Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psychiatry > Psychiatric Medications > Flashcards

Psychiatric Medications Flashcards

1
Q

What are some antidepressant classifications?

A

SSRI’s ; selective serotonin re-uptake inhibitors

Tricyclic antidepressants

Monamine Oxidase inhibitors

Serotonin/Noradrenaline Reuptake Inhibitors (SNRIs)

Novel antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are indications for antidepressants?

A

Unipolar and bipolar depression

Organic mood disorders

Schizoaffective disorder

Anxiety disorders; OCD, panic, social phobia, PTDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe TCA side effects

A

Very effective but potentially unacceptable side effect profile

  • antihistaminic (sedation and weight gain)
  • anticholinergic (dry mouth, eyes, constipation, memory deficits)
  • antiadrenergic (orthostatic hypotension, sedation, sexual dysfunction)

Lethal in overdose

Can cause QT lengthening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe tertiary TCAs

A

Have tertiary amine side chains

Side chains are prone to cross react with other types of receptors

Act predominantly on serotonin receptors

Examples; imipramine, amitriptyline, doxepin, clomipramine

Have active metabolites including desipramine, nortriptyline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe secondary TCAs

A

Are often metabolites of tertiary amines

Primarily block noradrenaline

Side effects are same as tertiary TCAs but generally less severe

Examples; desipramine, nortryptiline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe monoamine oxidase inhibitors (MAOIs) method of action

A

Bind irreversibly to monoamine oxidase thereby preventing inactivation of amines i.e. norepinephrine, dopamine and serotonin

V effective for depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the side effects of MAOIs

A 
Orthostatic hypotension
Weight gain
Dry mouth
Sedation
Sexual dysfunction
Sleep disturbance

Hypertensive crisis can occur when MAOIs taken with tyramine rich foods or sympathomimetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are symptoms of serotonin syndrome and when can it occur?

A

Can occur if MAOI taken with meds that increase serotonin or have sympathimomimetic actions

  • abdo pain
  • diarrhoea
  • sweats
  • tachycardia
  • HTN
  • myoclonus
  • irritability
  • delirium

Can lead to hyperpyrexia, CV shock and death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How can serotonin syndrome be avoided?

A

Wait two weeks before switching from SSRI to MAOI

Exception of fluoxetine where need wait 5 weeks due to long half-life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the action of SSRIs

A

Block presynaptic serotonin reuptake

Treat both anxiety and depressive symtpoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe side effects of SSRIs

A

GI upset, sexual dysfunction, nervousness, insomnia, fatigue, sedation, dizzyness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some SSRIs?

A 
Fluoxetine
Sertraline
Paroxetine
Citalopram
Escitalopram
Fluvoxamine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the action of SNRIs

A

Inhibit both serotonin and noradrenergic reuptake like TCAs but without antihistamine, antiadrenergic or anticholinergic side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some SNRIs?

A

Venlafaxine

Duloxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some novel antidepressants?

A

Mirtazapine

Buproprion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are side effects of lithium?

A

GI distress; reduced appetite, nausea/vom, diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How long do you keep someone on their medication for depression?

A

First episode : 6 months if provides remission

Second episode : 2 years

> Third episode : discuss lifelong prophylaxis

18
Q

What are indications for mood stabilisers?

A

Bipolar
Cyclothymia
Schizoaffective

19
Q

What are the main classes of mood stabilisers?

A

Lithium
Anticonvulsants
Antipsychotics

20
Q

What are signs of mild lithium toxicity?

A

Levels 1.5-2.0

vomiting
diarrhoea
ataxia
dizziness
slurred speech
nystagmus
21
Q

What are signs of moderate lithium toxicity?

A

2.0-2.5

Nausea
Vomiting
Anorexia
Blurred vision
Clonic limb movements
Convulsions
Delirium
Syncope
22
Q

What are signs of severe lithium toxicity?

A

> 2.5

Generalised convulsions
Oliguria
Renal failure

23
Q

What is the first line agent for acute mania and mania prophylaxis?

A

Carbamazepine

24
Q

What are side effects of carbamazepine?

A 
Rash
Nausea, vomiting, diarrhoea
Sedation, dizziness, ataxia, confusion
AV conduction delays
Aplastic anaemia and agranulocytosis
Water retention due to vasopressin-like effect; hyponatremia
Drug-drug interactions
25
Q

When is lithium given and when is depakote (valproic acid)?

A

Lithium; long term prophylaxis both manic and depressive episodes in BAD

Depakote; as effective as lithium for mania, but not for depression prophylaxis
Factors predicting good response
- rapid cycling
- comorbid substance issues
- mixed patients
- patients with co-morbid anxiety disorders

26
Q

What are indications for antipsychotic use?

A

Schizophrenia, schizoaffective disorder, bipolar disorder (mood stabilisation and/or psychotic features present), psychotic depression, augmenting agent in treatment resistant anxiety disorders

27
Q

Describe the mesocortical pathway

A

Projects from ventral tegmentum (brainstem) to cerebral cortex

Pathway felt to be where negative symptoms and cognitive disorders arise

Problem in a psychotic patient is TOO LITTLE dopamine

28
Q

What key pathways in the brain are affected by dopamine?

A

Mesocortical
Mesolimbic
Nigrostriatal
Tuberoinfundibular

29
Q

Describe the mesolimbic pathway

A

Projects from the dopaminergic cell bodies in ventral tegmentum to limbic system

Pathway is where positive symptoms arise (hallucination, thought disorder etc.)

Problem in a psychotic patient is TOO MUCH dopamine

30
Q

Describe the nigrostriatal pathway

A

Projects from dopaminergic cell bodies in sybstantia nigra to basal ganglia

Involved in movement regulation; remember dopamine suppresses acetylcholine activity

Dopamine hypoactivity can cause Parkinsonian movements

31
Q

Describe the tuberoinfundibular pathway

A

Projects from hypothalamus to AP

Doamine inhibits/blocks prolactin release

Blocking dopamine in this pathway will predispose patient to hyperprolactinemia
- gynecomastia, galactorrhoea, decreased libido, menstrual dysfunction

32
Q

Describe typical antipsychotics

A

D2 domapine receptor antagonists

High potency typical antipsychoics bind to D2 receptor with high affinity

  • Higher risk of extrapryamidal side effects
  • Includes Fluphenazine, Haloperidol, Pimozide

Low potentcy less affinity for D2 receptors but interact with nondopaminergic receptors resulting in more cardiotoxic aand aticholinergic adverse effects; sedation and hypotension
- examples include Chloropromazine, thioridazine

33
Q

Describe atypical antipsychotics

A

Serotonin-dopamine 2 antagonists (SDAs)

Considered atypical in that they affect dopamine and serotonin neurotransmission

examples

  • risperidone
  • olanzapine
  • quetiapine
  • aripiprazole
34
Q

What is the drug of choice in psychotic treatment resistance?

A

Clozapine

35
Q

What are adverse effects of antipsychotics?

A

Tardive dyskinesia; invol muscle movements that may not resolve with drug discontinuation

Neuroleptic Malignant Syndrome; severe muscle rigidity, fever, altered mental status, autonomic instability, elevated WBC, CPK and lfts. potentially fatal

Extrapyramidal side effects; acute dystonia, parkinson syndrome, akahisia

36
Q

What is akathisia?

A

Feeling of inner restlessness and inability to stay still

37
Q

What are agents for EPS?

A

Extrapyramidal side effects

Anticholinergics i.e. benztropine

Dopamine facilitators i.e. amantadine

Blockers propranolol

Need to watch for anticholinergic SE

38
Q

What bloods do you need in a treatment naive psychotic person?

A

Antipsychotics may cause dyslipidaemia, abnormal LFTs and elevated blood sugars

Need;

  • LFTs
  • fasting lipid profile
  • fasting blood sugar
  • CBC
39
Q

What treatement can be given for akathisia?

A

Need to treat as higher risk of suicide

  • anxiolytic
  • propranolol
40
Q

What are anxiolytics?

A

Used to treat many diagnoses incl. panic disorder, general anxiety, substance related, insomnia and parasomnia

In anxiety disorders often use in combo with SSRIs or SNRIs

41
Q

Name some anxiolytics

A

Buspirone

Benzos

42
Q

What are side effects of benzos?

A 
Somnolence
Cognitive deficits
Amnesia
Disinhibition
Tolerance
Dependence

Psychiatry (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions