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BNPH700 > Psychiatric Medications > Flashcards

Psychiatric Medications Flashcards

1
Q

What are some examples of Benzodiazepines?

A

alprazolam, diazepam, lorazepam, clonazepam

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2
Q

What is the indicator for Benzodiazepines? (Why are they used?)

A

used for anxiety, alcohol withdrawal, panic disorder (to calm aggressive patients), seizure, muscle spasm, sleep disorders (short term treatment for insomnia)
Increases effect of GABA in CNS (GABA is a neurotransmitter)

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3
Q

What is the Mechanism of Action (MOA) for Benzodiazepines?

A

Action occurs in the limbic system, causes the GABA to be more effective. This decreases the excitability of neuron and has a sedative anxiolytic or relaxant effect.

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4
Q

What are some adverse drug reactions with benzodiazepines?

A

All benzodiazepines can cause CNS depression, dependence and neurological dysfunction.

Fatigue/drowsiness
muscle weakness
blurred vision
sedation, amnesia
respiratory depression
Tolerance or dependency develop readily (Short-term use is advised)

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5
Q

What is the antidote for Benzodiazepines?

A

flumazenil

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6
Q

What are some contraindications for benzo?

A

in people with severe respiratory disease or liver disease
People with dependence on other substances
Cautioned in patients with impaired kidney or liver function as they are metabolised extensively in the liver, therefore need to be used very cautiously with people with liver disease, depression, or psychosis

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7
Q

What is an interaction in benzodiazepines?

A

has addictive CNS depressant effects

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8
Q

What is the pharmacokinetics for benzodiazepines?

A

diazepam is one of the longest benzodiazepines as it is very lipid soluble and has active metabolites. Half-life is between 2-60 hours.

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9
Q

What are some monitoring and patient education regarding benzodiazepines?

A

Monitor RR as can have sedative effects
Signs of tolerance or dependence
For short-term use only as can be highly addictive
Do not discontinue abruptly due to dependency
Adverse reaction includes fatigue, tolerance or dependence, muscle weakness, blurred vision or neurological dysfunction

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10
Q

What are some symptoms of Benzo Withdrawal?

A

Insomnia, agitation/irritability, fearfulness, muscle spasm/tremors, gastric problems, sweating

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11
Q

How would you answer this question:
Half-lives of Benzodiazepines range from 2-60 hours, think about how knowledge of the half-life will determine the choice of benzodiazepine prescribed.

A

Be aware of using in susceptible population and elderly as the long half-lives means longer time for body to remove the drug. Increased drug accumulation might occur in elderly and people with hepatic/renal impairment. Dose adjustment is required and close monitor for ADRs, i.e sedation, CNS depression, fall preventions

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12
Q

How would you answer this question:
When benzodiazepines are taken with other CNS depressants the result is an enhanced sedative and CNS depressant effects. What other CNS depressants should patients be educated to avoid?

A

Alcohol, MAO inhibitors (Monoamine oxidase inhibitor), TCAs (Tricyclic antidepressants), antipsychotic, opioids, antihistamines, anaesthetics, sedatives

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13
Q

What type categories of antipsychotics are there?

A

Typical
Atypical

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14
Q

What are some examples of typical antipsychotics?

A

haloperidol, zuclopenthixol

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15
Q

What are some examples of atypical antipsychotics?

A

olanzapine, risperidone, clozapine, Quetiapine

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16
Q

What is the indication for use with antipsychotics?

A

used to treat serious mental illnesses such as schizophrenia, drug induced psychosis, depression and autism. Antipsychotics are also used to treat extreme mania (as an adjunct to lithium), bipolar disorder, certain movement disorders (e.g. Tourette’s syndrome), and certain other medical conditions (e.g. nausea, intractable hiccups).

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17
Q

What is the mechanism of action overall for antipsychotics?

A

block dopaminergic receptors, especially D2 receptors. Antagonism of dopamine receptors.

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18
Q

What is the specific MOA for Typical antipsychotics?

A

the main action is blocking dopaminergic receptors, especially. D2 receptors, they also exert other synaptic effects on alpha, muscarinic and Histamine receptor sites and have more side effects.

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19
Q

What is the specific MOA for Atypical antipsychotics?

A

Atypical antipsychotics block D2 and 5-HT receptors.

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20
Q

Why are atypical antipsychotics favoured over typical antipsychotics?

A

A typical antipsychotics have major advances over typical antipsychotics due to its less EPS (extrapyramidal symptoms), it also suppresses negative symptoms of schizophrenia

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21
Q

What are some ADR’s with typical antipsychotics?

A

include dry mouth, urinary hesitancy (and even retention), constipation and visual disturbance, extrapyramidal symptoms

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22
Q

What are some ADR’s associated with typical antipsychotics on noradrenergic mechanisms?

A

lead to postural hypotension, disturbances of sexual functions and nasal congestion.

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23
Q

What are some ADR’s associated with typical antipsychotics on the antihistamine system?

A

Cause sedation and prolonged use may lead to weight gain.

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24
Q

What are some ADR’s with Atypical antipsychotics?

A

The biggest problem with atypical anti-psychotics is the increased risk of diabetes and metabolic syndrome causing weight gain, high blood pressure, decreased HDL cholesterol and elevated triglycerides.

weight gain, drowsiness, constipation, dizziness and hyper-salivation, sexual dysfunction and postural hypotension

25
Q

What are the monitoring/patient education associated with Atypical antipsychotics?

A

Less likely to cause EPSEs (unless you give enough)
More serotonergic, histaminergic, anticholinergic
Possibly improve negative symptoms
‘More’ likely to cause metabolic syndrome

26
Q

What are the monitoring requirements with metabolic syndrome?

A

Regular weights and waist circumference
HbA1c and lipid testing on admission and ongoing
Education related to life-style factors

27
Q

What are Extrapyramidal side effects and which category do these occur in?

A

Weight gain
Elevated HbA1c
Hypertension
Central obesity
Decreased HDL cholesterol/elevated LDL

28
Q

What baseline recordings should be taken prior to someone starting on an antipsychotic medication?

A

…

29
Q

What information would you include in an education session for someone who is prescribed clozapine?

A

Agranulocytosis or Neutropenia:
low white blood cell or neutrophil count
Weekly blood tests for first 18 weeks of treatment, then 4 weekly thereafter

Symptoms of concern - fever, rigor, sore throat, any signs of infection and cognitive changes.
FBC immediately and chase result

30
Q

What are three classes of antidepressants?

A

…

31
Q

What are some examples of SSRI’s?

A

Citalopram
Escitalopram
Paroxetine
Fluoxetine
Sertraline

32
Q

What is the indication for use of SSRI’s?

A

…

33
Q

What is the MOA for SSRI’s?

A

SSRIs block the reuptake of serotonin leading to increased neurotransmitter levelsin the synaptic cleft and increased stimulation of the postsynaptic receptors.

34
Q

What is the pharmacokinetics for SSRI’s?

A

…

35
Q

What are come common adverse reactions to SSRI’s?

A

insomnia, sexual dysfunction, nausea and vomiting, headache

36
Q

What is a rare and potential threatening adverse effect associated with SSRI’s?

A

Serotonin syndrome
On initiation, dose increase, drug interactions or drugs of abuse
Mild symptoms - increased heart rate, fever, sweating, dilated pupils, myoclonus (intermittent tremor or twitching), hyperreflexia
Moderatesymptoms -hyperactive bowel sounds, high blood pressure, fever, hypervigilance, confusion or agitation
Severe symptoms include severe increases in heart rate, blood pressure and temperature

37
Q

What are some examples of Tricyclic antidepressants (TCAs)?

A

Amitriptyline
Nortriptyline
Imipramine
Clomipramine

38
Q

What is the indication for use of TCA’s?

A

…

39
Q

What is the MOA for TCA’s?

A

block the reuptake of norepinephrine and serotonin leading to increased neurotransmitter levelsin the synaptic cleft and increased stimulation of the postsynaptic receptors.

40
Q

What are the pharmacokinetics for TCA’s?

A

…

41
Q

What are some adverse drug reactions associated with TCA’s?

A

Side-effects (most caused by inhibition of muscarinic receptors):
Common: dry mouth, blurred vision, constipation, urinary retention, drowsiness, weight gain.
Uncommon: headache, nausea, palpitations, postural hypotension, sexual dysfunction, sweating

42
Q

What are some examples of Monoamine oxidase inhibitors (MAOi’s)

A

Tranylcypromine

43
Q

What is the indication for use of MAOi’s?

A

…

44
Q

What is the MOA of MAOi’s?

A

MAOIs inhibit MAO, an enzyme in the nerves that breaks down norepinephrine, dopamine and serotonin. This allows these neurotransmitters to accumulate in the synaptic clefts, causing increased stimulation of the postsynaptic receptors.

45
Q

What is the pharmacokinetics of MAOi’s?

A

…

46
Q

What are some adverse drug reactions associated with MAOi’s?

A

hypertensive crisis - headache, stiff neck, nausea, rapid heartbeat  rarely a stroke

47
Q

What is an important patient information to provide to someone taking MAOi’s?

A

Avoid foods high in tyramine – activates noradrenaline receptors when in excess
hard cheeses, meat and fish that are not fresh, salami and dried meat, soy sauce, tofu, home-brew beer, yeast extracts such as marmite & vegemite), fermented foods

48
Q

What is an example of a mood stabiliser?

A

Lithium

49
Q

What is the indication for use with mood stabilisers?

A

Prevents and treats manic and depressive episodes
Reduces the risk of suicide and self harm by 80%
Narrow therapeutic index

50
Q

What is the MOA for mood stabilisers?

A

acts on sodium channels to stabilize serotonin neurons however largely unknown

51
Q

What is the pharmacokinetics associated with mood stabilisers?

A

…

52
Q

What is important to understand about Lithium and how it is excreted?

A

Lithium is 100% renally cleared and to the kidneys looks like sodium
Low sodium levels (more reabsorption) or dehydration (reducing renal clearance) can lead to toxicity

53
Q

What are some adverse drug reactions associated with mood stabilisers?

A

Common: tremor, stomach upset, polyuria, polydipsia.
Uncommon: weight gain, oedema, hypothyroidism

54
Q

What are some signs of lithium toxicity?

A

blurred vision, drowsiness, confusion, slurred speech, increased polyuria or polydipsia, dizziness, vomiting, unsteadiness, clumsiness, severe tremor.

55
Q

Why is it important to monitor lithium levels?

A

signs of toxicity

56
Q

What are some important patient education associated with mood stabilisers?

A

take with food
maintain hydration
3 monthly plasma levels

57
Q

What is the MOA for anti-convulsants?

A

stabilise nerve membranes throughout CNS, thereby reducing excitability and hyperexcitability.

58
Q

What are some adverse drug reactions associated with anti-convulsants?

A

Sodium Valproate - antimanic
Common side-effects: gastric irritation/nausea (take with food)
Uncommon side-effects: increased appetite and weight gain
Teratogenic

Lamotrigine - antidepressant Common side-effects: nausea (take with food), ataxia, drowisness, headache, dizziness, rash Uncommon side-effects: blurred vision, diplopia, confusion, insomnia, irritability/agitation/aggression

Carbamazepine – not commonly used Common side-effects: diplopia, dizziness, drowsiness Uncommon side-effects: nausea, vomiting, ataxia

BNPH700 (9 decks)

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