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CPT (Milpa) > Psycho Drugs > Flashcards

Psycho Drugs Flashcards

1
Q

What drugs are used in epilepsy?

A

Sodium valproate
Carbamazepine
Lamotrigine
Benzodiazepines and phenytoin

*all sodium channel blockers exclu. Benzodiazepines

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2
Q

Describe the management of status epileticus under 10 mins

A

ABCDE approach-stabilise
Benzodiazepines (further dose if not terminating within 5 mins)

Exclude hypoglycaemic causes

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3
Q

Describe the management of status epilepticus lasting over 10 minutes

A

(Same as before 10 minutes plus…)
Call ITU and Med specialist registrar
Give loading dose of IV phenytoin

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4
Q

What do you need to look out for when giving a IV loading dose of phenytoin?

A

Arrhythmias and hypotension

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5
Q

How should you manage pt taking anti-epileptics whilst pregnant?

A

Give folate supplements (prior to conception)

Vitamin K supplements in T3

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6
Q

What drugs are given for Parkinson’s?

A 
Levodopa + Carbidopa 
Dopamine receptor agonists 
COMT inhibitor
Anticholinergics
Amantidine
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7
Q

What drugs can be used to treat myasthenia gravis?

A 
ACh esterase inhibitors
Corticosteroids
Steroid sparing (azathioprine)
IV Ig
Plasmapheresis
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8
Q

What drugs are used to treat depression?

A

SSRIs (1st line)
TCAs
SNRIs
MAOIs

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9
Q

What is the advice given for length of treatment with depression and why?

A

Try for at least 6 wks before switching drugs

And continue medication for 1yr despite feeling better to reduce risk of relapse

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10
Q

What drug is used to treat schizophrenia?

A

Antipsychotics/ dopamine antagonists

atypical are 1st line

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11
Q

What are the extrapyramidal side effects of antipsychotics?

A

Dystonia (sustained or repetitive muscle contraction)
Akathisia (restlessness)
Tardive dyskinesia (involuntary repetitive movements)
Pseudo-Parkinsonism

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12
Q

What is the treatment for anxiety?

A

Anxiolytics (benzodiazepines short term)
Antidepressants
Occasionally antipsychotics

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13
Q

Describe the management of a benzodiazepine overdose

A

Flumazenil:

Antagonist at BDZ receptors

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14
Q

Bipolar disorder is a spectrum that consists of what?

A

Mania
Hypomania
Depression

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15
Q

Why aren’t antidepressants given to people with bipolar disorder?

A

Pushes them to mania

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16
Q

What drugs are used for bipolar disorder?

A 
Mood stabilisers;
Li
Sodium valproate 
Carbamazepine 
Lamotrigine 
Antipsychotics
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17
Q

What is the management for Li toxicity?

A

Anti-convulsants
Increase fluid intake/IV fluids
Haemodialysis (may be necessary)

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18
Q

What drugs can be given for dementia?

A

ACh esterase inhibitors

Memantine (NMDA antagonist)

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19
Q

Give 3 examples of benzodiazepines and how they are given

A

Lorazepam- IV
Midazolam- buccal
Diazepam- rectal

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20
Q

What is the mechanism of action of benzodiazepines?

A

Enhances action of GABA
Less excitable neurones (Cl-)
Decrease chance of reaching seizure threshold

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21
Q

Why are benzodiazepines not for long term use?

A

Increased ADRs as time continues
Tolerance build up
Dependence
Withdrawal-triggers seizures

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22
Q

What is sodium valproate used for?

A

Epilepsy - partial, generalise tonic-clonic, absence

Bipolar disorder

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23
Q

What are the ADRs of sodium valproate?

A 
Teratogenic 
CNS dysfunction 
Hepatic failure (rare)
24
Q

What is carbamazepine used for?

A

Epilepsy- Tonic clonic And all Partial seizures

Bipolar disorder

25
Q

What are the ADRs of carbamazepine?

A

Dizziness, drowsiness, ataxia, Motor disturbance, numbness and tingling

26
Q

What are the contraindications of carbamazepine?

A

AV conduction problems

Antidepressants

27
Q

What is phenytoin used for?

A

Generalise tonic-clonic, all partial seizures

Status epilecticus

28
Q

ADRs of phenytoin?

A 
Dizziness 
Ataxia
Headache 
Gingivial hyperplasia
Rash (Steven Johnson’s syndrome 2-5%)
29
Q

What is lamotrigine used for?

A

Epilepsy: all partial seizures, tonic-clonic and absence

Bipolar disorder

30
Q

What are the benefits of lamotrigine?

A

Less marked CNS side effects

Safer in pregnancy

31
Q

What is the mechanism of action for L-dopa?

A

Crosses BBB
Taken up by dopaminergic cells in Substantia nigra
Converted to dopamine (dopa decarboxylase)

32
Q

ADRs of L-dopa?

A 
Dyskinesia 
Dystonia 
Freezing 
Psychosis 
Nausea
Vomiting 
Hypotension
33
Q

What is the mechanism of carbidopa?

A

Used with L-dopa
Peripheral decarboxylase inhibitor
Thus prevents breakdown of L-dopa in peripheries

*COMT inhibitor does the same thing

34
Q

What are the benefits of using carbidopa with levodopa?

A

Reduces dosage of L-dopa

Decreases peripheral side effects

35
Q

How do anticholinergics treat Parkinson’s?

A

(Minor treatment)
ACh has antagonist effect on dopamine
Treats tremors but no effect on bradykinesia

36
Q

What are ADRs of anticholinergics?

A

Confusion
Drowsiness
Dry mouth
Urinary retention

37
Q

What are acetylcholine esterase inhibitors used for?

A

Myasthenia Gravis

Dementia (mild-moderate)

38
Q

What is the action of acetylcholine esterase inhibitors?

A

Enhances neuromuscular transmission

By preventing breakdown of ACh

39
Q

What are side effects of cholinergic drugs?

A 
SSLUDGE:
Sweating
Salivation
Lacrimation
Urinary incontinence
Diarrhoea
GI upset
Emesis
40
Q

What are side effects of anticholingergics?

A

Can’t see- no lacrimation
Can’t pee-urinary retention
Can’t spit- no salivation
Can’t shit- constipation

41
Q

What are the mechanism of SSRIs?

A

Limits reuptake of serotonin into presynaptic neurone
Increases serotonin levels in synaptic cleft
More neurotransmission

42
Q

Side effects of SSRIs?

A

NV
Sexual dysfunction
Insomnia

43
Q

What is serotonin syndrome?

A 
A life threatening presenting within a few weeks of initiating SSRIs or when two are used at once. Causes:
Tachycardia
Sweating
Dilated pupils 
Myoclonic seizures
Hyper reflexes
Hyperthermia
44
Q

What are the mechanism of action of tricyclics antidepressants?

A

Same as SSRIs
PLUS
Blocks ACh action (anti-muscarinic)

45
Q

Why cant TCAs if the pt is suicidal?

A

Cause they lethal in overdose due to toxic effects

46
Q

When do you use SNRIs?

A

In depression when SSRIs haven’t worked

47
Q

What are the different effects of SNRIs at different doses?

A

Low dose- serotonin action- anti-depressive effect

High dose- NA action as well- anxiolytics effect

48
Q

What is the difference between typical and atypical antipsychotics?

A

Typical - dopamine antagonists

Atypical - serotonin agonists and dopamine antagonists

49
Q

What are antipsychotics used for?

A

Schizophrenia

Bipolar disorder

50
Q

Side effects of antipsychotics?

A 
Anti cholinergic
nausea
Sexual dysfunction 
Insomnia 
Obesity
Extrapyramidal side effects
51
Q

What is neuroleptic malignant syndrome?

A 
Life-threatening reaction within 2 weeks of initiating anti-psychotics
Fever
Altered mental status
Hypertonia
Autonomic dysfunction
52
Q

What are the contraindications of lithium?

A

Renal failure
ACE inhibitors
NSAIDs

53
Q

What is the action of lithium?

A

Increases serotonin

54
Q

What are the side effect of lithium?

A 
Memory problems
Thirst
Polyuria
Tremor
Drowsiness
Weight gain
55
Q

Give an example of an example of an NMDA receptor blocker?

A

Memantine

56
Q

What are the side effects of memantine?

A 
Hypertension
Dyspnea
Headaches
Drowsiness
Dizziness
57
Q

What is the action of NMDA receptor blockers?

A

Reduces neurotoxic effects of dementia

Exerts modest effect on slowing down progression

CPT (Milpa) (20 decks)

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