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4th Year - Management > Psychiatry - Drugs > Flashcards

Psychiatry - Drugs Flashcards

1
Q

Dopamine Hypothesis

A

Mesolimbic (too much D2) - positive symptoms

Mesocortical (too little D2) - negative symptoms

Tuberofundibular - endocrine/metabolic SE

Nigrostriatal - EPSE

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2
Q

EPSE

A

Acute dystonia

  • Painful spastic contraction
  • Give procyclidine

Akathesia

  • Restlessness and distress
  • Procyclidine/propanolol

Parkinsonism

  • Tremor, rigidty and bradykinesia
  • Anticholinergics

Tardive dyskinesia

  • Involuntary, repeatitive movements
  • Tongue, lips face
  • Irreversible, anticholinergics make it worse
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3
Q

Neuroleptic Malignant Syndrome

A

Within 10 days on initiation

  • Severe rigidity
  • Temp >38 degrees
  • Fluctuating consciousness
  • Autonomic instability
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4
Q

Depot

A

1st generation and Risperidone

2-8 weeks, deep IM injection

Increased compliance and bioavailability
Decrease abuse/toxicity

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5
Q

1st Generation - MOA

A

Decrease D2 in all 4 pathways

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6
Q

1st Generation - Indications

A

Schizophrenia
Acute mania
Psychosis

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7
Q

1st Generation - Side Effects

A

Tuberoinfundibular

  • Prolactinaemia
  • Galactorrhoea, menstual disturbance

Acetylcholine
- Can’t spit can’t see can’t poo can’t pee

Adrenaline/noradrenaline

  • Postural hypotension
  • Sexual dysfunction

Histamine

  • Sedation
  • Weight gain
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8
Q

Achetylcholine Side Effects

A
  • Dry mouth
  • Blurred vision
  • Urinary retention
  • Constipation
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9
Q

2nd Generation - MOA

A

Decreased action on Nigrostriatal = decreased EPSE

Increased on other e.g. adrenergic/histamine = weight gain

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10
Q

2nd Generation - Indications

A

First line in schizophrenia

Clozapine = Treatment resistant schizophrenia

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11
Q

Clozapine - Indications

A

Treatment resistant schizophrenia

  • 2 or more other antipsychotics tried
  • At full dose for 6 months
  • With no effect (not stopped due to side effects)
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12
Q

Clozapine - Side Effects

A

Neutropenia and agranulocytosis

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13
Q

Clozapine - Monitoring

A
  • Weekly FBC etc for 18 weeks
  • 2 weekly for first year
  • 4 weekly after that

Withdraw if leucocytes <3000 or neutrophils <1500

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14
Q

2nd Generation - Side Effects

A 
Weight gain, 
dizziness, 
T2DM, 
postural hypotension, 
hyperlipidaemia
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15
Q

Quetipine/Zotepine - Side Effects

A

QT prolongation

No Ach side effects

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16
Q

2nd Generation - Baseline Monitoring

A

Bloods
- FBC, UEs, LFTs, HbA1c, Glucose, prolactin, lipids, cholesterol

Physical
- Weight, BP, HR

ECG

  • Hx CV/Smoker
  • On quetipine or zotepine
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17
Q

Lithium - Indications

A

BAD prophylaxis
Recurrent/resistant depression

Use for >3 years
- Poor compliance = rebound mania (hard to treat)

18
Q

Lithium Side Effects - Early

A 
Fatigue
Drowsiness
Fine Tremor
Weight gain
Polydipsia 
Polyuria
19
Q

Lithium Side Effects - Late

A

Thryoid problems
Renal failure
CVD

20
Q

Lithium Toxicity

A

Mild Drowsiness, ataxia, coarse tremore

Severe:
Convulsions, collapse

21
Q

Lithium Monitoring - Bloods

A

Lithium levels checked 12 hours post dose.

3-5 days for the first few weeks until stable, then 3-4 monthly levels

Check kidney and thyroid function too

22
Q

Lithium - Baseline Monitoring

A 
Weight
Renal function
TFTs
Pregnancy Test
ECG
23
Q

SSRIs - MOA and examples

A

Inhibit re-uptake of serotonin at the synaptic cleft

  • Fluoxetine
  • Sertraline
  • Paroxetine
  • Citalopram
  • Escitalopram
  • Fluvoxamine
24
Q

SSRIs - Side effects

A

Very Common

  • GI Disturbance
  • Insomnia (do not take at night)
  • Sexual disturbance

Common

  • Headache
  • Decreased appetite
  • Restlessness

Rare

  • Rash
  • Thoughts of self harm
25
Q

SSRIs - Counselling

A

How?
- One tablet each day in the morning

Effect
- By week 2, definitely by week 8

Duration
- 12 months to prevent relapse

Stopping
- Wean off

Overdose
- Not toxic

26
Q

SNRIs - MOA and Examples

A

Inhibit reuptake of serotonin and noradrenaline

  • Venlafaxine
  • Duloxetine
27
Q

SNRIs - Indication

A

Treatment resistant depression
- increased efficacy and rapid onset

GAD

28
Q

SNRIs - Side effects

A

Nausea, headache, sleepiness, dizziness

Cardiotoxic - avoid in heart disease/hypertension

29
Q

SNRIs - Monitoring

A

ECG and BP before starting

30
Q

Tricyclic Antidepressant - MOA and Examples

A

Inhibit reuptake of noradrenaline and serotonin

  • Amitriptyline
  • Imipramine
  • Lofepramine (not toxic in overdose)
31
Q

TCAs - Indications

A

Imipramine - non sedating

Amitriptyline - sedating

Clomipramine - use in OCD

32
Q

TCAs - Side Effects

A

Ach side effects

Histamine

Cardiotoxic (avoid in MI/heart block)

Neurotoxic - delirium etc.

33
Q

TCA - Overdose + Antidote

A

Very toxic

Increased HR, dilated pupils, low GCS, palpable bladder, seizures, arrythmias

Give Sodium Bicarbonate

34
Q

NASSA - MOA and Example

A

Noradrenaline and Serotonin Specific Antidepressant

Mirtazapine

Severe depression, especially if poor sleep/diet

35
Q

NASSA - Side Effects

A

Sedation
Weight gain
Dry mouth
Dizziness

SAFE IN OVERDOSE

36
Q

NARI - MOA and Example

A

Noradrenaline Re-uptake inhibitor

Reboxetine

Severe depression

37
Q

NARI - Side Effects

A

Nausea, anorexia, sweating, dizziness, postural hypotension

SAFE IN OVERDOSE

38
Q

Risperidone - Side Effects

A

Low BP

Restlessness

Headache

Sexual dysfunction

39
Q

Olanzapine - Side Effects

A

Weight gain

Sedation

Constipation

40
Q

SSRIs - Side Effects

A

N+V

Dizziness

Dry mouth

Sexual dysfunction

Increased suicidal thoughts

41
Q

Mirtazapine - Side Effects

A

Weight gain

Sedation

Dizziness

Dry Mouth

42
Q

Venlafaxine - Side Effects

A

NOT in CVD

N+V

Dizziness

Headache

4th Year - Management (11 decks)

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