Psycho Drugs Flashcards by Milly Abbott

What drugs are used in epilepsy?

Sodium valproate
Carbamazepine
Lamotrigine
Benzodiazepines and phenytoin

*all sodium channel blockers exclu. Benzodiazepines

How well did you know this?

Not at all

Perfectly

Describe the management of status epileticus under 10 mins

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

Exclude hypoglycaemic causes

How well did you know this?

Not at all

Perfectly

Describe the management of status epilepticus lasting over 10 minutes

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

How well did you know this?

Not at all

Perfectly

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

Arrhythmias and hypotension

How well did you know this?

Not at all

Perfectly

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

Give folate supplements (prior to conception)

Vitamin K supplements in T3

How well did you know this?

Not at all

Perfectly

What drugs are given for Parkinson’s?

Levodopa + Carbidopa 
Dopamine receptor agonists 
COMT inhibitor
Anticholinergics
Amantidine

How well did you know this?

Not at all

Perfectly

What drugs can be used to treat myasthenia gravis?

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

How well did you know this?

Not at all

Perfectly

What drugs are used to treat depression?

SSRIs (1st line)
TCAs
SNRIs
MAOIs

How well did you know this?

Not at all

Perfectly

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

Try for at least 6 wks before switching drugs

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

How well did you know this?

Not at all

Perfectly

What drug is used to treat schizophrenia?

Antipsychotics/ dopamine antagonists

atypical are 1st line

How well did you know this?

Not at all

Perfectly

What are the extrapyramidal side effects of antipsychotics?

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

How well did you know this?

Not at all

Perfectly

What is the treatment for anxiety?

Anxiolytics (benzodiazepines short term)
Antidepressants
Occasionally antipsychotics

How well did you know this?

Not at all

Perfectly

Describe the management of a benzodiazepine overdose

Flumazenil:

Antagonist at BDZ receptors

How well did you know this?

Not at all

Perfectly

Bipolar disorder is a spectrum that consists of what?

Mania
Hypomania
Depression

How well did you know this?

Not at all

Perfectly

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

Pushes them to mania

How well did you know this?

Not at all

Perfectly

What drugs are used for bipolar disorder?

Mood stabilisers;
Li
Sodium valproate 
Carbamazepine 
Lamotrigine 
Antipsychotics

How well did you know this?

Not at all

Perfectly

What is the management for Li toxicity?

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

How well did you know this?

Not at all

Perfectly

What drugs can be given for dementia?

ACh esterase inhibitors

Memantine (NMDA antagonist)

How well did you know this?

Not at all

Perfectly

Give 3 examples of benzodiazepines and how they are given

Lorazepam- IV
Midazolam- buccal
Diazepam- rectal

How well did you know this?

Not at all

Perfectly

What is the mechanism of action of benzodiazepines?

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

How well did you know this?

Not at all

Perfectly

Why are benzodiazepines not for long term use?

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

How well did you know this?

Not at all

Perfectly

What is sodium valproate used for?

Epilepsy - partial, generalise tonic-clonic, absence

Bipolar disorder

How well did you know this?

Not at all

Perfectly

What are the ADRs of sodium valproate?

Study These Flashcards

Teratogenic 
CNS dysfunction 
Hepatic failure (rare)

What is carbamazepine used for?

Study These Flashcards

Epilepsy- Tonic clonic And all Partial seizures

Bipolar disorder

What are the ADRs of carbamazepine?

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

What are the contraindications of carbamazepine?

AV conduction problems | Antidepressants

What is phenytoin used for?

Generalise tonic-clonic, all partial seizures | Status epilecticus

ADRs of phenytoin?

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

What is lamotrigine used for?

Epilepsy: all partial seizures, tonic-clonic and absence | Bipolar disorder

What are the benefits of lamotrigine?

Less marked CNS side effects | Safer in pregnancy

What is the mechanism of action for L-dopa?

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

ADRs of L-dopa?

``` Dyskinesia Dystonia Freezing Psychosis Nausea Vomiting Hypotension ```

What is the mechanism of carbidopa?

Used with L-dopa Peripheral decarboxylase inhibitor Thus prevents breakdown of L-dopa in peripheries *COMT inhibitor does the same thing

What are the benefits of using carbidopa with levodopa?

Reduces dosage of L-dopa | Decreases peripheral side effects

How do anticholinergics treat Parkinson’s?

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

What are ADRs of anticholinergics?

Confusion Drowsiness Dry mouth Urinary retention

What are acetylcholine esterase inhibitors used for?

Myasthenia Gravis | Dementia (mild-moderate)

What is the action of acetylcholine esterase inhibitors?

Enhances neuromuscular transmission | By preventing breakdown of ACh

What are side effects of cholinergic drugs?

``` SSLUDGE: Sweating Salivation Lacrimation Urinary incontinence Diarrhoea GI upset Emesis ```

What are side effects of anticholingergics?

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

What are the mechanism of SSRIs?

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

Side effects of SSRIs?

NV Sexual dysfunction Insomnia

What is serotonin syndrome?

``` 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 ```

What are the mechanism of action of tricyclics antidepressants?

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

Why cant TCAs if the pt is suicidal?

Cause they lethal in overdose due to toxic effects

When do you use SNRIs?

In depression when SSRIs haven’t worked

What are the different effects of SNRIs at different doses?

Low dose- serotonin action- anti-depressive effect | High dose- NA action as well- anxiolytics effect

What is the difference between typical and atypical antipsychotics?

Typical - dopamine antagonists | Atypical - serotonin agonists and dopamine antagonists

What are antipsychotics used for?

Schizophrenia | Bipolar disorder

Side effects of antipsychotics?

``` Anti cholinergic nausea Sexual dysfunction Insomnia Obesity Extrapyramidal side effects ```

What is neuroleptic malignant syndrome?

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

What are the contraindications of lithium?

Renal failure ACE inhibitors NSAIDs

What is the action of lithium?

Increases serotonin

What are the side effect of lithium?

``` Memory problems Thirst Polyuria Tremor Drowsiness Weight gain ```

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

Memantine

What are the side effects of memantine?

``` Hypertension Dyspnea Headaches Drowsiness Dizziness ```

What is the action of NMDA receptor blockers?

Reduces neurotoxic effects of dementia | Exerts modest effect on slowing down progression

Psycho Drugs Flashcards

(57 cards)