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Year 3 Psych > Psychopharmacology 2 > Flashcards

Psychopharmacology 2 Flashcards

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1
Q

When would you use a mood stabiliser

A

Bipolar disorder
Cyclothymia (sub clinical depression)
Schizioaffective

Lithium, anticonvulsants, antipsychotics

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2
Q

What is lithium

A

Only medication to reduce suicide rates

Effective in long term prophylaxis or long term and manic episodes

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3
Q

What to do before lithium use

A

U&E’s toxic to kidneys, causes small vessel damage, causes thyroid dysfunction so do TFT
Causes Epstein’s abnormality- females of childbearing age this is a problem,don’t give to woman of childbearing age but if you have to get pregnancy test

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4
Q

What is it therapeutic range?

A

Blood level between 0.6-1.2
A steady state is achieved after 5 days, check 12 hours after last dose. Once stabilised check every 3 months and TFT and creatinine every 6 months

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5
Q

What are the side effects of lithium

A

Hypothyroidism/ thyroid abnormalities
Polyuria
GI stress, reduced appetite, nausea and vomiting
Thyroid abnormalities
Non-significant leukocystosis
Polyuria/polydypsia secondary to ADH antagonism
Hair loss, acne
Reduces seizure threshold, cognitive slowing

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6
Q

What is the main side effects of lithium toxicity

A

Quite toxic,

Mild- vomiting, dizziness, ataxia, dizziness, slurred speech, nystagmus

Moderate-2.0-2,5 nausea, vomiting, anorexia, blurred vision, clonic limb movements, convulsions, delirium, syncope

Severe>2.5 generalised convulsions, oliguria and renal failure

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7
Q

What is valproic acid

When do you use it

A

Anticonvulsant
Effective as lithium in mania but not so good in depression

Use in
Rapidcycline patients (females>males)
Co-morbid substance issue
Patients with co-morbid anxiety disorders

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8
Q

What is done before starting valproic acid

How do you monitor an individual on valproic acid

A

LFT, pregnancy test, FBC

Monitoring- steady state achieved after 4-5days, check 12 hours after last dose and repeat CBC and LFT’s
Target 50-125

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9
Q

What are the side effects of valporic acid?

A

Thrombocytopenia and platelet dysfunction

nause vomiting and weight gain

Sedation tremor

Increased risk of neural tube defect due to reduction of folic acid

Hair loss

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10
Q

What is carbamazepine

A

FIRST LINE FOR MANIA

Indicated for rapid cyclers and mixed patients?

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11
Q

What should you do before starting carbamazepine

A

LFT, FBC, ECG
Target 4-12mcg/ml
Steady state achieved after 5 days, check 12 hours after last dose and then repeat CBC and LFT’s
Need to check dose and adjust after a month as this induces its own metabolism

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12
Q

What are the side effects of carbamazepine

A 
Rash most commonly seen
Nausea,vomiting, diarrhea
Sedatoin, dizziness, ataxia, confusion
AV coduction delays
Aplastic anemia and agranulocytosis
Water retention due to vasopressin like which result in hyponatremia
Drug-drug interactions
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13
Q

What are the drug to drug interactions of carbamazepine

A

Do you need to know ? Very extensive

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14
Q

What is lamotrigines side effects?

A

Nausea and vomiting

Sedation, dizziness, ataxia and confusion

Most sever are toxic epidermal necrolysis and Steven Johnson’s syndrome.

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15
Q

What are approved indications for bipolar diesel

A

Consult that table

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16
Q

When use antipsychotics

A

When am individual is in a manic phase,

particularly manic with psychotic symptoms

17
Q

How would you treat a 33y/o female with a singke episode of mania, no previous hsitory of deperssive episoed.No drug or ETOH history and has no medical issues.

She develops mild diarrhoea, does this change you management?

A

Stistically first presentation of mania will do best of lithium

Check pregnancy test, serum creatnine, and TSH before treatment

this is common in early treatment, encourage to drink plenty

18
Q

How would you treat a 27 year old wih 5-6 manic and depressive episodes a year. Struggles with alcohol abuse

His LFT’s increase on treatment What do you do?

A

Depakote due to patient having many cycles (4 or more per year) and because of alcohol abuse

Not unusual for LFT’s to increase adn as long as they do not more than triple then therapy is indicated

19
Q

What are antipsychotics

A

Drugs used to reduce psychosis. For diseases such as

Schizophrenia
Schizoaffective disorder
Bipolar disorder

Used for mood stabilisation and/or when psychotic features are present, psychotic depression, augmenting agent in treatment resistant anxiety disorders

20
Q

What is the mesocortical pathway?

A

Projects from the ventral tegmentum (brain stem) to the cerebral cortex. This pathway is felt to be where the negative symptoms and cognitive disorders arise.

Problem here for psychotic patients is too little dopamine

21
Q

What is the Mesolimbic pathway?

A

Where the positive symptoms come from (hallucinations, delusions and thought disorders) due to too much dopamine.

Projects from the dopaminergic cell bodies in the brain stem to the limbic system. Problem here in a psychotic patient is there is too much dopamine

22
Q

What is the nigrostriatal system?

A

Projects from the dopaminergic cell bodies in the substantia nigra to the basal ganglia. This pathway is involved in movement regulation. Remember that the dopamine suppresses acetylcholine activity.

Dopamine hypoactivity causes parkinsonian movements i.e. rigidity, bradykinesia, tremors, akathisia and dystonia

23
Q

What is the tuberoinfundibular pathway

A

Projects from the hypothalamus to the anterior pituitary. dopamine regulates (inhibits) prolactin release. Blocking dopamine in this pathway will predispose your patient to hyperprolactinemia

(gyeacomastia, galactorrhea, decreased libido. menstrual dysfunction)

24
Q

There are two types of anti psychotics. What is type 1?

A

Typical anti psychotics.

D2 dopamine receptors antagonists
High potency typical antipsychotics bind to the D2 receptor with a high affinity, as a result they have higher risk of extrapyramidal side effects

25
Q

What about low potency typical antipsychotics ?

A

They have less affinity for the D2 receptors but tend to interact with nondopaminergic receptors resulting in more cardiotoxic and anticholinergic adverse effects including sedation and hypotension

examples include chlorpromazine and thioridazine

26
Q

What are some examples of typical antipsychotics?

A

Fluphenazine, Haloperidol, Pimozide

27
Q

What are atypical antipsychotics

A

They are serotonin- dopamine 2 antagonists. They are considered atypical as they affect dopamine and serotonin neurotransmission in the four key dopamine pathways in the brain

28
Q

Discuss resperidone

A

An atypical antipsychotics used regularly

Rapidly dissolving tablets or IM injection
Functions more like a typical antipsychotics
Increased extrapyramidal side effects
Most likely atypical to induce hyperprolactinemia

29
Q

Discuss olanzapine

A

Regularly used atypical antipsychotic

Tablet or IM injection
Works slightly quicker than others 
Causes weight gain (30-50lbs)
May cause hypertriglyceridmeia, hypercholesterolemia, hyperglycemia
May cause hyperprolactinemia (
30
Q

Discuss quetiapine

A

Available in regular tablet form only

May cause abnormal LFT’s (6%) of all aptients
May be associated with weight gain, though less eevre than olanzapine
May cause hypertriglyceridmeia, hypercholesterolemia, hyperglycemia (less than seen with olanzapine)

31
Q

Discuss aripiprazole

A

Available in regular tabs, immediate release IM formulation and depo form.

Unique mechanism of action as a D2 partial agonist

Low EPS no QT prolongation, low sedation

Interacts with fluoxetine and paroxetine, carbamezapine and ketoconazole

Not associated with weight gain

32
Q

What to know for exams (antipsychotics)

A

Antipsychotics- atypical - new type

Typical- old type

Side effects-

33
Q

How do you pick your antipsychotic

A

Side effects

34
Q

What drug do you use for treatment resistant psychosis

A

Treatment resistance- tried 2 drugs and not worked

Clozapine

Available in an oral form

35
Q

What are the side effects of clozapine:

A

Agranulocytosis- need blood tests every week for 6 months and then 2 weeks for the next 6 months

Increased risk of seizures (especially if lithium is also on board)

Associated with the most sedation, weight gain and abnormal LFT’s

May cause hypertriglyceridmeia, hypercholesterolemia, hyperglycemia

36
Q

What is clozapine doesn’t work?

A

Add another antipsychotic to clozapine

Add lithium/anticonvulsant

ECT

Year 3 Psych (33 decks)

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