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Psychiatry Drugs Flashcards

1
Q

5 types of antidepressants

A
  • Selective serotonin re-uptake inhibitors (SSRIs)
  • Serotonin and noradrenaline re-uptake inhibitors (SNRIs)
  • Monoamine oxidase inhibitors (MAOIs)
  • Noradrenergic and specific serotonergic antidepressants
  • Tricyclic antidepressants
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2
Q

Name the 5 main SSRIs

A
  • Sertraline
  • Fluoxetine
  • Paroxetine
  • Citalopram
  • Escitalopram
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3
Q

Best SSRI for children/adolescents

A

Fluoxetine

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4
Q

Best SSRI for post MI

A

Sertraline

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5
Q

Side effects of SSRIs

A
  • Hyponatraemia
  • GI upset (prescribe PPI if also on NSAID)
  • increased anxiety and agitation after starting
  • risk of CHD (1st trimester of pregnancy)
  • risk of persistent pulmonary HTN (3rd trimester of pregnancy)
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6
Q

What drugs are contraindicated with SSRIs

A
  • Triptans
  • MAOIs
  • Warfarin and Heparin

As they all increase serotonin (risk of serotonin syndrome)

Ideally 2 weeks between stopping and starting

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7
Q

Stopping taking SSRIs suddenly can lead to

A

SSRI Discontinuation Syndrome

  • should gradually reduce over 4 weeks
  • not necessary for fluoxetine
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8
Q
  • diarrhoea
  • vomiting
  • abdo pain
  • blue-tinted vision
A

SSRI Discontinuation Syndrome

  • should gradually reduce over 4 weeks
  • not necessary for fluoxetine
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9
Q

Specific side effects of Paroxetine

A

High incidence of discontinuation symptoms
- paresthesia
- mood changes
- restlessness
- sweating
- GI upset
Risk of congenital malformations in 1st trimester (pregnancy)

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10
Q

Specific side effects of Citalopram

A
  • prolongs QT

- Torsades de pointes

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11
Q

Specific side effects of Escitalopram

A
  • prolongs QT
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12
Q

2 examples of SNRIs

A
  • Venlafaxine

- Duloxetine

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13
Q

MoA of SNRIs

A

Increase concentrations of serotonin and noradrenaline into the synaptic cleft

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14
Q

Side effects of SNRIs

A

HTN

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15
Q

3 examples of MAOIs

A
  • Phenelzine
  • Rasagiline
  • Selegiline
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16
Q

What food should you avoid if on MAOIs

A

Avoid foods high in tyramine (cheese), as they can cause a hypertensive crisis

  • extreme headache etc
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17
Q

What class of drugs does Mirtazapine belong to?

A

Noradrenergic and specific serotonergic antidepressant

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18
Q

MoA of noradrenergic and specific serotonergic antidepressants

A

Alpha-2-receptor antagonists increase the release of neurotransmitters

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19
Q

Side effects of noradrenergic and specific serotonergic antidepressant

A
  • increased appetite
  • increased weight gain
  • sedative (take at night)
  • headache from withdrawal

30mg is sweet spot

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20
Q

Tricyclic antidepressants can be split into 2 classes

A

sedative + less-sedative

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21
Q

4 examples of sedative tricyclic antidepressants

A
  • Amitriptyline
  • Clomipramine
  • Dosulepin
  • Trazodone
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22
Q

3 examples of less-sedative tricyclic antidepressants

A
  • Imipramine
  • Nortriptyline
  • Lofepramine
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23
Q

Amitriptyline and Dosulepin are at risk of

A

overdosing

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24
Q

Side effects of Tricyclic Antidepressants

A

Anti-muscarinic side effects

  • urinary retention
  • tachycardia
  • dry mouth
  • mydriasis
  • drowsiness
  • blurred vision
  • increased QT
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25
Name 3 mood stabilising drugs
- Lithium carbonate - Carbamazepine - Sodium valproate
26
What monitoring is required for lithium
- bloods 12 hours post dose - bloods weekly until stable (in change of dose also) - check every 3 months once stable TFTs and U&Es (renal function) every 6M
27
Lithium has a very narrow therapeutic range of
0.4-1.0 mmol/L Long half-life, excreted in the kidneys
28
Side effects of lithium
- Nausea, vomiting + diarrhoea - Fine tremor - Nephrotoxic - Hypothyroidism - T wave inversion/flattening - weight gain - Idiopathic intracranial HTN - Leucocytosis (increased WCC) - Hyperparathyroidism > hypercalcaemia
29
Examples of extra-pyramidal side effects
- Parkinsonism - Acute dystonia - Torticollis (neck stuck downwards) - Oculogyric crisis (eyes stuck upwards) - Akathisia (restlessness) - Tardive dyskinesia - chewing - jaw pouting - tongue poking - excessive blinking - lip smacking
30
Management of tardive dyskinesia
Tetrabenazine
31
Examples of anti-muscarinic side effects
- Dry mouth - blurred vision - urinary retention - constipation
32
2 classes of Antipsychotics
Typical and Atypical
33
General side effects of antipsychotics
Increased VTE risk Sedation More common in Typicals: - Extra-pyramidal side effects - Hyperprolactinaemia - Anti-muscarinic side effects
34
Side effect of being on long-term atypical antipsychotics
glucose dysregulation > diabetes
35
3 examples of typical (1st Gen) anti-psychotics
- Haloperidol - Chlopromazine - Zuclopenthixol decanoate (IM)
36
5 examples of atypical (2nd Gen) anti-psychotics
- Clozapine - Olanzapine - Quetiapine - Risperidone - Amisulpride
37
Name a 3rd Gen antipsychotic
Aripiprazole
38
Specific side-effect for haloperidol
increased QT
39
Relationship between Clozapine and smoking
- smokers will require a higher dose | - therefore smoking cessation will increase clozapine levels
40
Specific side-effects of Clozapine
- Agranulocytosis (neutropenia) - Decreased WBC (leukocytes + neutrophils) - Reduced seizure threshold - Myocarditis - Hyper-salivation - Constipation
41
Specific side-effects of Risperidone
- Extra-pyramidal side effects - Postural hypotension - Sexual dysfunction
42
Specific side-effects of Olanzapine
- Dyslipidaemia (hypercholesterolaemia) > obesity | - Sedation
43
Specific side-effects of Quetiapine
- Weight gain | - Dyslipidaemia
44
Management for acute dystonia
Procyclidine (anti-cholinergic)
45
``` Altered mental status - agitated - confusion Autonomic dysfunction - hyperthermia - HTN - Tachycardia Neuromuscular abnormality - tremor - clonus - hyperreflexia ```
Serotonin Syndrome
46
Onset of serotonin syndrome
hours
47
Causes of serotonin syndrome
SSRIs MAOIs Ecstacy Psychoactive stimulants
48
Management of serotonin syndrome
Cyproheptadine | Chlorpromazine
49
- Pyrexia - "lead pipe rigidity" of muscles - Autonomic features - Delirium
Neuroleptic malignant syndrome
50
Causes of neuroleptic malignant syndrome
- antipsychotics | - levodopa (if suddenly stopped/reduced in Parkinsons)
51
Pathophysiology of neuroleptic malignant syndrome
``` dopamine blockade (induced by antipsychotics) triggers massive glutamate release > neurotoxicity + muscle damage ```
52
Investigation findings in neuroleptic malignant syndrome
^ CK from muscle damage Leukocytosis AKI (from rhabdomyolysis)
53
Management of neuroleptic malignant syndrome
Stop antipsychotics IV Fluids to prevent AKI Dantrolene (muscle relaxant) Bromocriptine (dopamine agonist)
54
MoA of Benzodiazepines
Enhance GABA by increasing the frequency of chloride channels
55
7 examples of short acting benzodiazepines
ATOMZ ``` Alprazolam Triazolam Oxazepam Midazolam Zopiclone Zolpidem Zaleplan ```
56
3 examples of intermediate acting benzodiazepines
TLC Temazepam Lorazepam Clonazepam
57
4 examples of long acting benzodiazepines
Clorazepate Clordiazepoxide Diazepam Flurazepam
58
Benzodiazepines used in liver failure
OUT THE LIVER Oxazepam Temazepam Lorazepam
59
MoA of carbamazepine
Binds to Na channels | Increases refractory period
60
Side effects of carbamazepine
``` Dizziness Ataxia Diplopia Hyponatraemia Agranulocytosis Leucopenia Steven Johnson Syndrome ```
61
Tricyclic antidepressants are contraindicated in
Dementia | - worsens cognitive function

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