Psychopharmacology (medications) Flashcards
What are the five main classes of drugs?
Antipsychotics, antidepressants, Benzodiazepine anxiolytics, Mood stabilisers, and hypnotics
What are antipsychotic medications used for?
Primarily used for schizophrenia, BPAD, emergency sedation, ASD, OCD, PTSD, and MSS.
What are the two types of antipsychotics?
Typical and atypical
What are examples of typical antipsychotics?
- Haloperidol (oral/depo/IM)
- Zuclopenthixol (oral/depo/IM)
- Flupenthixol (depo only)
- Levomepromazine
What are examples of atypical antipsychotics?
- Olanzapine (oral/depo/IM)
- Rideridone/paliperidone (oral/depo)
- Clozapine
- Quetiapine
- Ziprasidone
- Aripiprazole
- Amisulpride
Is typical or atypical more likely to cause extrapyramidal side effects?
Typical is more likely to cause extrapyramidal side effects, however atypical is more likely to cause metabolic side effects.
What are the extrapyramidal side effects?
Parkinsonism, dystonia, akathisia, tardive dyskinesia
What is Neuroleptic malignant syndrome?
a life-threatening neurologic emergency associated with the use of antipsychotic (neuroleptic) agents and characterized by a distinctive clinical syndrome of mental status change, rigidity, fever, and dysautonomia
What are the symptoms of Neuroleptic malignant syndrome?
Fever
Encephalopathy
Vitals (tachycardia, BP changes)
Elevated enzymes (CK, WBCs)
Rigidity
What is Hyperprolactinaemia
Hyperprolactinemia is a condition characterized by excess prolactin, the hormone responsible for milk production in a woman’s breasts.
typical antipsychotics can cause this. It can affect 40% of patients on typical antipsychotics.
What are the signs and symptoms of Hyperprolactinemia?
Galactorrhoea (milk discharge from breasts)
Amenorrhoea
Gynocomastia (breast development in males)
Hypogonadism
Sexual dysfunction (eg impotence)
Decreased fertility
Increased risk of hip fracture
Increased risk of breast cancer
Is Clozapine the most effective antipsyhotic?
Yes
What are the side effects of Clozapine?
constipation/bowel obstruction, myocarditis, cardiomyopathy, sedation, hypersalivation, weight gain, rise lipids/hyperglycaemia, and seizures
What are the significant risks when on Clozapine?
Neutropenia and agranulocytosis, constipation, myocarditis and cardiomyopathy
What are some advantages of a depot antipsychotic?
Compliance, reasonable stability, potentially less risk of relapse, less possibility of overdose.
What are some disadvantages of a depot antipsychotic?
Little empowerment, baring backwards= subservience, side effects not easily reversed by immediate reduction in dose, setting on right dose may take some time, limited flexibility in dosing.
What are the ‘common’ side effects of typical antipsychotics?
Dry mouth, increased salvia, constipation, nausea, blank facial expression, unusual/slowed/uncontrolled body movements.
What are the ‘common’ side effects of atypical antipsychotics?
Increased salvia, constipation, nausea, blank facial expression, unusual/slowed/uncontrolled body movements, increased appetite, weight gain, drop in BP.
What are the ‘common’ side effects of depot antipsychotics?
Rigidity, muscle spasms, tremors and drowsiness.
What are the types of antidepressants?
SSRI’s - selective serotonin reuptake inhibitors.
SNRI - serotonin and noradrenaline reuptake inhibitors
NaSSA - Noradrenergic and specific serotonergic
NDRI - Noradrenaline/dopamine reuptake inhibitors
TCA’s - tricyclic antidepressants
MAOI - mono amine oxidasr inhibitors
Reversible MAOI
What medications are SSRI’s?
citalopram, escitalopram fluoxetine, paroxetine, setraline.
What medications are SNRI?
venlafaxine
What medications are NaSSa?
Mirtazapine
What medications are NDRI?
bupropion
What medications are TCA’s?
amitriptyline, clomipramine, desipramine, dothiepin, doxepin, imipramine, norteiptyline
What medications are MAOI?
phenelzine, tranylcypromine
What medications are Reversible MAOI?
moclobemide
What are ‘common’ side effects of SSRI’s?
dry mouth, loss of appetite, indigestion, nausea, diarrhoa or constipation, dizziness
What are ‘common’ side effects of TCA’s?
Dry mouth, excessive sweating at night, drowsiness, difficulty passing urine, constipation
What are mood stabiliser medications?
Lithium, sodium valproate, and carbamazepine
What are the adverse effects of lithium?
Tremor, hypothyroidism, acne like lesions, psoriasis, pregnancy; ebstein’s anomaly
What are the adverse effects of lithium?
Tremor, hypothyroidism, acne like lesions, psoriasis, pregnancy; ebstein’s anomaly
what is the lithium therapeutic index?
Normal range; o.6 to 1 mmol/L
1.3 to 2.0 mmol/L = slurred speech, unbalanced gait, confusion, irritable, restless, vomiting, muscle twitching, disorientation, cognitive impairment
2.0 to 2.5 mmol/L = frank ataxia, choreiform movements, seizures, coma, renal failure, electrolyte imbalances, dehydration, hypotension
What are the ‘common’ side effects for mood stablisers?
Dry mouth, excessive thirst, changes to heart rate, frequent urination, slurred speech.
Can sodium valproate be used during pregnancy?
Valproate should not be used routinely for woman who may become pregnant. It may;
20-30% of babies are born with foetal abnormalities
50 % of new borns have a developmental delay
If prescribed, ensure adequate contraception.
What are benzodiazepines used for?
Anxiety disorders
Insomnia
Agitation
Alcohol withdrawal
EPSE’s
Pre procedure sedation
Status epilepticus
What are the different types of benzodiazepines and the medications?
Short acting; Triazolam (6h), midazlolam (6-12h), Temazepam (<12h)
Mid acting; Lorazepam (12-24h)
Long acting; Clonazepam (24-36h), Diazepam (36-48h), clobazam (36-40h)
What are adverse effects of benzodiazepines?
Cognitive- sedations, anterograde amnesia, psychomotor slowing, learning impairment, longer term cognitive impairment
Dependence
Withdrawal
Tolerance
