40
Q

Lithium toxicity
- S&S

A

Lithium toxicity
- S&S

  1. Confusion and drowsiness
  2. Visual disturbance
  3. Loss of appetite
  4. Difficulty speaking
  5. Seizures
  6. Excessive thirst/urination
41
Q

LITHIUM
- Mnemonic

A

LITHIUM
- Mnemonic

L - lethargy
I - Insipidus (DI)
T - Tremor
H - Hypothyroidism
I - Insides (GI)
U - Urine
M - Metallic taste

42
Q

Lithium counseling
- Pregnancy

A

Lithium counseling
- Pregnancy

  1. Evidence not entirely clear
  2. First trimester
    - Birth defects increased
  3. Fetal heart defect increased
  4. Breastfeeding
    - Not safe
  5. Contraception
    - Sub Dermal
    - IUS
    - Birth defects
43
Q

Extrapyrimidal SEs
- Timeline

  1. Hours
  2. Days to weeks
  3. Months
  4. Years
A

Extrapyrimidal SEs
- Timeline

  1. Hours
    - Acute dystonia
    Eg. Eye movements
  2. Days to weeks
    - Bradykinesia
    Eg. Slowing
  3. Months
    - Akathisia
    Eg. Jumping out of skin
  4. Years
    - Tardive dyskinesia
    Eg. Tongue or lip smacking
44
Q

Dopaminergic effects
- Prolactin pathway

A

Dopaminergic effects
- Prolactin pathway

  1. Tuberoinfundibular
45
Q

Anti-HAM SEs

A

Anti-HAM SEs

H- histaminergic
1. Sedating

A - Alpha adrenergic
1. Ortho hypertension
2. Arrhythmia
3. Sexual dysfunction

M - muscarinic
1. Weight gain
2. Liver enzymes
3. Ophthalmic
4. Dermatology
5. Seizures

46
Q

Bipolar antidepressant

A

Bipolar antidepressant
- Quetiapine

Year 4 - Psych (11 decks)

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