Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Yr4: Psychiatry > Psychopharmacology: Mood Stabilisers, Anxiolytics & Others > Flashcards

Psychopharmacology: Mood Stabilisers, Anxiolytics & Others Flashcards

1
Q

State two indications for mood stabilisers

A
  • Bipolar affective disorder
  • Schizoaffective disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

State some examples of mood stablisers

A
  • Lithium
  • Anti-epileptics e.g. sodium valporate, lamotrigine, carbamezapine

*NOTE: gabapentin and topiramate have been found to have beneficial effect in bipolar but not licenses for use and further evidence required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Summarise the acute management of mania or hypomania , considering:

  • What to do if on antidepressant
  • What to do if on an anti-manic medication
  • What to do if not on an anti-manic medication
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why might you use antipsychotics over mood stablisers in acute severe manic episode?

A

Antipsychotics have rapid onset of action compared to mood stabilisers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

State the mechanism of action of lithium

A
  • Some evidence that pts with bipolar have increased intracellular sodium and calcium and lithium can decrease these
  • Modulation of dopamine & serotonin neurotransmitter pathways
  • Decreased activity protein kinase C
  • Decreased turnover arichidonic acid
  • Neuroprotective factors through its effects on NMDA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

State some side effects of lithium highlighting which is most common

*HINT: think GI LITHIUM

A
  • GI disturbance (nausea/vomiting, diarrhoea, GI discomfort)
  • Leucocytosis
  • Impaired renal function
  • Tremor (fine)
  • Thirst
  • Hypothyroidism (which may lead to thyroid enlargement)
  • Hair loss
  • Increased weight & fluid retention
  • Urine increased (secondary to nephrogenic diabetes insipidus)
  • Metallic taste

Also idiopathic intracranial hypertension, hypeparathyroidism and resultant hypercalcaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

State some contraindication to lithium

A
  • Pregnancy & breastfeeing (teratogenic)
  • Untreated hypothyroidismAddison’s disease
  • Brugada syndrome or FH
  • Renal impairment
  • Cardiac disease associated with rhythm disorders.
  • Low sodium levels
  • History of diabetes insipidus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are normal therapeutic levels of lithium?

What are toxic levels?

A

Therapeutic: 0.6mmol/L to 0.8mmol/L (can be up to 1mmol/L)

Toxic: >1.5mmol.L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Discuss what monitoring is required for pts on lithium

A

Before initiation:

  • U&Es: renal func
  • eGFR: renal func
  • TFTs: check hypothyroidism
  • Pregnancy status
  • ECG
  • BMI

Lithium levels should be monitored weekly until therapeutic level stable for 4 weeks. Once stable check every 3 months. Levels must always be taken 12hrs after the dose. If you alter the dose of lithium you should go back to weekly monitoring until stable for 4 weeks. BNF suggest that if lithium levels are stable after a year you can go to monitoring e very 6 months in low risk patients.

Then monitor BMI, U&Es, eGFR, TFTs and calcium every 6 months.

*NOTE: if tests show derangment consider monitoring more often

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is lithium administerd?

A

PO as lithium carbonate

Start at 400mg at night then work up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How long must lithium be given for in order for it to have a clear benefit?

A

At least 18 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Can you give lithium to women of child-bearing age?

A

Do so with caution, must ensure they are on contraceptives and compliant and be informed of risks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What condition can lithium cause if given to mother during pregnancy?

A

Ebstein’s anomoly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What other medications do pts who take lithium need to avoid?

What part of diet do pts on lithium need to keep the same?

A
  • NSAIDs
  • ACE inhibitors
  • Diuretics (particulary thiazides)

*NOTE from lecture: should also keep salt content of diet same (a sudden decrease in sodium intake may result in higher serum lithium levels, while a sudden increase in sodium might prompt your lithium levels to fall.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Explain why a pt taking lithium may present with back pain, constipation & low mood

A

Lithium can cause hyperparathyroidism resulting in hypercalcaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Summary of Do’s and Don’ts for lithium

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

For lithium toxicity, discuss:

  • What can precipitate toxicity (4D’s)
  • Symptoms & signs
  • Management
  • Complications
A
  • Four D’s: dehydration, drugs (ACE inhibitors, NSAIDs, thiazides, loop diuretics), depletion sodium, decreased renal function
  • Symptoms & signs (TOXIC):
    • Tremor coarse
    • Oligiuric renal failure
    • ataXia
    • Increased reflexes
    • Convulsions/coma/consciousness decreased
    • (also diarrhoea, vomiting & tinnitus)
  • Management:
    • Stop lithium
    • Mild-moderate toxicity may respond to volume resuscitation with normal saline (increase excretion of lithium)
    • Haemodialysis may be needed in severe toxicity
    • Benzodiazepines for seizures
    • If severe, renal failre then dialysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

State some indications for sodium valporate

A

Used in combination with lithium for rapid cyclcing bipolar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

State some side effects of sodium valporate

A
20
Q

State 2 contraindications for sodium valporate

A
  • Pregnancy
  • Hepatic dysfunction
21
Q

How is sodium valporate administered?

A

PO

22
Q

Which mood stablisier is least teratogenic?

A

Lamotrigine

23
Q

State some side effects of carbamezapine

A
  • GI disturbance
  • Dermatitis
  • Dizziness
  • Hyponatraemia
24
Q

State some side effects of lamotrigine

*Less important to know

A
  • GI disturbance
  • Rash (including Stevens- Johnsons syndrome)
  • Headahce
  • Tremor
25
Q

What are anxiolytics?

State some medciations that can be used an anxiolytics

A

Drugs used to relieve anxiety

  • Benzodiazepines
  • Antipsychotics
  • Beta-blockers
  • Buspirone
  • Pregabalin
26
Q

What are hypnotics?

A

Drugs used to improve sleep

  • Z drugs: zopiclone, zolpidem etc…
  • Benzodiazepines
  • Low dose amitriptyline
27
Q

State some examples of benzodiazepines indicating which are long-acting and which are short-acting

A
  • Long acting (>24hrs): diazepam, nitrazepam, chlordiazepoxide
  • Short acting (<12hrs): lorazepam, midazolam
28
Q

State 5 potential uses of benzodiazepines

A
  • Insomnia (short term use)
  • Anxiety disorders (including panic & phobic. Short term if anziety is severe)
  • Delerium tremens & alcohol withdrawal (commonly chlordiazepoxide)
  • Acute psychosis (in addition to antipsychotics for sedation)
  • Violent behaviour (can sometimes make worse)
29
Q

Describe the mechanism of action of benzodiazepines

A
  • Bind to GABA receptors and potentiates/enhances the effects of GABA binding
  • Leads to increased chloride conductance into neurones causing hyperpolarisation
  • Decreases likelihood of action potential firing

“Positive allosteric inhibitors”

30
Q

State some side effects of benzodiazepines

A
  • Drowsiness
  • Headache
  • Hypotension
  • Respiratory depression
  • Muscle weakness
  • Confusion (elderly)
  • Ataxia & increased falls risk (elderly)
31
Q

State 2 contraindications for benzodiazepines

A
  • Respiratory depression
  • Severe hepatic impairment
32
Q

What routes can you give benzodiazepines?

A
  • PO (most common)
  • IM
  • IV
  • PR

Latter are used for non-compliance or status epilepticus

33
Q

What dose of lorazepam can you give for anxiety?

A

1-4mg QDS with max of 4mg in 24hrs.

34
Q

State some features of benzodiazepine overdose

A
  • Respiratory depression
  • Ataxia
  • Dysarthria
  • Nystagmus
  • Coma
35
Q

Discuss management of benzodiazepine overdose

A
  • ABCDE
  • IV flumazenil (benzodiazepine antidote)
36
Q

You must always wean someone off benzodiazepines to prevent withdrawal. Benzodiazepine withdrawal syndrome can occur within days (if short acting) or up to 3 weeks later (if long acting); state some symptoms of benzodiazpine withdrawal

A
  • Insomnia
  • Anxiety
  • Loss of appetite
  • Tremor
  • Muscle twitching
  • Sweating
  • Tinnitus
  • Perceptual disturbances
37
Q

Benzodiazpeines shouldn’t be given for more than….?

A

6 weeks

Significant potential for tolerance & dependence

38
Q

Sometimes benzodiazepines can cause paradoxical disinhibition; what is this?

A
  • Usually occurs in low doses
  • People get very agitated and behaviour is disinhibited (as opposed to becoming relaxed)
  • Theory is that the benzo’s are blocking bit of brain that says (in response to their anxiety) ‘calm down and behave responsibly’ so they end up very agitated and behaving irresponsibly
39
Q

When are beta blockers used as an anxiolytic?

A

Reducing somatic symptoms e.g. tachycardia, palpitations, tremor

Usually give propanolol

40
Q

Describe the mechanism of action of pregabalin as an anxiolytic

A
  • Binds to and inhibits voltage gated calcium channels
  • Decreases calcium influx
  • Decreases subsequent calcium-dependent release of neurotransmitters such as glutamate (excitatory)
  • To have an inhibitory effect on CNS

CHECK AS LECTURE SAID DIFFERENT

41
Q

Other than anxiety, state two other conditions for which pregabalin may be used

A
  • Neuropathic pain
  • Epilepsy
42
Q

Can pregabalin be used long term?

A

BNF says short term use (6 weeks)

But many pts use it indefinitely

Less potential for misuse/abuse than benzo (but still potential)

43
Q

State some side effects of pregablin

A
  • Sedation
  • Weight gain
  • Impaired concentration
  • GI (constipation, diarrhoea, abdo distention)
44
Q

How do Z-drugs work?

A

Work like benzodiazepines: bind to GABA receptors and enhance effects of GABA causing increased Cl- conductance, hyperpolarisaiton and decreased likelihood of action potential firing.

45
Q

Sumary of Do’s and Don’ts for anxiolytics

A
46
Q

If SSRI’s are used in OCD doses are much smaller than those used in depresion; true or false?

A

FALSE; doses of SSRIs used in OCD are higher than doses used in depression

Yr4: Psychiatry (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions