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Y4 Psychiatry > Therapeutics > Flashcards

Therapeutics Flashcards

1
Q

What is ECT ?

A

Electroconvulsive therapy is a treatment for severe depression where a small dose of electric current is used to induce seizures

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2
Q

What is the regimen of ECT ?

A

Administered twice weekly for up to 12 treatments

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3
Q

What type of pulse is given for optimal results in ECT ?

A

Brief pulse

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4
Q

What are the indications for ECT ?

A

Depression
Mania
Catatonia

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5
Q

What are some contra-indications for ECT ?

A

Raised intra-cranial pressure, cerebral aneurysm, recent cerebrovascular event
MI within 3 months
Unstable angina
DVT
Acute resp distress
Cochlear implant
Pregnancy
Uncontrolled epilepsy

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6
Q

What are some size effects of ECT ?

A

Confusion
Headache
Status epilepticus
Stroke
Bleeding from ulcers
Broken teeth
Memory loss

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7
Q

What are some side effects from the anaesthesia used in ECT ?

A

MI
Arrhythmia
Aspiration pneumonia
Nausea
Malignant hyperthermia

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8
Q

What are the physiological changes that occur from ECT ?

A

EEG changes
Cerebral blood flow increases
Blood brain barrier may be breached
Hormonal changes - TSH, ACTH, growth hormone and prolactin

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9
Q

What is needed for consent for ECT in someone lacks capacity ?

A

Second opinion approved doctor and complete T6
If emergency complete a C6

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10
Q

What monitoring is needed for ECT ?

A

Pre ECT physical health check
Consent
Medication
Monitoring side effects
Hamilton depression rating scale

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11
Q

What are some common adrenergic / noradrenergic receptor effects ?

A

Sweating
Tremor
Headaches
Nausea
Dizziness

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12
Q

What are some common Muscarinic receptor effects ?

A

Dry mouth , difficulty swallowing, thirst
Difficulty urinating
Urinary retention
Hot and flushed skin
Dry skin

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13
Q

How do most antidepressants work ?

A

Work on serotonin activity and the aim is to increase activity at post synaptic receptors

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14
Q

How long do most antidepressants take to work ?

A

2 - 3 weeks

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15
Q

How do SSRI’s work ?

A

Increase serotonin activity by reducing the presynaptic reuptake of serotonin after release. Therefore more serotonin sits in the synapse. This leads to a down regulation of post-synaptic receptors.

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16
Q

What are some common side effects of SSRI’s ?

A

Restlessness
Nausea
Headache
Weight changes
Sexual dysfunction

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17
Q

What are some examples of SSRI’s ?

A

Sertraline
Citalopram
Fluoxetine
Paroxetine

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18
Q

What are some risks for citalopram ?

A

Prolongs QTc

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19
Q

How do SNRI’s work ?

A

Act in the same way as SSRI’s nut bind to noradrenaline reuptake receptors as well

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20
Q

What are some side effects of SNRI’s ?

A

Sedation
Nausea
Sexual dysfunction

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21
Q

What are some SNRI’s ?

A

Duloxetine
Venlafaxine

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22
Q

When does venlafaxine need to started with caution ?

A

In heart disease - monitor BP at doses above 225mgs

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23
Q

What does mirtazapine act on ?

A

Acts as a 5HT-2 and 5HT-3 antagonist
Strong histamine 1 activity

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24
Q

What are the major side effects on mirtazapine ?

A

Sedation
Weight gain

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25
Q

What are some types of tricyclic antidepressants ?

A

Lofepramine
Nortiptyline
Amitriptyline

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26
Q

What are some side effects of tricyclic antidepressants ?

A

Muscarinic and histaminic side effects

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27
Q

Why do tricyclic antidepressants need close observation ?

A

Causes QTc prolongation and arrhythmias

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28
Q

What are MAOI’s ?

A

Monoamine oxidase inhibitors work on serotonin (A) or dopamine ( B ).

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29
Q

What is discontinuation syndrome ?

A

Antidepressants aren’t addictive but they can be difficult to stop as they cause sweating, shaking, agitation, insomnia.
Very unpleasant
Shorter the half life the bigger the problem

30
Q

What are some signs and symptoms of serotonin syndrome ?

A

Headaches
Agitation
Hypomania
Shivering
Sweating
Hyperthermia
Tachycardia
Nausea
Hyper-reflexia

31
Q

How do most antipsychotics work ?

A

Reduce level of dopamine activity at D2 receptors
Target dopaminergic pathways in the brain - mesocorticol and mesolimbic

32
Q

What are some examples of typical antipsychotics ?

A

Haloperidol
Flupenthixol
Zuclopenthixol

33
Q

What are some examples of atypical antipsychotics ?

A

Clozapine
Olanzapine
Risperidone

34
Q

What are some side effects of antipsychotics ?

A

Sedation
Weight gain
QTc prolongation
Typical - bradykinesia, muscle stiffness, tremor, tardive dyskinesia, dizziness, sexual dysfunction
Atypical - weight gain, DM

35
Q

What monitoring is required when starting antipsychotics ?

A

Baseline - FBC, lipids, HbA1c, weight ECG BP
Weekly - weight
3 monthly - FBC, lipids, LFT, HbA1c, ECG BP

36
Q

What is neuroleptic malignant syndrome ?

A

Rare, life-threatening reaction to antipsychotics

37
Q

What are some features of neuroleptic malignant syndrome ?

A

Fever
Confusion
Muscle rigidity
Sweating
Rhabdomyolysis
Renal failure
Seizures

38
Q

What is the treatment for neuroleptic malignant syndrome ?

A

Emergency referral to ED
Stop antipsychotics
Give benzodiazepines
Fluid resus
Cooling blankets
O2 if necessary
Dantrolene to relax muscles

39
Q

What does clozapine work on ?

A

D2 and 5HT-2 antagonist

40
Q

What are some side effects of clozapine ?

A

Constipation - fatal bowel obstruction
Agranulocytosis
Hypersalivation
Urinary incontinence

41
Q

What are some examples of anxiolytics ?

A

Beta blockers
Benzodiazepines
Pregabalin
Antidepressants

42
Q

How do beta blockers reduce anxiety ?

A

They act by reducing autonomic nervous system activation
Bio-psycho-feedback

43
Q

When are beta blockers contra-indicated ?

A

Asthma

44
Q

How do benzodiazepines reduce anxiety ?

A

They bind to GABA receptors and potentate the effect of GABA and therefore reduce the excitability of neurones.
They are positive allosteric modulators of GABA receptor

45
Q

What are some risks of benzodiazepines ?

A

Tolerance
Dependence
Misuse
Paradoxical disinhibition

46
Q

How does pregabalin reduce anxiety ?

A

Binds to voltage gated calcium channels of neurones and reduces neuronal activity

47
Q

What are some side effects of pregabalin ?

A

Sedation
Weight gain

48
Q

What are some examples of hypnotics ?

A

Benzodiazepines - temazepam
Nonbenzodiazepines - zopiclone and zolpidem

49
Q

What are some risks of prescribing hypnotics ?

A

Misuse
Dependence
Rebound insomnia

50
Q

What are some examples of mood stabilisers ?

A

Lithium
Anticonvulsants
Second generation antipsychotics

51
Q

How does lithium work ?

A

Mechanism of action is unknown
Lowers noradrenaline release and increases serotonin synthesis

52
Q

What are some side effects of lithium ?

A

GI disturbance
Metallic taste
Dry mouth
Fine tremor
Polydipsia and polyuria
Weight gain

53
Q

What are some long term effects of lithium ?

A

Hypothyroidism - usually reversible
Renal impairment - usually irreversible

54
Q

What can lithium toxicity cause ?

A

Can be fatal
Confusion
Coarse tremor
Nausea and vomiting
Ataxia and seizures

55
Q

What treatment is given for lithium toxicity ?

A

Stop lithium
IV fluids
Dialysis
Benzodiazepines for seizures

56
Q

What are some medications that interact with lithium causing increasing levels ?

A

NSAIDs
Loop diuretics
ACEi

57
Q

What second generation antipsychotic is used for bipolar ?

A

Quetiapine

58
Q

What anticonvulsants can be used as mood stabilisers ?

A

Sodium valproate
Carbamazepine
Lamotrigine

59
Q

What are some side effects of anticonvulsants as mood stabilisers ?

A

Sedation
Weight gain
Thrombocytopenia

60
Q

What drugs are most commonly used in ADHD ?

A

CNS stimulants -
Methylphenidate
Dextroamphetamine

61
Q

What is the mechanism of action of mirtazapine ?

A

Antidepressant that works by blocking alpha 2 adrenergic receptors which increases the release of neurotransmitters.

62
Q

Why is mirtazapine used in the elderly ?

A

Two side effects - sedation and increased appetite - may help with insomnia and low weight

63
Q

What is a risk of using MAOI’s ?

A

Have lots of side effects
- causes increased levels of tyramine which can result in a hypotensive crisis

64
Q

What are some side effects of olanzapine ?

A

Metabolic syndrome - weight gain, hypertension, DM, hyperlipidaemia

Increased QRISK

Parkinsonism

Increased sedation

65
Q

What are some risks of using risperidone ?

A

Increased prolactin release which causes
- galactorrhoea
- breast development
- amenorrhea
- low libido
- decrease in sperm production
- osteoporosis

66
Q

What is beneficial about using risperidone ?

A

Less weight gain
Less sedation

67
Q

What are the benefits from using aripiprazole ?

A

No weight gain
No sedation
No effect on the heart
Doesn’t affect prolactin
Restlessness

68
Q

What is the mechanism of action of aripiprazole ?

A

Partial agonist of dopamine

69
Q

What are the major risks of using clozapine ?

A

Agranulocytosis - risk of neutropenia sepsis
Cardiac Myositis
Constipation
Metabolic syndrome

70
Q

What monitoring is needed when a patient is on clozapine ?

A

ECG
Blood tests
Required before medication is released to patient

71
Q

What are some risks of using sodium valproate ?

A

Very teratogenic - can’t be given to women of child bearing age
Hepatotoxic
Weight gain

72
Q

If sodium valproate has to be prescribed what must a woman of child bearing age be put on ?

A

Highly effective contraceptive - implant or copper coil

Y4 Psychiatry (7 decks)

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