Psychiatric Treatments Flashcards
Name 3 atypical antipsychotics
Olanzapine
Risperidone
Quetiapine
Name 3 typical antipsychotics
Haloperidol
Sulpiride
How is clozapine monitored?
Weekly for first 18/52
Then fortnightly for 1 year
Then monthly
What is a specific side effect of clozapine?
Hypersalivation (wake up with pillow soaked)
Why do patients on clozapine have to gave frequent bloods?
To check their WCC
Clozapine can cause agranulocytosis and neutropenia
What are some differences between atypical and typical antipsychotics?
Typicals are more likely to cause EPSEs and hyperprolactinaemia
Atypicals are more likely to cause metabolic side effects e.g. weight gain, dyslipidaemia, diabetes
Atypicals also exert a serotoninergic effect, thought to reduce negative symptoms
What are some EPSEs of antipsychotics?
Parkinsonism: tremor, bradykinesia, rigidity
Dystonia
Tardive dyskinesia
Akathisia
How do antipsychotics generally work?
Inhibiting dopamine activity, by blocking mainly D2 receptor
Target the mesocortical and mesolimbic pathway, unwanted pathways are nigostriatal and tuberoinfundibular
What is a life threatening reaction to antipsychotics called?
Neuroleptic malignant syndrome
What are some symptoms of neuroleptic malignant syndrome?
Fever
Muscle rigidity
Altered mental state e.g. confusion, LOC
Autonomic instability e.g. tachycardia, sweating, tremor, fluctuating BP
How often is lithium monitored in a patient?
12 hours post first dose
Then weekly until stable for 4/52
Then every 3/12
Which mood stabiliser is safe to give to a woman of child bearing age/ in pregnancy?
Lamotrigine
What are some side effects of lithium?
Teratogenic Renal failure Metallic taste Hypothyroidism GI upset Weight gain Polydipsia and polyuria Convulsions
When would a mood stabiliser be prescribed?
To prevent depression or mania in bipolar or schizoaffective disorder
What are some examples of SSRIs?
Sertraline
Fluoxetine
Citalopram
Paroxetine
What is ECT used for?
Severe depression
Occasionally used for schizophrenia, good for catatonic type
What are some examples of SSRIs?
Fluoxetine
Sertraline
Citalopram
Paroxetine
Which SSRI is safest in people under age 18?
Fluoxetine
What are some ADRs of SSRIs?
GI upset Nausea Weight changes Headache Sexual dysfunction
What are some examples of mood stabilisers?
Lithium
Sodium valproate
Carbamazepine
Lamotrigine
What marker is often raised in neuroleptic malignant syndrome?
Creatine kinase
What are some appropriate investigations to do before prescribing an antipsychotic and why?
ECG, as they can lead to prolonged QTc which can lead to torsades de pointes
Baseline BMI, waist circumference, blood glucose and lipids (due to metabolic and anti histamine side effects)
What regular blood tests are needed for a patient taking lithium carbonate?
U&Es as lithium is nephrotoxic
Lithium levels (as it has a narrow therapeutic index)
TFTs as lithium can damage thyroid and cause hypothyroidism
What is the only absolute contraindication for ECT?
RICP
Which antidepressant is safest post-MI?
Sertraline
Why are SSRIs 1st line antidepressants?
Low side effect profile
Safe in overdose
In an OSCE, when asked for management, how should this be presented?
BIOPSYCHOSOCIAL MODEL
How should neuroleptic malignant syndrome be treated?
Stop the antipsychotic
IV Fluids
Dantrolene (can decrease release of calcium from the sarcoplasmic reticulum)
How do antipsychotics affect prolactin?
Antipsychotics antagonise dopamine
Dopamine inhibits prolactin (tubero-infundibular)
Hence antipsychotics raise plasma prolactin
Hence side effect e.g. galactorrhea
How long should a px continue their antidepressants for once their depression has remitted?
Continue for at least 6 month after first episode of depression
After a second episode, continue for 2 years
Which drug is first line for ADHD?
Methylphenidate
What is ECT?
Put patient under general anaesthesia (and give a muscle relaxant)
Place electrodes on head and send an electric current though the brain to induce a tonic clonic seizure
When is ECT indicated?
In severe depression, uncontrolled mania or catatonia
Which antidepressants are safest in OD?
SSRIs
What are some side effects of SSRIs?
Stomach upset Sexual dysfunction Serotonin syndrome Suicidal thoughts Sex drive decrease Sleep disturbance QTc elongation Sodium low so seizure threshold lowered in epilepsy
What are some examples of SNRIs?
Venlafaxine
Duloxetine
What are some examples of TCAs?
Amitriptyline
Clomipramine
When are TCAs used?
For patients unresponsive to SSRIs
Can be used in neuropathic pain
How does mirtazapine act?
5HT2 and 5HT3 antagonist
Also has strong histamine activity so causes sedation
Also causes weight gain
What are some examples of hypnotics?
Benzodiazepines
Zopiclone
Zaleplon
Zolpidem
Which class of antidepressants have most marked sleep disturbance?
SNRIs
What is oculogyric crisis?
When the eyes are held in upward deviation
Type of dystonic reaction to dopamine antagonists (eg haloperidol, metoclopramide)
What is bromocriptine an example of?
Dopamine agonist
Can use in Parkinson’s
Reduces muscle rigidity but can cause impulse control disorders
What is an example of a COMT inhibitor?
Entacapone
What drug can be used to help control EPSEs and how does this work?
Procyclidine
It is an anti muscarinic so blocks cholinergic receptors to hell tremor and rigidity
What side effects are more common with atypical antipsychotics?
Hyperglycaemia
Weight gain
Sedation
QTc prolongation
Hyperprolactinaemia (so infertility, galactorrhea)
Hypotension
(So monitor BP, weight, glucose, lipids, ECG)
What can be seen on bloods in neuroleptic malignant syndrome?
Raised CK
Raised WCC
What could precipitate lithium toxicity?
Dehydration, renal failure, diuretics, ACEi, NSAIDs
How could lithium toxicity be treated?
Volume resuscitation with IV fluids
If severe, haemodialysis
What are some features of lithium toxicity?
Coarse tremor (fine tremor seen at therapeutic levels)
Seizures
Acute confusion
Hyperreflexia
