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Psychopharm > Psychopharm > Flashcards

Psychopharm Flashcards

1
Q

What are the two main groups of antipsychotics?

A

Typical and atypical

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2
Q

What are some examples of typical antipsychotics? (x3)

A
  • Chlorpromazine
  • Haloperidol
  • Fluphenazine
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3
Q

What are some examples of atypical antipsychotics? (x4)

A
  • Clozapine
  • Olanzapine
  • Quetiapine
  • Risperidone
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4
Q

What is the mechanism of action of antipsychotics?

A

Block D2 dopamine receptors in the brain (excess dopamine causes psychosis)

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5
Q

What is Chlorpomazine also known as?

A

Largactil (due to its large action - acts on many receptor types)

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6
Q

What type of symptoms are ALL antipsychotics useful against?

A

POSITIVE symptoms - eg. hallucinations, delusions

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7
Q

What percentage of patients are antipsychotics effective for, and how long does it take to achieve therapeutic effects?

A

Effective in 70% of all cases

Takes 6 weeks

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8
Q

What type of antipsychotics are useful against negative symptoms?

A

Atypical, but in varying degrees

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9
Q

Why are antipsychotics associated with such a large range of adverse effects?

A

Because they have such a broad spectrum of activity

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10
Q

What classes of psych drugs can cause dependence and withdrawal and when does this occur?

A

Classes of drugs include:

  • Antidepressants
  • Antipsychotics
  • Mood stabilisers
  • Anxiolytics

Occurs when these drugs are abruptly stopped

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11
Q

What are some examples of the adverse effects associated with antipsychotics?

A
  • EPSEs (extrapyramidal side effects)
  • NMS (neuroleptic malignant syndrome)
  • Prolactin elevation (manboobs)
  • Sedation
  • Weight gain
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12
Q

What are antipsychotics used to treat?

A

Treatment of choice for schizophrenia and other psychoses, also used as prophylaxis for relapse

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13
Q

What are anticholinergics also known as?

A

Antimuscarinic or antiparkinsonian medications

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14
Q

What is the mechanism of action of anticholinergics?

A

Block the effects of acetylcholine

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15
Q

Why is the prophylactic use of anticholinergics avoided? (x3)

A
  • Efficacy of antipsychotics at lower doses
  • Long term use may mask the development of Tardive Dyskinesia (severe EPSE)
  • Abuse problems - creates a euphoric effect that is addictive
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16
Q

What are some examples of anticholinergics? (x4)

A
  • Benztropine
  • Biperiden
  • Procyclidine
  • Orphenadrine
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17
Q

How long does it take for antidepressants to have a therapeutic effect?

A

Takes 6-8 weeks due to the complexity of biochemical alterations occurring in the brain

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18
Q

How long is antidepressant therapy recommended for and why?

A

1-2 years, in order to prevent relapse.

Many patients stop too soon due to how long it takes for the drugs to have therapeutic effects.

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19
Q

How long a period should a patient be weaned off antidepressants for?

A

6-12 months (even if they feel good)

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20
Q

What drug groups of antidepressants are the first line of therapy for the treatment of depression?

A
  • SSRIs - selective serotonin reuptake inhibitors
  • RMAOIs - reversible monoamine oxidase inihibitors
  • Tetracyclic antidepressants (Mirtazapine)
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21
Q

What are some examples of SSRIs? (x3)

A
  • Fluoxetine
  • Paroxetine
  • Escitalopram
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22
Q

What are 4 advantages of SSRIs?

A
  • Long half life = one daily dose = increased adherence
  • Usually well tolerated
  • Minimal toxicity in overdose (unless combined with other drugs)
  • High therapeutic index
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23
Q

What are some adverse effects of SSRIs? (x4)

A
  • GI disturbances (most common)
  • Sexual dysfunction
  • Insomnia
  • Agitation
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24
Q

What is an example of a RMAOI?

A

Moclobemide

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25
Q

What type of drug is Moclobemide?

A

RMAOI (antidepressant)

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26
Q

What kind of receptor is Moclobemide selective for?

A

MAO-A receptors (binds reversibly)

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27
Q

Are consumers on Moclobemide allowed to have tyramine? Why/why not?

A

Yes they are!

Acts on MAO-A which IS NOT found in the liver, and so has nothing to do with tyramine breakdown

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28
Q

What kind of drug is Mirtazapine?

A

Tetracyclic antidepressant

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29
Q

What do RMAOIs allow for?

A

Allow metabolism of dietary amines

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30
Q

What is the mechanism of action of Mirtazapine?

A

Presynaptic alpha2 receptor antagonist

To a lesser extent, also increases serotonin release

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31
Q

When are tricyclic antidepressants (TCAs) a first line of therapy?

A

When a sedative effect is required

32
Q

What are some examples of TCAs? (x3)

A
  • Amitrityline
  • Imipramine
  • Doxepin
33
Q

What time of day are TCAs usually given and why?

A

At night, due to sedative effects

Can still cause daytime drowsiness - caution when driving and operating machinery

34
Q

Other than sedative effects, what other effects do TCAs exert?

A
  • Anxiolytic properties
  • Anticholinergic
  • Antiadrenergic
  • Antihistaminergic

(last three are all secondary effects)

35
Q

What happens during overdose of TCAS?

A

HIGHLY LETHAL - cardiotoxic

Blocks muscarinic receptors on the myocardium of the heart, resulting in cardiac arrest

36
Q

What are the contraindications of TCAs? (x3)

A
  • MAOIs
  • SSRIs
  • Alcohol

Also not to be given to suicidal consumers due to lethality in overdose

37
Q

What is an example of a second line antidepressant?

A

IMAOI (irreversible monoamine oxidase inhibitor)- Phenelzine

38
Q

What is the mechanism of action of Phenelzine?

A

Acts on both MAO-A and MAO-B receptors

39
Q

Can those on Phenelzine have tyramine in their diet? Why/why not?

A

NO

MAO-B is found in the liver - associated with tyramine metabolism = REQUIRES DIETARY RESTRICTION

40
Q

When are IMAOIs used? Why?

A

Used when SSRIs and TCAs do not work for a consumer -
limited use due to toxicity and lower efficacy than SSRIs and TCAs

Also used when there has been a previous response to IMAOIs

41
Q

What is a contraindication of IMAOIs?

A

Foods containing tyramine - eg. cheese, beer, wine, sour cream, vegemite, soy sauce

42
Q

What are some adverse effects of IMAOIs? (x5)

A
  • Headache
  • Postural hypotension
  • Insomnia
  • Ankle oedema
  • Weight gain
43
Q

Which two classes of antidepressants have a similar efficacy and what is the rate of efficacy?

A

SSRIs and TCAs have a similar efficacy with about 60% of patients responding in 6 weeks

44
Q

What are mood stabilisers used to treat?

A

Acute and long term management of bipolar disorder for the prevention of mood swings

45
Q

Which drug is the ONLY effective mood stabiliser?

A

Lithium Carbonate

even though some antiepileptic and anticonvulsants are used for this purpose

46
Q

Why might anticonvulsants be used with lithium?

A

Because lithium has a long response period, takes 1-2 to have any therapeutic events, and so anticonvulsants are used during this period to manage manic episodes

47
Q

What are some examples of anticonvulsants that might be used with lithium?

A
  • Sodium valporate (Valporic acid)
  • Carbamazepine
  • Lamotrigine
48
Q

What are some common adverse effects of lithium? (x4)

A
  • GI disturbances
  • Increased thirst and urination
  • Muscle weakness
  • fine hand tremor
49
Q

How much water to consumers need to drink when taking lithium and why?

A

6-8 glasses

Because Li with compete with Na in the renal system. When there is too little water, Li will be absorbed and block Na/K pump function, leading to toxicity

50
Q

What are some symptoms of lithium toxicity? (x4)

A
  • Coma
  • Confusion
  • Lethargy
  • Cardiac arrest
51
Q

Why should you NOT give lithium to consumers with renal dysfunction?

A

Because lithium is metabolised solely by the kidneys, no kidney function = lithium toxicity. The liver does not metabolise Li as it is a metal

52
Q

How do epileptic drugs stabilise mood?

A

Inactivate Na channels - leads to decreased neuron excitability, increased GABA release and GABA(A) receptor density, inhibition of GABA degradation

53
Q

What classes of drugs are used in the treatment of anxiety disorders?

A
  • Sedatives
  • Hypnotics
  • Anxiolytics
  • SSRIs and Quetiapine (antipsychotic)
54
Q

What are two examples of hypnotics?

A
  • Nitrazepam

- Temazepam

55
Q

What are three examples of anxiolytics?

A
  • Diazepam
  • Alprazolam
  • Oxazepam
56
Q

Benzodiazepines are safe compared to which class of drug?

A

Barbiturates - these cause excessive sedation and fatalities in overdose

57
Q

Why are benzodiazepines regarded as dangerous?

A

Due to their high potential for dependency and withdrawal problems

58
Q

What are some adverse effects of sedatives, hypnotics and anxiolytics? (x6)

A
  • Drowsiness (hangover effect)
  • Slowing of cognitive function
  • Suppression of REM sleep
  • Confusion in older patients
  • Rebound insomnia
  • Vivid dreams
59
Q

When are sedatives, hypnotics and anxiolytics fatal in overdose?

A

When taken in excess with alcohol and other drugs

Otherwise overdose is rarely fatal in healthy adults

60
Q

What is the mechanism of action of psychostimulants?

A

Enhance DA and NA transmission - causes these neurotransmitters to hit their ceiling effect and drop back down, leaving the consumer feeling calmer

61
Q

What is an example of a psychostimulant and what is it used to treat?

A

Ritalin (amphetamine derivative)

Used to treat ADHD

62
Q

What are some examples of drugs used in substance dependence? (x4)

A
  • Disulfiram
  • Acamprosate
  • Methadone
  • Naltrexone
63
Q

What is Disulfiram use for?

A

Makes consumers feel physically ill when they consume alcohol - promotes abstinence in people with chronic alcohol abuse

64
Q

What is Acamprosate used for?

A

Decreases craving and withdrawal symptoms, used in combination with psychosocial support

65
Q

What is Methadone used for?.

A

Reduces craving and withdrawal symptoms in heroin abusers

66
Q

What is Naltrexone used for?

A

Blocks the actions of endogenous opioid and peptides released by drugs of abuse

67
Q

Which groups of people require extra care during drug administration?

A

Breastfeeding or pregnant mothers, children and older patients

68
Q

What is the rule for psych drug administration?

A

Give ONLY if it has been established that the benefits of the drug outweigh the risks associated with the drug, monitor closely and stop/review if concerned

69
Q

What is non-adherence?

A

Deviations from recommendations of drug treatment (major issue in the mental health setting)

70
Q

What is adherence?

A

The active involvement in taking medication following diet and/or executing lifestyle changes

71
Q

What are some common reasons for non-adherence?

A
  • Denial of mental illness and stigma
  • Lack of belief in drug efficacy
  • Fear of losing control
  • Concerns about unwanted side effects
  • Personal and cultural beliefs
  • Costs of medications
72
Q

What are some nursing strategies that can be implemented to improve adherence (x4)

A
  • Establish a good relationship and effective reporting system
  • Honestly and explore the client’s view on medication
  • Correct misinformation and share information - evidence for and against
  • Discuss risks and benefits
73
Q

What is ECT (electroconvulsive treatment) used to treat?

A
  • Persistent and severe depression
  • Bipolar disorder
  • Schizophrenia
74
Q

What is ECT?

A

Induction of controlled seizures to give a therapeutic effect, considered safe and should be offered as treatment during all stages of illness

75
Q

What are the mechanisms of actions of ECT? (x4)

A
  • Increase serotonin, has an indirect impact on the levels of endogenous opioids
  • Increase DA - improve Parkinson-like symptoms
  • Upregulation of cAMP - increases BDNF for regulation of neuronal strength, growth and survival, also regulates 5-HT and NA receptor expression
  • Increase GABA transmission and endogenous opioids for the suppression of neuronal excitation

Psychopharm (1 decks)

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