Psychopharmacology Flashcards
Give 4 side effects of 1st gen anti-psychotic use?
Extrapyramidal SE
Postural hypotension
Galactorrhoea
Erectile dysfunction
4 complications of anti-psychotic use?
Neuroleptic malignant syndrome
Acute dystonic reaction
Tardive dyskinesia
Akathisia
3 common side effects with clozapine?
Agranulocytosis (most common)
Constipation
Hypersalivation
4 side effects of 2nd gen anti-psychotic use?
Arrhythmias (QT interval prolongation)
Weight gain
Hyperglycemia
Dyslipidaemia
Which group of patients should anti-psychotics be prescribed with caution in?
Elderly patients
Dementia patients
Patients with Parkinson’s disease
Note: STOPP-START criteria
A 45-year old woman has recently started phenelzine. She is out for lunch with her friend who is a doctor. She asks her friend what she can eat from the menu.
A) Broccoli and stilton soup B) Pickled herring on a bed of salad C) Marmite and sesame toast D) Smoked mackerel pate E) Egg mayonnaise toastie
E) Egg mayonnaise toastie
Phenelzine is MAO-i, and you need to avoid cheese, red meat and wine. These react with MAO-i because of the presence of tyramine –> precipitates hypertensive crisis (headache, tremor, hypertension)
A 29-year-old man is brought to the emergency department at 4 am after a night out. He is unable to give a clear history as his Glasgow coma scale is 12 and he is confused, but on examination you find he is pyrexic (39 °C), and on neurological examination you find he is hyperreflexic, with muscle rigidity, and his pupils are dilated.
A. Cocaine B. Ecstasy C. Heroin D. Marijuana E. Paracetamol
Ecstasy
This is serotonin syndrome
Which antipsychotic has the highest risk of QT interval prolongation?
Haloperidol
Which antipsychotic has the highest risk of hyperglycaemia?
Olanzapine
Which antipsychotic has the lowest risk of tardive dyskinesia?
Clozapine
Name 4 1st gen antipsychotics
Haloperidol Zuclopenthixol Clozapine Chlorpromazine Prochlorperazine
Which antipsychotic is associated with the lowest chance of QT interval prolongation?
Aripiprazole
Which antipsychotic is associated with the lowest chance of weight gain?
Aripiprazole
Which antipsychotic is good to use in the dementia-related mood disturbance in the elderly?
Risperidone
Give 4 side effects of SSRI use
Increased risk of GI bleed Hyponatraemia QT interval prolongation i.e citalopram Loss of libido Increased suicidal ideation (in younger men)
Which SSRI is safe for breast feeding and in patients with previous history of MI?
Sertraline
SSRI co-prescribed with warfarin/heparin, what should you do?
Change to mirtazapine
SSRI co-prescribed with Aspirin, what should you do?
Discontinue or give gastroprotection
MAO-i with cheese/red meat/wine, what is the resulting reaction cause?
Hypertensive crisis due to tyramine in cheese
Which class of antidepressant is most likely to cause a manic switch?
TCAs
Which antidepressant is good for sleep and appetite?
Mirtazapine
Which antipsychotic has the highest risk of weight gain?
Olanzapine/Clozapine
Which class of antidepressant is associated with increased risk of HTN?
SNRI i.e Venlafaxine
What are anti-psychotics not encouraged to be used in the elderly with dementia?
Slightly increased risk of stroke and TIA
