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Pharmacology of Drugs > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

How do Benzodiazepines work?

A

Enhance the effect of GABA inhibitory neurotransmitter.

Increase FREQUENCY of chloride channels.

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2
Q

Indications for Benzodiazepines?

A 
Sedation 
Hypnotic 
Anxiolytic 
Anticonvulsant.
Muscle relaxant.

Not for long term usage (Max 2-4 weeks ideally)
Measured withdrawal process [1/8 of daily dose fortnightly)

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3
Q

Name Withdrawal symptoms from Benzodiazepines?

A 
Insomnia
Irritability
Anxiety
Tremor
Loss of appetite
Tinnitus
Perspiration
Perceptual disturbances
Seizures
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4
Q
  1. Explain Z-Drugs?

2. Give some examples?

A
  1. Structuarlly different to benzodiazepines but different structurally. Act of GABA Receptors
  2. Zopiclone, Zolpidem

Note - Increases the falls risk in elderly.

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5
Q

Common Side Effects of SSRIs?

A

GI Symptoms
Hyponatremia
Increased anxiety and suicidal ideation on initiation of medication.

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6
Q

Name SSRIs

A 
Citalopram 
Escitalopram 
Sertraline 
Fluoxetine
Paroxetine
Fluvoxamine
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7
Q

Specific S/E of SSRIs?

  1. Citalopram
  2. Paroxetine
  3. Fluoxetine
A
  1. QT Prolongation/Interactions
  2. Paroxetine - High risk for drug interactions. Increased risk of discontinuation symptoms.
  3. Fluoxetine &
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8
Q

List some SSRI discontinuation symptoms?

A 
increased mood change
Restlessness
Difficulty sleeping
Unsteadiness
Sweating
GI symptoms: pain, cramping, diarrhoea, vomiting
Paraesthesia

Gradually weaned of 4 week period.

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9
Q

Patients On Anticoagulation should AVOID which type of psychiatric medication?

A

SSRIs - Consider Mirtazapine as an alternative.

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10
Q

Name Atypical Antipsychotics?

A

Clozapine
Olanzapine - Increased risk of dyslipidemia & obesity
Risperidone
Quetiapine
Aripiprazole - Good side effect profile (e.g Prolactin elevation)
Amisulpride

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11
Q

Adverse Effects of Clozapine?

A 
Low WCC- Agranulocytosis, Neutropenia
Reduced seizure threshold
Hypersalivation
Constipation
Myocarditis
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12
Q

What is a fundamental thing to monitor during clozapine treatment?

A

If smoking is started or stopped - DOSAGE ADJUSTMENT

Regular FBC monitoring. (Weekly)

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13
Q

What warning risks need to be considered using antipsychotics in elderly patients?

A

Increased risk of stroke

Increased risk of VTE

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14
Q

Important drug Interactions to avoid with SSRIs?

A

NSAIDs - If prescribed give PPI
Triptans
Anticoagulation - Warfarin/Heparin

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15
Q

Name SNRIs?

Describe MOA?

A

Serotonin and Noradrenaline Reuptake Inhibitors
Venlafaxine
Duloxetine

SNRIs work by inhibiting reuptake of serotonin and noradrenaline which increases their concentrations in the synaptic cleft leading to the effects.

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16
Q

Indications for SNRIs?

A 
MDD
GAD
Social anxiety disorder 
Menopausal symptoms 
Panic disorder
17
Q

Mirtazapine

  1. Drug Class?
  2. Mecahanism of Action?
  3. Primary S/E?
A
  1. Antidepressant
  2. Blocks A2-adrengic receptors. Increases the release neurotransmitters
  3. Sedation and increased appetite
18
Q

What monitoring needs to happen for ANTIPSYCHOTICS?

Comment on the Frequency for each?
[8 Marks]

A 
FBC - Baseline, Annually 
Lipids -  Baseline, 3M, Annually
Weight - Baseline, 3M, Annually
Prolactin - Baseline, 6M, Annually
Fasting blood glucose - Baseline, 6M, Annually
ECG - Baseline
CVS Assessment - Annually
BP - Baseline, Periodically (More during dose titrations)
19
Q
  1. Name Typical Antipsychotics?
  2. MOA?
  3. Main Adverse S/E?
A
  1. Haloperidol (Prolonged QT Risk), Chlorpromazine
  2. Dopamine D2 receptor antagonists, blocking dopaminergic transmission in the mesolimbic pathways
  3. Extrapyramidal side-effects and hyperprolactinaemia common
20
Q

List Extrapyramidal Symptoms?

A

Parkinsonism
Acute dystonia
Sustained muscle contraction (e.g. torticollis, oculogyric crisis)
Akathisia (severe restlessness)
Tardive dyskinesia (Most common is chewing and pouting of jaw)

21
Q

How can you treat Extrapyramidal symptoms?

A

Procyclidine

22
Q

Common Antipsychotic Side-effects?

A

Antimuscarinic: dry mouth, blurred vision, urinary retention, Constipation
Sedation, weight gain
Raised prolactin (galactorrhoea?)
Impaired glucose tolerance
Neuroleptic Malignant Syndrome (pyrexia, muscle stiffness)
Reduced seizure threshold
Prolonged QT interval (particularly haloperidol)

23
Q

Switching fluoxetine to another SSRI

What steps should be taken?

A

withdraw then leave a gap of 4-7 days (as it has a long half-life) before starting a low-dose of the alternative SSRI

24
Q

What switching steps should be taken for

  1. SSRI to TCA
  2. SSRI to SNRI
A
  1. Cross-taper (Slowly titrate up new drug, Slowly reduce prev. drug) Fluoxetine stop completely
  2. Cross-taper
25
Q

What is the therapeutic range for lithium?

What route is main method excretion?

A

0.4-1.0 mmol/L

Kidneys

26
Q

What is monitoring schedule for lithium?

A

Blood Samples - 12 hours post-dose
Weekly Blood- Lithium levels after dosages until concentration levels stabilise
Every 3 Months once stable
TFTs + Renal function - 6M

Dosage Adjustments - Weekly bloods until levels stabilise.

27
Q

Main Adverse effects of lithium?

A 
Nausea/vomiting, diarrhoea
Fine tremor
Nephrotoxicity: polyuria, 
Nephrogenic diabetes insipidus
Thyroid enlargement (hypothyroidism)
Hyperparathyroidism (Resultant Hypercalcaemia)
ECG: T wave flattening/inversion
Weight gain
Idiopathic intracranial hypertension
Leucocytosis

Pharmacology of Drugs (1 decks)

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