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P3A Med > Psychiatry - Handbook > Flashcards

Psychiatry - Handbook Flashcards

1
Q

What are benzodiazepines indicated for?

A

Acute stress reactions, episodic anxiety, fluctuations in generalised anxiety, and as initial treatment for severe panic and agoraphobia

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2
Q

What are barbiturates indicated for?

A

Barbiturates are a group of sedative-hypnotic medications used for the treatment of seizure disorder, neonatal withdrawal, insomnia, preoperative anxiety, induction of coma for increased intracranial pressure

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3
Q

What are non-benzodiazepine hypnotics indicated for?

A

Offer alternatives to benzodiazepines for the treatment of sleep disturbances due to their short half-life and preservation of normal sleep architecture

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4
Q

Describe the action of benzodiazepines.

A

Benzodiazepines enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABAA receptor, resulting in sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant properties.

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5
Q

Describe the action of barbiturates.

A

GABAA agonists. Instead of increasing the opening frequency of GABA channels like benzos, they increase the length of time at which the GABA channel is open.

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6
Q

Describe the action of non-benzodiazepine hypnotics

A

Like the benzodiazepines, they exert their effects by binding to and activating the benzodiazepine site of the receptor complex. Many of these compounds are subtype selective providing novel anxiolytics with little to no hypnotic and amnesiac effects and novel hypnotics with little or no anxiolytic effects.

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7
Q

State some side effects of benzodiazepines.

A

Drowsiness, light-headedness, confusion, unsteadiness, dizziness, slurred speech, muscle weakness, memory problems, decreased alertness

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8
Q

State some side effects of barbiturates.

A

Drowsiness, sedation, can lead to respiratory depression if given in too large a dose

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9
Q

State some side effects of non-benzodiazepine hypnotics.

A

Dizziness, light-headedness, confusion, double vision, memory impairment, pronounced amnesia, and depression.

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10
Q

Give example benzodiazepines.

A

Diazepam, lorazepam, alprazolam

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11
Q

Give example barbiturates.

A

Pentobarbital, phenobarbital, secobarbital

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12
Q

Give example non-benzodiazepine hypnotics.

A

Zolpidem, zaleplon, eszopiclone

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13
Q

What is the monoamine hypothesis?

A

The idea that depression is caused by the deficiency of monoamines (or upregulation of their receptors), namely serotonin, norepinephrine and/or dopamine.

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14
Q

What is the mode of action of SSRIs?

A

SSRIs exert action by inhibiting the reuptake of serotonin, thereby increasing serotonin activity. Little impact on norepinephrine or dopamine.

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15
Q

What are the side effects of SSRIs?

A

Increase in suicidal tendencies, sexual dysfunction, sleep disturbances, weight changes, anxiety, dizziness, xerostomia, headache, and gastrointestinal distress

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16
Q

What is the mode of action of SNRIs?

A

Similar to SSRIs, but also work on norepinephrine.

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17
Q

What are the side effects of SNRIs?

A

Similar to SSRIs, but more prevalent due to the action on norepinephrine.

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18
Q

What is the mode of action of TCAs?

A

Tricyclic antidepressants act on approximately five different neurotransmitter pathways to achieve their effects. They block the reuptake of serotonin and norepinephrine in presynaptic terminals, which leads to increased concentration of these neurotransmitters in the synaptic cleft. The increased concentrations of norepinephrine and serotonin in the synapse likely contributes to its anti-depressive effect. Additionally, they act as competitive antagonists on post-synaptic alpha cholinergic (alpha1 and alpha2), muscarinic, and histaminergic receptors (H1).

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19
Q

Why are TCAs less commonly used compared to SSRIs?

A

TCAs cause more significant adverse effects due to their anticholinergic activity and a lower threshold for overdose

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20
Q

What are the most common SEs of TCAs?

A

The most common adverse effects include constipation, dizziness, and xerostomia.

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21
Q

What SEs arise due to the cholinergic effects of TCAs?

A

Due to its blockade of cholinergic receptors, it can lead to blurred vision, constipation, xerostomia, confusion, urinary retention, and tachycardia

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22
Q

What SEs arise due to the alpha-1 adrenergic action of TCAs?

A

Due to the blockade of alpha-1 adrenergic receptors, it can cause orthostatic hypotension and dizziness.[

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23
Q

What SEs arise due to the histamine blocking effects of TCAs?

A

TCA-induced histamine blockade (H1) may lead to sedation, increased appetite, weight gain, and confusion

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24
Q

What is the action of MAOIs?

A

An enzyme called monoamine oxidase is involved in removing the neurotransmitters norepinephrine, serotonin and dopamine from the brain.

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25
Q

What are the SEs of MAOIs?

A

Dry mouth, nausea, diarrhea or constipation; headache, drowsiness, insomnia, dizziness or lightheadedness, skin reaction at the patch site

26
Q

Why do we use SSRIs more than MAOIs?

A

They’re used less frequently than selective serotonin reuptake inhibitors (SSRIs) and other antidepressants because of necessary dietary precautions and risks of adverse reactions when mixed with certain drugs

27
Q

Define lithium toxicity

A

A safe blood level of lithium is 0.6 and 1.2 milliequivalents per liter (mEq/L). Lithium toxicity can happen when this level reaches 1.5 mEq/L or higher. Severe lithium toxicity happens at a level of 2.0 mEq/L and above, which can be life-threatening in rare cases. Levels of 3.0 mEq/L and higher are considered a medical emergency.

28
Q

Give four side effects of lithium

A

Frequent urination, hand tremors, dry mouth, weight change, flatulence, restlessness, constipation, rash, muscle weakness

29
Q

What are the three types of lithium toxicity?

A

Acute toxicity. This happens when you take too much lithium at once, either accidentally or on purpose.

Chronic toxicity. This happens when you take a little too much lithium daily over a long period of time. Dehydration, other medications, and other conditions including kidney problems, can affect how your body handles lithium. Over time, these factors can cause lithium to slowly build up in your body.

Acute-on-chronic toxicity. This can happen if you take lithium every day for a long period of time, but then suddenly take an extra pill one day, either accidentally or on purpose.

30
Q

How do we treat lithium toxicity?

A

Stomach pumping, whole bowel irrigation, hemodialysis, IV fluids (electrolytes imbalances)

31
Q

What foods can affect lithium levels?

A

Caffeine, alcohol, salt

32
Q

What medications can affect lithium levels?

A

NSAIDs, metronidazole, diuretics, acetaminophen

33
Q

What are the four main symptoms seen in psychosis?

A

Delusions, hallucinations, thought disorders, agitation/aggressiveness

34
Q

What is a delusion?

A

Strongly held false belief that is not typical for the patient. Split into bizarre (e.g. family member being replaced) and non-bizarre (partner cheating).

35
Q

What is a hallucination?

A

Wakeful sensory experiences of content that is not actually present.

36
Q

What is an illusion?

A

Distortion or misinterpretation of sensory stimuli

37
Q

Give three diseases that present with primary psychosis.

A

Schizophrenia, schizophreniform, schizoaffective disorder, delusional disorder, schizotypal personality disorder, substance induced

38
Q

Give three diseases that present with secondary psychosis

A

Thyroid disease, adrenal disease, hepatic encephalopathy, Wilson’s disease, Alzheimer’s disease, Huntington’s disease, stroke

39
Q

Describe the pathophysiology behind positive symptoms in psychosis.

A

Mesolimbic pathway. High levels of dopamine activate D2 receptors on the NAC (nucleus accumbens) cause delusions and hallucinations.

40
Q

Describe the pathophysiology behind negative symptoms in psychosis.

A

Mesocortical pathway. Low levels of dopamine at the prefrontal cortex mean the D1 receptors aren’t activated, leading to social withdrawal and lack of motivation.

41
Q

What are the two types of antipsychotic drug?

A

First generation (typical) and second generation (atypical)

42
Q

Give three examples of typical antipsychotics.

A

Haloperidol, fluphenazine, chlorpromazine (low potency)

43
Q

Give five examples of second generation antipsychotics.

A

Aripiprazole, clozapine, olanzapine, quetiapine, risperidone, ziprasidone

44
Q

Which antipsychotic can cause agranulocytosis?

A

Clozapine

45
Q

What is agranulocytosis?

A

Blood disorder that is characterized by a severe reduction in the number of white blood cells (granulocytes) in the circulating blood. Symptoms include sudden fever, chills, sore throat, and weakness

46
Q

What extrapyramidal SEs can typical antipsychotics cause and why?

A

Due to blockage of dopamine receptors in the nigrostriatal pathway, pts can suffer from Parkinson’s like symptoms, akathisia (feeling restless) and dystonia (sustained/repetitive muscle contractions)

47
Q

What is neuroleptic malignant syndrome?

A

A life-threatening reaction to antipsychotic drugs characterized by fever, altered mental status, muscle rigidity, and autonomic dysfunction. (neuroleptic = antipsychotic)

48
Q

How do we treat NMS?

A

Treatment includes immediately stopping the offending agent and implementing supportive measures, as well as pharmacological interventions in more severe cases.

49
Q

Which SSRI has the fewest drug interactions?

A

Citalopram

50
Q

Which SSRI is the most stimulating and has the longest half life?

A

Fluoxetine

51
Q

Which SSRI is the most nauseating, constipating and sedating?

A

Fluvoxamine

52
Q

Which SSRI causes the most diarrhoea and male sexual dysfunction?

A

Sertraline

53
Q

Give the main SEs of taking olanzapine.

A

High sedation, significant weight gain due to antihistaminergic and antimuscarinic effects, largest cardiometabolic risk along with quetiapine, high EPS

54
Q

Give the main SEs of taking quetiapine.

A

High sedation, medium chance of weight gain, low EPS

55
Q

Give the main SEs of taking asenapine.

A

Oral hypoesthesia, high sedation, medium EPS, medium chance of weight gain

56
Q

Give the main SEs of clozapine

A

High sedation, high weight gain, low EPS hypersalivation, constipation, HTN, tachycardia, fever, seizures, agranulocytosis

57
Q

Give the main SEs of taking risperidone

A

High chance of EPS, high chance of weight gain, medium sedation risk

58
Q

Why would we want to use apriprazole?

A

Low sedation, low weight gain, low-med EPS

59
Q

What is oral hypoesthesia?

A

Hypoesthesia is the medical term for a partial or total loss of sensation in a part of your body

60
Q

What is the mnemonic for depressive symptoms?

A

SIG-E-CAPS: Sleep changes, Interest loss, Guilt (worthlessness), (lack of) Energy, Cognition/Concentration, Appetite, Concentration, Psychomotor (agitation/lethargy), Suicidal/Homicidal ideation

61
Q

How do we monitor clozapine use in patients?

A

Patients on clozapine require regular blood tests to check their neutrophil levels as clozapine can cause agranulocytosis, which is potentially life-threatening.

P3A Med (9 decks)

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