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Yr 5 - Psych > Revision - Psych Drugs > Flashcards

Revision - Psych Drugs Flashcards

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1
Q

When would typical antipsychotics be indicated over atypical in the management of schizophrenia?

A

Particularly when the METABOLIC side effects of second generation (atypical) antipsychotics are likely to be problematic

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2
Q

Give 3 contraindications for 1st line antipsychotics

A

1) Elderly

2) Dementia

3) Parkinson’s

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3
Q

What are elderly patients on typical antipsychotics at a particularly increased risk of?

A

Stroke & VTE

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4
Q

What is an alternative to typical antipsychotics for Parkinson’s patients?

A

Small dose of lorazepam might be alternative in distress

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5
Q

Management of akathisia?

A

Propranolol

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6
Q

What is NMS?

A

A life-threatening idiosyncratic reaction to (often 1st line) antipsychotic drugs (rare).

Can happen after change in dose, treatment commencing or suddenly stopping

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7
Q

What happens in NMS?

A

Ridigity –> muscle breakdown –> rhabomyolysis –> kidney failure

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8
Q

Give some symptoms seen in NMS

A

Fever
Altered mental status
Autonomic dysfunction
Neuromuscular excitability –> hypertonia, hyperreflexia
Confusion
Autonomic dysregulation –> tachycardia, hyperthermia, unstable BP

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9
Q

Management for NMS?

A

1) Stop antipsychotic
2) IV fluids
3) Sodium bicarbonate
4) Codeine
5) Dantrolene (muscle relaxant)
6) Bromocriptine (dopamine agonist)

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10
Q

Management of tardive dyskinesia?

A

Tetrabenazine

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11
Q

Which 1st line antipsychotics particularly causes QT interval prolongation?

A

Haloperidol

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12
Q

In an emergency, what 1st line antipsychotic is typically given?

A

Haloperidol can be given via rapid acting IM injection

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13
Q

What investigations are required 3 MONTHS after starting 1st line antipsychotics?

A

Weight
Lipids

Then annually.

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14
Q

What investigations are required 6 MONTHS after starting 1st line antipsychotics?

A

Fasting blood glucose.

Then annually.

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15
Q

Which 2nd line (atypical) antipsychotic is associated with weight gain and hypercholesterolaemia?

A

Olanzapine

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16
Q

Which 2nd line (atypical) antipsychotic is LEAST likely to help with SLEEP?

A

Risperidone

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17
Q

Which 2nd line (atypical) antipsychotic has the MOST TOLERABLE side effect profile, particularly for prolactin elevation?

A

Aripiprazole

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18
Q

Which class of antipsychotics should be used in schizophrenia where NEGATIVE symptoms are prominent?

A

Atypical

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19
Q

What are 2 major contraindications of clozapine?

A

1) severe heart disease

2) history of neutropenia

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20
Q

Give some drug interactions for 2nd line antipsychotics

A

1) dopamine blocking antiemetics e.g. metoclopramide

2) drugs which prolong the QT interval

3) sedating drugs

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21
Q

Why can carbamazepine (anti-epileptic) not be prescribed with clozapine?

A

Both affect bone marrow function

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22
Q

Symptoms of agranulocytosis?

A

o Myocarditis
o Weight gain
o Excessive salivation – sleep sitting up/towels
o Seizures

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23
Q

How does lithium affect calcium levels?

A

Often mild hypercalcaemia seen (due to hyperparathyroidism)

24
Q

What is dysarthria?

A

Difficulty speaking because the muscles you use for speech are weak.

25
Q

Why is lithium contraindicated in Cardiac disease or Addison’s disease?

A

Causes sodium depletion

26
Q

Which SSRI is licensed in bulimia nervosa?

A

Fluoxetine

27
Q

Which SSRI causes QT prolongation?

A

Citalopram

28
Q

Why should SSRIs NOT be given with monoamine oxidase inhibitors?

A

both increase synaptic serotonin levels so together may precipitate serotonin syndrome

29
Q

Give 4 classes of drugs that SSRIs should not be prescribed with/prescribed with caution with?

A

1) MAOIs, triptans & tramadol –> risk of serotonin syndrome

2) Aspirin or NSAIDs –> risk of GI adverse effects

3) Anticoagulants –> risk of bleeding

4) Drugs that prolong QT interval e.g. antipsychotics

30
Q

How long should SSRI treatment be continued for after the patient feels better?

A

6m

31
Q

How should patients stop SSRIs?

A

Gradual dose reduction over 4 weeks

32
Q

What class of drug are amitriptyline, clomipramine & imipramine?

A

TCAs

33
Q

Which TCA is licensed for OCD?

A

Clomipramine

34
Q

Cardiac effect of TCAs antidepressants blocking a1 receptor?

A

Inhibit smooth muscle contraction –> hypotension

35
Q

What is the side effect caused by tricyclic antidepressants blockage of H1 receptors?

A

Sedation & weight gain

36
Q

What is the side effect caused by tricyclic antidepressants blockage of a1 receptors?

A

Hypotension

37
Q

What are the side effects caused by tricyclic antidepressants blockage of dopamine receptors? Why?

A

o Breast changes –> due to raised prolactin levels

o Sexual dysfunction –> due to raised prolactin levels

o EPSEs (tremors, dyskinesia) –> thought to create a dopaminergic-cholinergic imbalance that leads to development of extrapyramidal symptoms

38
Q

Anticholinergics and IOP?

A

Can increase IOP –> avoid in raised IOP e.g. glaucoma

39
Q

Why should TCAs be used with CAUTION in people with prostatic hypertrophy and/or raised intraocular pressure?

A

May be worsened by antimuscarinic effects

40
Q

Give 3 examples of monoamine oxidase inhibitors (MAOIs)

A

1) Phenelzine

2) Isocarboxazid

3) Moclobemide

41
Q

MOA of MAOIs?

A

Inhibit the enzyme monoamine oxidase –> prevent the breakdown of amine
neurotransmitters:
- 5-HT (serotonin)
- Dopamine
- Noradrenaline

42
Q

How can MOAIs interact with food?

A

‘Tyramine’ reaction

If you take an MAOI and you eat high-tyramine foods, tyramine can quickly reach dangerous levels.

This can cause hypertensive crisis.

43
Q

What class of drug is Mirtazapine?

A

NaSSa

44
Q

Name 2 SNRIs

A

1) Venlafaxine

2) Duloxetine

45
Q

How does venlafaxine affect the QT interval?

A

Prolongs it –> fainting, seizures

46
Q

Why is the efficacy of antiepileptic drugs reduced by antipsychotics?

A

As antipsychotics lower the seizure threshold

47
Q

What is the interaction between carbamazepine and antipsychotics?

A

Carbamazepine DECREASES plasma concentrations of antipsychotics

(is an enzyme inducer)

48
Q

What condition are benzos contraindicated in?

A

Mysathenia gravis

49
Q

Contraindications of AChEIs?

A

1) Use with caution in asthma and COPD (due to increased secretions), and those at risk of developing peptic ulcers

2) Avoid in patients with heart block or sick sinus syndrome, or bradycardia

50
Q

What MMSE score indicates severe dementia?

A

<10

51
Q

Why should AChEIs be used with caution alongside NSAIDs and corticosteroids?

A

Concomitant therapy with NSAIDs and corticosteroids may increase risk of peptic ulceration

52
Q

How long should z drugs be prescribed for?

A

Max 4 weeks

53
Q

What class of drug is used in the management of NMS?

A

Dopamine agonist - bromocriptine

54
Q

Why are SSRIs contraindicated in epilepsy?

A

Cause hyponatraemia (can lead to seizures)

55
Q
A

Yr 5 - Psych (4 decks)

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