Psychiatry drugs Flashcards
Haloperidol class and action?
Typical antipsychotic
D2 receptor antagonist, blocking dopaminergic transmission in the mesolimbic pathways
Akathisia
A form of restlessness which will present as constant pacing up and down, or the patient describing an inability to sit still.
EPSE side effect of antipsychotics
Tardive dyskinesia
A side effect of antipsychotics that occurs after many years.
It typically affects the face and involves repetitive, involuntary, writhing movements such as grimacing, tongue protrusion and lip smacking.
Parkinsonism
General term for side effects of antipsychotics that mimic Parkinson’s disease, such as bradykinesia, cogwheel rigidity and shuffling gait.
Venlafaxine mechanism of action
SNRI
Venlafaxine blocks the reuptake of serotonin and noradrenaline in the central nervous system (CNS), enhancing their availability in the synaptic cleft and thus modulating mood pathways. This increased neurotransmitter availability can be particularly helpful in refractory cases of depression.
Mirtazapine is an antidepressant preferred in patients with anorexia nervosa
why?
it also elevates the appetite and produces weight gain.
in the UK, mirtazapine is not routinely recommended for children and adolescents under 18. If it is prescribed, it is usually done so with caution and under close monitoring by a healthcare provider.
Bupropion
Aminoketone class (atypical antidepressant)
inhibits Dopamine DA and NA noradrenaline reuptake in brain
improves energy and mood
used in smoking cessation and depression
an established life-threatening side effect of clozapine?
Agranulocytosis/neutropenia is a life-threatening side effect of clozapine - monitor FBC
Agranulocytosis is a side effect of?
clozapine
this is thought to occur in approximately 1% of those taking clozapine - an antipsychotic medication used to treat refractory schizophrenia. Therefore, patients taking clozapine require ongoing monitoring which involves weekly blood tests for the first 18 weeks, every 2 weeks until 1 year and every 4 weeks thereafter.
main two side effects of olanzapine (atypical 2nd gen antipsychotic)
obesity
sedation
Adverse effects of clozapine
agranulocytosis (1%), neutropaenia (3%)
reduced seizure threshold - can induce seizures in up to 3% of patients
constipation
myocarditis: a baseline ECG should be taken before starting treatment
hypersalivation
cardinal feature of lithium toxicity
coarse tremor
- nausea , vomiting, confusion, ataxia, muscle weakness
- renal impairment, arrhythmias, seizures
most common movement disorder with lithium toxicity
ataxia
safe antidepressants while breast feeding
SSRIs
- paroxetine and sertraline
what is ritalin
ADHD drug - methylphenidate
most common side effect of SSRIs
GI disturbance - nausea , vomiting, adominal pain,
antipsyhotic least likely to cause gynaecomastia?
arpiprazole
what class of drug is citalopram?
SSRI
major side effect of ctialopram?
prolonged QT interval
SSRI
major side effects of sertaline
GI upset
increased risk of bleeding if on NSAIDs
sertaline is the best antidepressants if CV risk
a. true
b. false
a. true
which class of drug is fluxoatine
SSRI
Mirtazapine belongs to what class of drugs
noradrenergic and specific serotonergic antidepressant (NaSSA) class of drugs.
works by enhancing norepinephrine and serotonin activity through antagonism of certain receptors (α₂-adrenergic and serotonin 5-HT₂/5-HT₃ receptors), which helps improve mood, sleep, and appetite.
when SSRIs are used with triptans there is a risk of what syndrome?
serotonin syndrome
what drugs cannot be taken with mirtazapine
warfarin/heparin
what class of drug is venlafaxine
SNRI
contradindications and side effects of venlafaxine
elevates BP at high doses - do not use in hypertension or heart disease
do not use in liver dysfunction
suicide and seziure risk
venlafaxine has a short half life
a. true
b.false
true - quick onset of action
short half life
what class of drug is duloxetine
SNRI
also helps with neuropathic pain - fibromyalgia/diabetes
if pain . sleep, fatigue issues
side effects of duloxetine
hyponatremia - esp in elderly if on diuretics
low sodium
what are MAOIs
prevents enzyme monoamine oxidase from metabolising serotonin and noradrenaline in presynaptic cells (in brain)
what class of drug is Phenelzine.
MAOI-A
used less frequently now
caution in cerebrovascular disease, manic bipolar, phaeochromocytoma, severe CV disease
Antidepressants that interact with tyramine are primarily ?
MAOIS
These drugs inhibit the enzyme monoamine oxidase, which is responsible for breaking down tyramine in the body. Consuming high-tyramine foods while taking an MAOI can lead to a hypertensive crisis (a dangerous spike in blood pressure).
Foods - oxo, marmites, cheese, salami
antedote to TCAs overdose
sodium bicarbonate
side effects of TCAs
arrythmias
tachycarida
prolonged QT
bundle branch block
dangerous if overdose!! side effects are dose dependent
contraindications to TCAs
suidice risk - dangerous if overdose
heart disease
TCAs have anti-cholinergic effects
a. true
b. false
a. true
dry mouth, constipation, urinary retention, blurry vision, cognitive impairment
sedative - take at night
side effects of mirtazapine
sedation - take at night
increased appetite
weight gain
(may be pro if patient has loss of appetite , and poor sleep - often older patients)
do not use if already overweight and sleepy
which class of anti-psychotics are more likely to have extra-pyramidal side effects?
typical - 1st generation
-Haloperidol
Chlorpromazine (Thorazine)
Fluphenazine (Prolixin)
how do 1st generation . typical antipsychotics work
D2 receptor antagonists - block DA transmission in the mesolimbic pathways
(side effects common because also blocks ACh, NA/A and H1 receptors) - wide variety
side effects of 1st generation antipsychotics (E.g. halopridol)
MiSHADE
metabolic - weight gain, dyslipdaemia, impaired glucose metabolism.
Impotence
Sedation and seizures (reduced seizure threshold)
Hypotension/hyperprolactinaemia
Akathisia - feeling of inner restlessness
Dermatological
EPSE (extra-pyramidal)
common extra pyramidal side effects of anti-psychotics
more likely in 1st generation - typical
acute dystonia (sustained muscle contraction)
tardive dyskinesia
parkinsonisn (BTRAP)
- bradykinesia
- tremor
- rigidity
- akinesia (diminsed spontaenous movement/slow/stiff movement)
- postural stiffnes
what is akathisia
feeling of inner restlessness
what is tardive dyskinesia
involuntary, repetitive movements of the face, tongue, and sometimes other parts of the body. It is most commonly associated with the use of antipsychotic medications, particularly first-generation antipsychotics (typical antipsychotics), though it can also occur with second-generation (atypical) antipsychotics
Facial movements: Repetitive movements like grimacing, lip smacking, tongue protrusion, or chewing motions.
Involuntary limb movements: Jerking or twisting of the arms or legs.
Trunk movements: Such as twisting or rocking of the torso.
what is akinesia
loss or lack of voluntary movement. It is a type of motor dysfunction where a person has difficulty initiating or carrying out movements.
side effects of DA receptor blocking
prolactinaemia
parkinsonism
sexual dysfunction
gynecomastia
mentrusal irregularities
side effects of H1 receptor blocking
sedation, drowiness
, sleepiness
side effects of A1 blocking
orthostatic hypertension
anti-cholinergic side effects
dry mouth
urinary retention
blurred vision
constipation
sedation
side effects of atypical second generation anti-psychotics
EPSEs are less pronounced
metabolic side effect still - weight gain, increased lipids and glucose
name some 2nd generation anti-psyhotics
olanzapine
risperidone
quietazpine
aripiprazole
clozapine
when is clozapine used
refractory cases - (2 antipsychotics have been tried)
treats - and + symptoms
side effects of clozapine?
Some Say Clozapine Has Too Many Weird Adverse Effects
S- sedation
S- seizures
C- constipation
H- hypotension/hypersalvatin
T- tachycardia
M- myocarditis
W- weight gain
A - agranulocytosis/neutropenia
E- enuresis (involuntary urination/bedwetting)
weekly WBC, lipids, weight, glucose, FBC
lithium is a mood stabliser
a. true
b. false
a. true
what is lithium used for
bi-polar/mania
- prophylaxis
adjunct in refractory depression
lithium has a narrow therapeutic range
a. true
b. false
a. true
check weekly until stable and then every 3 months kidney function, thyroid function
= primary excreted by kidneys
has a long half life in the plasma
side effects of lithium
nausea/vomiting
fine tremor
polyurea/diabetes inspidous (renal toxic)
thyroid - enlarges first - then hypo
weight gain
T-wave flattening
intracranial hypertension
leucocytosis
hyperparathyroid
side effects of lithium at therapeutic range
fine tremor
dry mouth
GI disturbance
thirst
urination
drowiness
thyroid dysfunction
side effects of thyroid toxicity
course tremor
CNS disturbance - seizures, co-ordination, dysarthia ,
arrythmias,
visual disturbance
side effects of lithium
L- leucocytosis
I - inspidous
T- tremor- fine
H- hyperparathryoid
I- impaired renal function
U-urination increases
M- metallic taste
contradindications to lithium use
hypoparathyroidism /addison
cardiac disease - rhythm disroders
low sodium diets/renal impairments
methanism of action of benzodiapzepines
enhace the effect of inhibitory neurotransmitters (GABA) by increasing the FREQUENCY of chloride channels
same as alcohol, can build tolerance
how do you work out the units of alcohol?
ml x %
1000
effects of alcohol on neurotransmitters
stimulates GABA receptors (relaxing effect on brain - inhibitory)
inhibiting/downregulating NMDA (glutamate - further relaxing effect - excitatory neurotransmitter)
the body will try to cope in LT alchohol abuse by downregulating GABA and upregulating NMDA
need to continue drinking or will experience withdraw
signs of hypokalaemia on ECG
prominent U waves
describe delirium tremons
withdrawel 24-74 hours (2-3 days effects)
- tremor
- ataxia (loss of co-ordinated movement)
- hyperthermia
- acute confusion
- severe agigtation
- delusions and hallucinations
- tachycardia
(GABA system underfunctions + Glutamate overfucntions - -> extreme excitability and excess adrenergic related activity
how is alcohol withdrawl treated?
chlordiazepoxide (librium)
- benzodiazepine
pabrinex (B vitamins IV or IM)
Long term oral thiamine
CBT
drugs that could be used to maintain absence in alcoholism
aramprosate
naltrexone
disulfiram
features of ADHD
- difficulty maintianing concentration
- excess energy
- excessive activity
- impuslsivity
consistent across all enviroments/settings (exlcude enviroment effects)
1- conservation
2-stimulates (methylphenidate, lisdexamfetamine - monitor HR, BP, weight, mood changes) -speacilist
features of ASD
impairments in
- social interactions
- communication
- behaviour
impairments in social interactions ASD
- lack of eye contact
- delay in smiling
- avoid physical contact
- cant read non verbal cues
- difficulty establish reindships
features of lewy body dementia
- visual hallucinations
- parkinsonism
- flucuations in cognition/memory -attention/alertness
capgras belief
someone close to them has been replaced with someone else (misidentification)
word salad
bunch of random words
derailment
series of unrelated sentences
tangentiality
diverts from the original train of thought and never returns
cirumstancial
leaves train of thought but eventually returns
1st line drug for alzhiemers
Donepezil (acetycholiesterase inhibitors)
mild
(contraindiated in bradycardia because they increase vagal tone further/heartblock/syncope)
2nd line for alzheimers
NMDA recepter antagonist
- Memantine
moderate to severe dementia
Xhigh BP, hypertension X renal impairment X asthma
postural hypotension is defined as
drop in systolic BP of 20mmhg or more from standing/sitting
circumstantiality
over-inclusve speech - that is delayed in reaching its final goal
can be a sign of anxiety or hypomania
possible to follow speech as it eventually reaches its goal
anergia
lack of energy or increased fatigability with minimal exertion
(unipolar depression)
peservation of speech
repreated a word of phrase needlessly which they had previously expressed
associated with parkinsons disease
flight of ideas
rapid shifting of ideas with only superifical associations between them
speech difficult to follow
manic episode phase
korsakoffs symptoms
RACK
retrograde amneisa
anterograde amnesia
confabulation
-> korakoffs
untreated thiaine B1 deficiency
Wernickes symptoms
COAT
Confusion
Opthalameplgia
Ataxia
Thiamine deficiency
management of patients with alcohol withdraw
- long acting benzodiazepines (chloridiazepoxide or diazepam)
2,. Lorazepam - may be preferrable in patients with hepatic failure (part of reducing dose protocol) - safer - avoid risk of increased sedation
examples of atypical antipsychotics
- risperidone
- quetiapine
- olanzapine
- clozapine
- aripiprazole
- paliperidone
examples of typical antipsychotics
- haloperidol
- trifluperazine
- chlorpromazine
- perciyazine
- levomepromazine
atypical antipsychotics carry a higher risk of what side effects?
- metabolic side effects
- weight gain
- diabetes mellitus
- hyperlipademia
can still cause EPS at higher doses
delusions associated with depression
olfactory
guilty delusions (psyhcotic depression)
persecutory delusins are suggestive of?
schizophrenia
venlafaxine mechanism of action
SNRI
serotonin and noradrenaline reuptake inhibitor (in CNS)
enhancing their availability in the synaptic cleft -
what is methylphenidate
ADHD drug
DA and NA reuptake inhibitor
- enhances focus, increases HR and BP
drugs that are agonists of GABA
benzodiapzepines
- enhancing inhibitory effects of GABA in CNS
- relieve anxiety and induce sleep
problems with dependence
how do MAOIs work
inhibit monoaminie oxidase enzyme
- preventing the breakdown of neurotransmiters (Serotonin and noradrenaline)
can cause hypertensive crisis if interact with TYRAMINE IN DIET
what is zoplicone
used to help sleep
stimulates a-subunit of GABA receptor (non-benzodiazepine) but similar effects
used for insomnia
benzos work via direct stimulation of GABA receptors
how do promethazine and cyclizine work
H1 receptor antagonists
what type of CBT for OCD
exposure - response prevention (ERP) therapy
1st line intervention for OCD
+/- SSRI (but not fluxotine)
Third-person auditory hallucinations involve hearing voices that refer to the person in the third person, as if discussing them rather than speaking directly to them
most commonly in schizophrenia
secondary auditory hallucination
Second-person auditory hallucinations involve hearing voices that speak directly to the person, using “you.” These hallucinations can be commanding, critical, or even supportive.
more typical mood disroders (mania and dpression)
what is hypomania
seen in type 2 bipolar disorder
less severe - but still changes in mood and behaviour
(still socialable/conifdent and social functioning isnt impaired yet).
mania v hypomania
mania -severe functional impairment or pschotic symptoms for 7 days or more
hypomania - decreased or increased function for 4 days or more
(delusions of grandeur or auditory hallucinations - suggest MANIA)
what type of medication is phenelzine
monoamine oxidase inhibitor (MAOI) class of drugs. It is a non-selective, irreversible MAOI, meaning it inhibits both MAO-A and MAO-B enzymes, which are responsible for breaking down neurotransmitters like serotonin, dopamine, and norepinephrine.
treatment resistent depression
DO not USE with SRRI -> will cause central serotonin syndrome
sublimation
channeling unacceptable thoughts , feelings, and impusles due to a situations into a socially acceptable alternative
psychotics features in depression are usually mood-congruent
e.g.
guilt
nihilism
and resolve once the mood episode resolves
‘depressing delusions’
features of psychotic features in schizophrenia
auditory** hallucinations
persecutory delusions
what is splitting?
believing that people are either all good or all bad at different times due to intelorance of ambiguity
commonly seen in BPD
duloxetine mechanism of action?
SNRI
serotonin and NA reputake inhibitor
benzodiapzepines can cause respiratory depression
a. true
b. false
a. true
espeacially when prescribed with other respiratory depressant drugs such as opiods
what antipsychotic is resevered for resitstant cases of schizophrenia
clozapine
Chlordiazepoxide
long-acting benzodiazepines are used in the management of alcohol withdrawal
clinical signs of alcohol withdrawal
anxiety, restlessness, visual and auditory hallucinations, and tremor.
Citalopram IS AN SSRI
A. TRUE
B. FALSE
TRUE
serotonin, NE and dopamine are monoamines
A. TRUE
B. FALSE
A. TRUE
antidepressant preferred in patients with anorexia nervosa as it also elevates the appetite and produces weight gain.
Mirtazapine
Duloxetine mechanism of action
serotonin and noradrenaline reuptake inhibitor
Common features of PTSD
re-experiencing e.g. flashbacks, nightmares
avoidance e.g. avoiding people or situations
hyperarousal e.g.hypervigilance, sleep problems
Phenytoin is a cause of folic acid deficiency
A. TRUE
B. FALSE
A. TRUE
