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Top 100 Drugs > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

acetylcholinesterase inhbiitors are indicated for which conditions?

A

Alzheimers disease

Dementia in Parkinsons disease

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2
Q

what is the MoA of acetylcholinesterase inhibors (donepezil, rivastigmine) in alzhemiers and parkinsons dementia?

A

increases availabilty of acetylcholine for neurotransmission improving cognitive function and reducing rate of decline

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3
Q

what are some side effects of acetylcholinesterase inhibotors?

A

N&V, diarrhoea

bradycardia and heart block

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4
Q

acetylcholinesterase inhibitors should be used in caution in which pt groups?

A

asthma

COPD

risk of peptic ulcers

heart block

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5
Q

examples of acetylcholinesterase inhibitors?

A

donepezil

rivastigmine

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6
Q

what drug interactions are important to consider when prescribing acetylcholinesterase inhibitors?

A

B blockers- bradycardia/ heart block

NSAIDs- peptic ulcers

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7
Q

how can explain acetylcholinesterase inhibitord to teh patient?

A

treatment improves memory and brain function and may slow rate of decline

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8
Q

should acetylcholinesterase inhibotrs be monitored?

A

review at 2-4 weeks for adverse effects

repeat cognitive assessment at 3 months to assess efficacy

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9
Q

why are some patients advised to take donepezil in the mornign rather than the usual bed time dose?

A

can cause vivid dreams which could be problematic for pts

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10
Q

when are SSRIs indicated for use?

A

depression

panic disorder

OCD

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11
Q

name some SSRIs?

A

citalopram

fluoextine

sertraline

escitalopram

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12
Q

what is the MoA of SSRIs?

A

inhibit neuronal reuptake of 5-HT from synaptic cleft

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13
Q

which SSRI can prolong the QT interval?

A

citalopram

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14
Q

what is the triad in serotonin syndrome?

A

autonomic hyperactivity, altered mental state, neuromuscular excitation

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15
Q

how are SSRIs metabolised?

A

metabolised by liver

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16
Q

SSRIs should not be given alongside which other drugs?

A

monoamine oxidase inhibitors as may precipitate serotonin syndrome

drugs that prolong the QT interval i.e. antipsychotics

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17
Q

how long should patients carry on with SSRI treatment?

A

at least 6 months even after feeling better from depression

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18
Q

SSRIs should be stopped over how long?

A

4 weeks

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19
Q

when are tricyclics indicated?

A

second line in dperession (SSRIs ineffective)

neuropathic pain

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20
Q

what is the MoA of tricyclic antdepressants?

A

inhibit neuronal reuptake of 5-HT and noradrenaline from synaptic cleft

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21
Q

side effects of tricyclic antodepressants?

A

blockade of antimuscarins receptors cause dry mouth, constipation, retention and blurred vision

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22
Q

tricyclic antidepressants should not be given alongside which other drugs?

A

monoamine oxidase inhibitors as both inc 5-HT and noradrenaline

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23
Q

examples of tricyclic antidepressants?

A

amitriptyline

lofepramine

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24
Q

what is the MoA of antidepressants venlafaxine and mirtazapine?

A

venlafaxine is an SNRI

mirtazapine is an antagonist of inhibitory pre-synaptic a2-receptors

both inc availability of monoamines for transmission

25
Q

indications for venlafaxine?

A

depression (SSRIs inneffective)

generalised anxiety disorder

26
Q

when during the day should mirtazapine be taken?

A

at night to beneift from sedative effects

27
Q

how are the sedative effects of mirtazapine affected by the dose?

A

sedative effects less severe at higher doses

28
Q

are first or second generation antipsychotics typical?

A

first generation = typical

second generation = atypical

29
Q

name some first gen (typical) antipsychotics?

A

haloperidol, chlorpromazine, prochlorperazine

30
Q

indications for first gen (typical) antipsychotics?

A

psychomotor agitation causing dangerous/ violent behaviour

schizophrenia

bipolar disorder

31
Q

MoA of antipsychotics?

A

block post-synpatic dopamine D2 receptors

all have some sedative effect

32
Q

important adverse effects of first gen (typical) antipsychotics?

A

extrapyramidal effects: acute dystonia, akathisia, tardive dyskinesia

drowsiness

hypotension

prolonged QT interval

erectile dysfunction

33
Q

important adverse effects of second gen (atypical) antipsychotics?

A

extrapyradimal effects: more common w first gen

prolonged QT interval

34
Q

what are extrapyramidal effects?

A

‘drug induced movement disorders’

acute dystonia, akathasia (restlessness), tardive dyskinesia

35
Q

what rare but serious side effect can occur with antipsychotic use?

A

Neuroleptic malignant syndrome

rigidity, confusion, autonomic dysregulation, pyexia

36
Q

which pt population are particulary sensitive to antipsychotics?

A

elderly- start with lower dose

37
Q

who should not take antipsychotics?

A

dementia- inc risk of stroke and death

parkinsons- extrapyradimal effects

cardiovascular disease- interacts with drugs prolong QT interval

38
Q

which first gen (typical) antipsychotic is a popular choice for managing acute violent behaviour?

A

haloperidol

39
Q

oral antipsychotics are best taken at which time?

A

bed time

40
Q

which antipsychotic requires regular blood test monitoring?

A

Clozapine- risk of agranulocytosis (neutrophil deficiency)

41
Q

name some second gen (atypical) antipsychotics?

A

quetiapine, olanzapine, risperidone, clozapine

42
Q

when are benzodiazepines indicated?

A

management of alchol withdrawal

sedation

short term treatment of severe, distressing anxiety

43
Q

list some benzodiazepines?

A

diazepam, lorazepam, temazepam, chordiazepoxide, midazolam

44
Q

MoA of benzodiazepines?

A

facilitate and enhance binding of GABA to the GABAA receptor

opens chloride channel making cell more resistant to depolarisation

45
Q

why are benzos useful in alcohol withdrawal?

A

alcohol acts on GABAA receptor so chronic alcohol use causes tolerance- abrupt cessation provokes the excitatiry state of alcohol withdrawal

benzos can be withdrawn in a gradual and controlled way

46
Q

important adverse effects of benzos?

A

drowsiness, sedation, dependence can develop

abrupt cessation can cause withdrawal reaction similar to alcohol

47
Q

benzos should be used with caution in which patient groups?

A

elderly, repiratory impairment, neuromuscular disease, liver disease

48
Q

which benzodiazepine is best for sedation in the short term?

A

midazolam

49
Q

what psychiatric illness is lamotrogine indicated for?

A

bipolar depression, not mania or hypomania

50
Q

lamotrogine binds to which channels?

A

Na+ channels interfering with Na influx

51
Q

common adverse effects of lamotrogine?

A

headache, drowsiness, irritability, blurred vision, GI upset

can develop skin rash which may be sign of severe hypersensitivity reaction

52
Q

is lamotrogine safe during pregnancy?

A

yes- no evidence to suggest inc risk of congenital abnormnality but should be discussed with pt

53
Q

lamotrogine is metabolised by the ?

A

liver: hepatic glucuronidation

may need to reduce dose in heptic impairment

54
Q

which drugs interact with lamotrogine by inducing glucuronidation?

A

carbamazepine, oestrogens, rifampicin, protease inhibitors

all can cause lamotrogine levels to fall

55
Q

why is lamotrogine unique with its use in bipolar disease?

A

treats depressive symtpoms without increasinf risk of switch to mania

56
Q

indications for naloxone?

A

treatment of opiod toxicity

(respiratory depression)

57
Q

MoA of Naloxone?

A

binds to opiod receptors acting as competitive antagonist

if an opiod is present naloxone displaces it from its receptors and reverses its effects

58
Q

psychiatric indication for sodium valproate?

A

bipolar disorder- acute manic episodes and prophylaxis of recurrence

59
Q

which pt population should sodium valproate be avoided in?

A

women of child bearing age

avoid in hepatic and severe renal impairment

Top 100 Drugs (13 decks)

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