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Year 3 Exams: Psychiatry > Psychopharmacy > Flashcards

Psychopharmacy Flashcards

1
Q

Indications for Antidepressants? (7)

A

Unipolar and Bipolar Depression

Organic Mood Disorders

Schzioaffective Disorder

Anxiety Disorder

PTSD

Phobia

Premenstrual Dysphoric Disorder

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2
Q

What is the delay after therapeutic dose of antidepressants has been reached?

A

2-4 Weeks

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3
Q

How long should you give antidepressants to work?

A

2 Months at least

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4
Q

Tricyclics Side Effects (5)

A

Antihistaminic

Anticholinergic

Antiadrenergic

Lethal in Overdose

Can cause QT Lengthening

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5
Q

Name 4 Tertiary TCA’s?

A

Impiramine

Amitryptyline

Doxepin

Clomipramine

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6
Q

Name 2 Secondary TCA’s?

A

Desipramine and Notriptyline

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7
Q

What do Secondary TCA’s do?

A

Primarily block noradrenaline

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8
Q

Side Effects of Secondary TCA’s?

A

Antihistaminic

Anticholinergic

Antiadrenergic

Lethal in Overdose

Can cause QT Lengthening

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9
Q

Action of Monoamine Oxidase Inhibitors?

A

Bind to monoamine oxidase thereby preventing inactivation of amines such as Norepinephrine, Dopamine and Serotonin = Increased Synaptic Levels

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10
Q

Monoamine Oxidase Inhibitors are very effective for?

A

Resistant Depression

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11
Q

Monoamine Oxidase Inhibitors Side Effects? (5)

A
  1. Orthostatic Hypotension
  2. Weight Gain
  3. Sedation
  4. Sexual Dysfunction
  5. Sleep Disturbance
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12
Q

Hypertensive Crisis can develop with what psychiatric medication?

A

MAOI’s taken with Tyramine Rich Foods or Sympathomimetics

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13
Q

MAOI’s taken with what can cause Hypertensive Crisis?

A

Tyramine Rich Foods or Sympathomimetics

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14
Q

Serotonin Syndrome can develop if take MAOI with?

A

Meds that contain Serotonin or have Sympathomimetic Actions

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15
Q

Serotonin Syndrome Symptoms? (6)

A 
Abdo Pain
Diarrhoea
Sweats
Tachycardia
Myoclonus
Irritability Delirium
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16
Q

Serotonin Syndrome can lead to? (3)

A

Hyppyrexia
Cardiovascular Shock
Death

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17
Q

How to avoid Serotonin Syndrome? (2)

A

Wait 2 weeks before switching from SSRI to MAOI

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18
Q

How long to wait from switching from Fluoxetine to MAOI?

A

5 Weeks

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19
Q

What do selective serotonin reuptake inhibitors (SSRIs) do?

A

Block presynaptic serotonin reuptake

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20
Q

What do SSRI’s treat?

A

Treat Anxiety and Depressive Symptoms

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21
Q

Side Effects of SSRI’s? (6)

A 
GI Upset
Sexual Dysfunction
Anxiety
Insomnia
Fatigue
Dizzy
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22
Q

Activation Syndrome is caused by?

A

Increased Serotonin

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23
Q

Symptoms of Activation Syndrome (4)

A

Nausea
Increased Anxiety
Panic
Agitation

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24
Q

Length of Activation syndrome

A

2-10 Days

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25
Q

Symptoms of Discontinuation Syndrome? (4)

A

Agitation
Nausea
Disequilibrium
Dysphoria

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26
Q

If a patient gets discontinuation syndrome what should you consider switching to?

A

Fluoxetine

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27
Q

Sertraline Pros? (4)

A

Very Weak P450 Interactions
Short Half Life
Lower Build up of Metabolites
Less Sedating when Compared to Paroxietine

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28
Q

Sertraline Cons? (2)

A

Max Absorption requires full stomach

Increases number of GI adverse drug reactions

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29
Q

Fluoxetine is also known as?

A

Prozac

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30
Q

Fluoxetine Pros? (3)

A

Long Half Life

Good for Patients with Medication Noncompliance Issues

May provide Increased Energy

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31
Q

How to taper someone off SSRI when trying to prevent SSRI Discontinuation Syndrome?

A

Give 20mg Fluoxetine

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32
Q

Cons of Fluoxetine

A

Active Metabolite may build up

Significant P450 Interactions

Initial activation = Anxiety and Insomnia

Can Induce Mania

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33
Q

Fluoxetine is not a good choice in what type of Gi patient?

A

Hepatic illness

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34
Q

SNRI Action?

A

Inhibit both serotonin and noraadrenergic reuptake but without the bad side effects

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35
Q

SNRI uses? (3)

A

Depression
Anxiety
Neuropathic

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36
Q

Venlafaxine is a type of what drug?

A

SNRI

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37
Q

Duloxetine is a type of what drug?

A

SNRI

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38
Q

Venlafaxine Pros?

A

Minimal Interactions

Almost no P450 Activity

Short Half Life

Fast Renal Clearance

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39
Q

Venlafaxine is good for what population?

A

Geriatrics

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40
Q

Cons of Venlafaxine? (5)

A

Can cause 10-15mmHg dose Dependent increase in a diastolic BP

May Cause significant nausea

Can cause Discontinuation Syndrome

QT Prolongation

Sexual Side Effects

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41
Q

Venlafaxine can cause what increase in bp?

A

10-15mmHg dose dependent diastolic bp

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42
Q

Venlafaxine can cause what syndrome?

A

Discontinuation

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43
Q

Duloxetine cons? (3)

A

CYP2DS and CYPA1A Inhibitor

Cannot break capsule as active ingredient not stable within stomach

Higher drop out rate

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44
Q

What types of SSRI are least sedating?

A

Citalopram

Fluxoetine

Sertraline

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45
Q

What psychiatric tablets are sedative/weight gain

A

Paroxetine

Mirtazepine

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46
Q

Novel Antidepressants Pros? (2)

A

5HT2 and 5HT3 Receptor Antagonist

Can be used as Hypnotic at Lower Dose

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47
Q

Novel Antidepressants Cons (2)

A

Increased Serum Cholesterol by 20% and Triglycerides in 6%

Very Sedating at Lower Doses

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48
Q

Novel Antidepressants: At what dose can become activating and needing change of admin time?

A

30mg +

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49
Q

Novel Antidepressants at doses below 45mg are associated with?

A

Weight Gain

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50
Q

Indications for Mood Stabilisers (3)

A

Bipolar
Cyclothymia
Schizoaffective

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51
Q

Three Classes of Mood Stabilisers?

A

Lithium
Anticonvulsants
Antipsychotics

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52
Q

Which medication is the only medication to reduce suicide rate?

A

Lithium

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53
Q

Rate of Completed Suicide in BAD is?

A

15%

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54
Q

Lithium is effective in long term prophylaxis of?

A

Mania and Depressive Episodes in 70% of BAD

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55
Q

Factors that predict positive response to lithium? (3)

A

Prior Long Term Response or Family Member with Good Response

Pure Mania

Mania followed by Depression

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56
Q

Before starting Lithium bloods to do (3)

A

Baseline U+E
TSH
Pregnancy Test

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57
Q

Pregnancy and Lithium are associated with what anomaly?

A

Ebstein’s

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58
Q

Ebstein’s is associated with what risk in first trimester with lithium use?

A

20x greater risk

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59
Q

Steady State is achieved after how many days with lithium use?

A

5 Days

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60
Q

Check steady state how many hours after last dose?

A

12

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61
Q

How to check steady state, TSH and creatinine long term into lithium use?

A

Steady State 3 Months

TSH and Creatinine 6 months

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62
Q

Goal blood level with lithium?

A

0.6 and 1.2

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63
Q

Side Effects of Lithium use? (7)

A 
GI Distress
Thyroid Abnormalities
Nonsignificant Leukocytosis
Polyuria/Polydyspia
Interstitial Renal Fibrosis
Hair Loss
Reduces Seizure Threshold
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64
Q

More common side effects of lithium?

A

GI Distress

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65
Q

Polyuria/Polydypsia as a side effect to lithium can be caused secondary to what?

A

ADH Antagonism

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66
Q

Lithium use can cause?

A

Interstitial Renal Fibrosis

67
Q

Mild Lithium Toxicity levels are?

68
Q

Moderate Lithium Toxicity levels are?

A

2.0 to 2.5

69
Q

What happens to patients limbs in moderate lithium toxicity?

A

Clonic Limb Movements

70
Q

Severe Lithium Toxicity Levels are?

71
Q

Oliguria and Renal Failure can present in what level of Lithium Toxicity?

72
Q

Valproic Acid is what type of psychiatric drug?

A

Anticonvulsant

73
Q

Name a type of valproic acid?

74
Q

Valproic acid Depakote is useful in?

A

Mania Prophylaxis

75
Q

Factors predicting positive response in Valproic Acid (Depakote)? (3)

A

Rapid Cycling Patients (Females)

Substance Issues

Patients with Comorbid Anxiety Disorders

76
Q

Valproic Acid (Depakote) is better tolerated than what?

77
Q

Tests to do before starting Valproic Acid (Depakote)?

A

Baseline Liver Function Tests

Pregnancy Test

FBC

78
Q

Avoid Valproic Acid in what patients?

A

Child bearing age

79
Q

Valproic Acid can cause?

A

Neural Tube Defects

80
Q

Steady State for Valproic Acid can be achieved after?

81
Q

Check Valproic Acid Steady state how long after last dose?

82
Q

How to monitor steady state of Valproic Acid?

A

Repeat CBC and LFT

83
Q

Goal of Valproic Acid Steady State?

A

Target Level 50-125

84
Q

Side Effects of Valproic Acid? (8)

A 
Thrombocytopenia
Platelet Dysfunction
GI Upset
Weight Gain
Sedation
Tremor
Increased Risk of Neural Tube Defects
Hair Loss
85
Q

Carbamazepine is also called?

86
Q

First line agent for acute mania and mania prophylaxis?

A

Carbamazepine (Tegretol)

87
Q

Tests to do before starting Carbamazepine (Tegretol) (3)

A

Baseline Liver Function Tests

FBC

ECG

88
Q

How to check steady state for Carbamazepine (Tegretol)

A

Check after 5 Days

89
Q

When to check steady state after last dose of Carbamazepine (Tegretol)

90
Q

What tests should be repeated after last dose of Carbamazepine (Tegretol)

A

CBC and LFT

91
Q

Goal for Steady State level for Carbamazepine (Tegretol)?

A

4-12 mcg/ml

92
Q

When to check level and adjust dosing with Carbamazepine (Tegretol)?

93
Q

Why to check Carbamazepine (Tegretol) levels and adjust dosing after a month?

A

It induces own metabolism

94
Q

Tests to do before starting Carbamazepine (Tegretol)? (3)

A

Baseline Liver Function, FBC, ECG

95
Q

Steady State for Carbamazepine (Tegretol) is achieved when?

A

12 hours after last dose

96
Q

Which tests to repeat for Carbamazepine (Tegretol) after last dose?

A

Repeat CBC and LFTs

97
Q

Target Level for Carbamazepine (Tegretol)?

A

4-12mcg/ml

98
Q

Most Common side effect for Carbamazepine (Tegretol)?

99
Q

Side Effects for Carbamazepine (Tegretol) (7)

A 
Rash
GI
Sedation/Dizzy/Ataxia
Av Conduction Delays
Aplastic Anaemia and Agranulocytosis 
Hyponatraemia
100
Q

What blood disorders can be caused by Carbamazepine (Tegretol)

A

Aplastic Anaemia and Agranulocytosis

101
Q

What cardiovascular complication can be caused by Carbamazepine (Tegretol)

A

AV Conduction Delays

102
Q

What psychiatric tablet can cause Hyponatraemia?

A

Carbamazepine (Tegretol)

103
Q

Lamotrigine is also known as?

104
Q

Lamotrigine (Lamictal) is indicated for?

A

Neuropathic/Chronic Pain

105
Q

What test before starting Lamotrigine (Lamictal)?

A

Baseline Liver Function test

106
Q

What dose to start Lamotrigine (Lamictal) at?

A

25mg Daily for 2 Weeks

107
Q

Faster titration of Lamotrigine (Lamictal) has higher incidence of what side effect?

A

Serious Rash

108
Q

If a patient stops Lamotrigine (Lamictal) for 5+ days then re-start at what dose?

A

25mg Daily

109
Q

Side Effects of Lamotrigine (Lamictal)? (6)

A 
GI Symptoms
Sedation/Dizzy
Ataxia/Confusion
Toxic Epidermal Necrolysis and Steven Johnson syndrome
Blood Dyscrasis
110
Q

What serious dermatological side effects can Lamotrigine (Lamictal) cause?

A

Toxic Epidermal Necrolysis and Steven Johnson syndrome

111
Q

What serious blood side effects can Lamotrigine (Lamictal) cause?

A

Blood Dyscrasias

112
Q

Which drugs can increase Lamotrigine (Lamictal) levels?

A

VPA

Sertraline

113
Q

Which drug can double concentration of Lamotrigine (Lamictal)

114
Q

Which four pathways are affected by Dopamine in brain?

A

Nigrostriatal
Mesolimbic
Mesocortical
Tuberoinfundibular

115
Q

Mesocortical Dopamine Pathway projects from and to?

A

Ventral Tegmentum (Brain Stem) to Cerebral Cortex

116
Q

Mesocortical Dopamine Pathway is where what happens?

A

Neg Symptoms and Cognitive Disorders (Lack of executive function) arise

117
Q

Lack of executive function arises in what dopamine pathway?

A

Mesocortical

118
Q

What problem is present in Mesocortical Dopamine pathway for patients?

A

Too Little Dopamine

119
Q

Mesolimbic Dopamine Pathway projects from and to?

A

Dopaminergic cell bodies in ventral tegmentum to limbic system

120
Q

Mesolimbic Dopamine Pathway is where what happens?

A

Positive Symptoms come from hallucinations, delusions and thought disorders

121
Q

What problem is present in Mesolimbic Dopamine Pathway

A

Too much dopamine

122
Q

Nigrostriatal Dopamine pathway projects from?

A

Dopaminergic cell bodies in substantia nigra to basal ganglia.

123
Q

Which dopamine pathway is involved in movement regulation?

A

Nigrostriatal Dopamine pathway

124
Q

Dopamine suppresses what?

A

Acetylcholine activity

125
Q

Dopamine hyperactivity can cause what?

A

Parkinsonian movements eg Rigidity, Bradykinesia, Tremors, Akathisia and Dystonia

126
Q

Tuberoinfundibular Dopamine pathway projects from

A

Hypothalamus to Anterior Pituitary

127
Q

Dopamine release inhibits/regulates what release?

128
Q

Blocking dopamine in Tuberoinfundibular dopamine pathway will predispose patient to?

A

Hyperprolactinaemia (Gynaecomastia, Galactorrhoea, Decreased Libido and Menstrual dysfunction)

129
Q

What do typical antipsychotics do?

A

D2 Dopamine Receptor Antagonists

130
Q

Typical antipsychotics can cause? (3)

A

Dyslipidaemia
Abnormal LFT
Elevated BP

131
Q

Monitoring tests needed for putting a patient on Atypical Antipsychotics? (3)

A

Fasting Lipids
Fasting Blood Sugar
LFT and CBC

132
Q

Risperidone (Risperdal) functions at doses greater than?

133
Q

Which antipsychotic drug is most likely atypical to induce hyperprolactinaemia?

A

Risperidone (Risperdal)

134
Q

Side Effects of Risperidone (Risperdal) (3)

A

Hyperprolactinaemia
Weight Gain and Sedation
Akathisia

135
Q

What is Akathisia?

A

Feels uncomfortable in skin like can’t sit still

136
Q

Akathisia is associated with what high risk thing in psychiatry?

137
Q

Olanzapine (Zyprexa) is what type of drug?

A

Antipsychotic

138
Q

Olanzapine (Zyprexa) side effects? (6)

A 
Weight Gain
Hypertriglyceridemia
Hypercholesterolemia
Hyperglycemia 
Hyperprolactinamia 
Abnormal LFT's
139
Q

How much weight can be gained from Olanzapine (Zyprexa)?

140
Q

Quetiapine (Seroquel) is available in what form?

A

Regular tablet only

141
Q

Quetiapine (Seroquel) side effects? (6)

A 
Abnormal LFT
Weight Gain
Hypertriglyceridemia
Hypercholesterolemia
Hyperglycemia
Orthostatic Hypotension
142
Q

Quetiapine (Seroquel) is most likely to cause what type of side effect?

A

Orthostatic Hypotension

143
Q

What does Aripiprazole (Abilify) do?

A

D2 Partial Agonist

144
Q

Clozapine (clozaril) is used for?

A

Treatment resistant patients

145
Q

Clozapine (clozaril) side effects (6)

A 
Agranulocytosis
Seizures
Hypertriglyceridemia
Hypercholesterolemia
Hyperglycemia
Non Ketoic Hypersmolar Coma and Death
146
Q

Non Ketoic Hypersmolar Coma and Death is a side effect for what antipsychotic

A

Clozapine (clozaril)

147
Q

What blood side effect can Clozapine (clozaril) cause?

A

Agranulocytosis

148
Q

Most common psychotic symptom?

A

Lack of insight

149
Q

People with psychotic illnesses relapse most commonly due to?

A

Non Compliance

150
Q

What is Tardive Dyskinesia?

A

Involuntary Muscle Movements

151
Q

Tardive Dyskinesia is an adverse effect of what?

A

Antipsychotic

152
Q

Neuroleptic Malignant Syndrome is an adverse effect of what psychiatric drug?

A

Neuroleptic Malignant Syndrome

153
Q

Neuroleptic Malignant Syndrome symptoms? (4)

A

Severe Muscle Rigidity
Fever
Altered Mental Status
Autonomous Instability

154
Q

Neuroleptic Malignant Syndrome Tests will show? (3)

A

Elevated WBC, CPK and LFT

155
Q

Extrapyramidal Side effects (3) for Antispsychotics?

A

Acute Dystonia
Parkinsons
Akathisia

156
Q

Anxiolytics are used to treat? (6)

A 
Panic Disorder
GAD
Substance Related Disorder
Withdrawal
Insomnia
Parasomnia
157
Q

Anxiolytics can be used in combination with what in Anxiety Disorders?

A

SSRI or SNRI

158
Q

Buspirone (Buspar) pros?

A

Good Augmentation strategy

159
Q

Buspirone (Buspar) action?

A

5HT1A Agonist

160
Q

How long does Buspirone (Buspar) take to work?

A

2 Weeks before patients notice results

161
Q

Buspirone (Buspar) and Bzodiazapine are what?

A

Anxiolytics

162
Q

Benzodiazapines are used to treat? (3)

A

Insomnia
Parasomnias
Anxiety Disorders

163
Q

Side Effects of Benzodiazapines? (6)

A 
Somnolence
Cognitive Deficits
Amnesia
Disinhibition
Tolerance
Dependence

Year 3 Exams: Psychiatry (29 decks)

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