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Psychiatry > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

What is the first line antidepressant type?

A

Selective Serotonin Reuptake Inhibitor (SSRI) e.g. fluoxetine, sertraline, citalopram

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2
Q

Which SSRI will be best to offer if you are worried about poor compliance?

A

Fluoxetine - longest half life, have to take fewer pills per day

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3
Q

Which SSRI is a good choice if a patient has hepatic or renal impairment?

A

Citalopram - but beware QT prolongation

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4
Q

What are some common side effects with SSRIs?

A

N+V, insomnia, sexual dysfunction (anorgasmia), headache, loss of apetite, diarrhoea, restlessness.

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5
Q

What are some rarer but important side effects with SSRIs?

A

Thoughts of harming self (increased risk of suicide in initial phase of treatment), hyponatraemia, serotonin syndrome, GI bleeds.

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6
Q

When is the best time to take SSRIs?

A

In the morning as they can make it harder to fall asleep

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7
Q

How long does it take before antidepressants have their effects on raising mood?

A

4-6 weeks, so wait this long before deeming ineffective

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8
Q

How long should a patient be on antidepressants for?

A

For 6-9 months following recovery.

If multiple episodes of depression, they should be on it for 2 years

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9
Q

What potentially beneficial side effects does mirtazapine have?

A

Sedation and appetite stimulant (weight gain)

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10
Q

Which less commonly used antidepressant drug class is most dangerous in overdose?

A

Tricyclic antidepressants

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11
Q

What additional tests may someone starting on venlafaxine need?

A

ECG - can prolong QT interval

BP - can cause hypotension

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12
Q

Which SSRI is thought to be safest for breastfeeding women?

A

Sertraline

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13
Q

How long is the onset of action of the tranquilizing effect, side effects, and anti-psychotic effects of antipyschotic drugs?

A

Tranquilizing effect: hours
Side effects: hours to days
Anti-psychotic effect: days to weeks

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14
Q

What is the primary mode of action of antipsychotics?

A

Dopamine receptor antagonists - particularly D2

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15
Q

What tests are required before starting someone on an antipsychotic?

A

Bloods - FBC, U+Es, LFTs, HbA1c, glucose, prolactin, lipids, cholesterol
Physical - ECG, weight, blood pressure, HR. (Some APs are prone to QTc prolongation

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16
Q

Which side effects are more common with first generation antipsychotics?

A

Extrapyramidal side effects such as (acute) dystonia, akithesia, tardive dyskinesia, parkinsonism. Also get hyperprolactinaemia causing sexual dysfunction, gynaecomastia, galactorrhoea, amenorrhoea.

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17
Q

How may acute dystonia present?

A

Torticollis
Occulogyric crisis
Opisthotonus

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18
Q

What medication can help to reduce symptoms of dystonia and akithesia following Antipsychotic therapy?

A

Procyclidine

19
Q

Which side effects are more common with second generation antipsychotics?

A

Metabolic side effects such as weight gain, hyperglycaemia, dyslipidaemia

20
Q

What side effects of both generations of antipsychotics should you be aware of?

A

Lowered seizure threshold, QTc prolongation.

21
Q

What is, generally, considered the first line antipsychotic?

A

Olanzapine

22
Q

Which side effect is common with olanzapine that may make it intolerable?

A

Weight gain

23
Q

Which anitpsychotic is thought to have the least effect on weight changes and is therefore preferential for some patients?

A

Aripiprazole

24
Q

When should a patient be considered for clozapine (a more effective antipsychotic therapy)?

A

After no response to full trials of 2+ other antipsychotics.

25
Q

What risk is there to the fetus if the mother is taking risperidone during pregnancy?

A

Slightly elevated risk of congenital heart defects

26
Q

What risk is there to the fetus if the mother is taking an SSRI (particularly paroxetine) during pregnancy?

A

Slightly elevated risk of persistent pulmonary hypertension of the newborn

27
Q

What risk is there to the fetus if the mother is taking Lithium during pregnancy?

A

Teratogenic: Risk of Ebstein’s anomaly (abnormal tricuspid valve) and other, more minor heart defects

28
Q

What are some important side effects of clozapine?

A

AGRANULOCYTOSIS, myocarditis, weight gain, hypersalivation, seizures, sleepiness

29
Q

How often should a patient on clozapine have blood tests?

A

Weekly FBCs for first 18 weeks to check for agranulocytosis then fortnighlty up to 1 year then monthly

30
Q

What are the features of neuroleptic malignant syndrome?

A

Fever, sweating, confusion, racing heart beat, muscle stiffness, difficulty moving

31
Q

What is the therapeutic window for lithium?

A

Narrow at 0.4-1.0

32
Q

How is lithium excreted?

A

Via the kidneys, and is therefore dependent on renal function, fluid intake and sodium intake

33
Q

When should blood lithium levels be monitored?

A

12 hours after the last dose

34
Q

What baseline investigations should a patient have before starting lithium?

A

Physical exam and weight.
Bloods: U+Es, TFTs, Calcium, eGFR
ECG
Pregnancy test (if a woman of childbearing age)

35
Q

How frequent is the monitoring of a patient on lithium?

A 
Monitor blood Lithium levels every 3 months once a steady dose has been achieved.
U+Es every 3 months
TFTs every 6 months
Calcium and creatinine every 12 months
Regular weight and ECG monitoring
36
Q

What are some early side effects of lithium?

A

Fine tremor, metallic taste, N+V, dry mouth, polyuria, polydipsia

37
Q

What are some late side effects of lithium?

A

Hypothyroidism, weight gain, diabetes insipidus, ataxia, arrhythmias, dysarthria

38
Q

At what level will lithium be toxic?

A

When blood levels reach >= 1.5 mmol/L

39
Q

What are the signs and symptoms of lithium toxicity?

A

Early: Blurred vision, anorexia, N+V, diarrhoea, coarse tremor, ataxia, dysarthria
Late: Confusion, renal failure, delirium, fits, coma, death

40
Q

What may precipitate lithium toxicity?

A

Concurrent use of nephrotoxic drugs (esp. thiazide diuretics, NSAIDs, ACE-is), renal failure, dehydration, UTI.

41
Q

How is lithium toxicity managed?

A

Medical emergency.

Stop lithium. Aggressive fluid therapy and consider dialysis. Treat underlying cause.

42
Q

What are some important side effects of valproate?

A

Gastric irritation, dose-related tremor, thrombocytopenia, hair loss with curly regrowth

43
Q

Which antipsychotic is most likely to reduce seizure threshold?

A

Clozapine

Psychiatry (11 decks)

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