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The One Deck To Rule Them All > Psychiatry Drugs > Flashcards

Psychiatry Drugs Flashcards

1
Q

5 types of antidepressants

A
  • Selective serotonin re-uptake inhibitors (SSRIs)
  • Serotonin and noradrenaline re-uptake inhibitors (SNRIs)
  • Monoamine oxidase inhibitors (MAOIs)
  • Noradrenergic and specific serotonergic antidepressants
  • Tricyclic antidepressants
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2
Q

Name the 5 main SSRIs

A
  • Sertraline
  • Fluoxetine
  • Paroxetine
  • Citalopram
  • Escitalopram
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3
Q

Best SSRI for children/adolescents

A

Fluoxetine

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4
Q

Best SSRI for post MI

A

Sertraline

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5
Q

Side effects of SSRIs

A
  • Hyponatraemia
  • GI upset (prescribe PPI if also on NSAID)
  • increased anxiety and agitation after starting
  • risk of CHD (1st trimester of pregnancy)
  • risk of persistent pulmonary HTN (3rd trimester of pregnancy)
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6
Q

What drugs are contraindicated with SSRIs

A
  • Triptans
  • MAOIs
  • Warfarin and Heparin

As they all increase serotonin (risk of serotonin syndrome)

Ideally 2 weeks between stopping and starting

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7
Q

Stopping taking SSRIs suddenly can lead to

A

SSRI Discontinuation Syndrome

  • should gradually reduce over 4 weeks
  • not necessary for fluoxetine
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8
Q
  • diarrhoea
  • vomiting
  • abdo pain
  • blue-tinted vision
A

SSRI Discontinuation Syndrome

  • should gradually reduce over 4 weeks
  • not necessary for fluoxetine
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9
Q

Specific side effects of Paroxetine

A

High incidence of discontinuation symptoms
- paresthesia
- mood changes
- restlessness
- sweating
- GI upset
Risk of congenital malformations in 1st trimester (pregnancy)

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10
Q

Specific side effects of Citalopram

A
  • prolongs QT

- Torsades de pointes

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11
Q

Specific side effects of Escitalopram

A
  • prolongs QT
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12
Q

2 examples of SNRIs

A
  • Venlafaxine

- Duloxetine

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13
Q

MoA of SNRIs

A

Increase concentrations of serotonin and noradrenaline into the synaptic cleft

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14
Q

Side effects of SNRIs

A

HTN

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15
Q

3 examples of MAOIs

A
  • Phenelzine
  • Rasagiline
  • Selegiline
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16
Q

What food should you avoid if on MAOIs

A

Avoid foods high in tyramine (cheese), as they can cause a hypertensive crisis

  • extreme headache etc
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17
Q

What class of drugs does Mirtazapine belong to?

A

Noradrenergic and specific serotonergic antidepressant

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18
Q

MoA of noradrenergic and specific serotonergic antidepressants

A

Alpha-2-receptor antagonists increase the release of neurotransmitters

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19
Q

Side effects of noradrenergic and specific serotonergic antidepressant

A
  • increased appetite
  • increased weight gain
  • sedative (take at night)
  • headache from withdrawal

30mg is sweet spot

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20
Q

Tricyclic antidepressants can be split into 2 classes

A

sedative + less-sedative

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21
Q

4 examples of sedative tricyclic antidepressants

A
  • Amitriptyline
  • Clomipramine
  • Dosulepin
  • Trazodone
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22
Q

3 examples of less-sedative tricyclic antidepressants

A
  • Imipramine
  • Nortriptyline
  • Lofepramine
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23
Q

Amitriptyline and Dosulepin are at risk of

A

overdosing

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24
Q

Side effects of Tricyclic Antidepressants

A

Anti-muscarinic side effects

  • urinary retention
  • tachycardia
  • dry mouth
  • mydriasis
  • drowsiness
  • blurred vision
  • increased QT
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25
Q

Name 3 mood stabilising drugs

A
  • Lithium carbonate
  • Carbamazepine
  • Sodium valproate
26
Q

What monitoring is required for lithium

A
  • bloods 12 hours post dose
  • bloods weekly until stable (in change of dose also)
  • check every 3 months once stable

TFTs and U&Es (renal function) every 6M

27
Q

Lithium has a very narrow therapeutic range of

A

0.4-1.0 mmol/L

Long half-life, excreted in the kidneys

28
Q

Side effects of lithium

A
  • Nausea, vomiting + diarrhoea
  • Fine tremor
  • Nephrotoxic
  • Hypothyroidism
  • T wave inversion/flattening
  • weight gain
  • Idiopathic intracranial HTN
  • Leucocytosis (increased WCC)
  • Hyperparathyroidism > hypercalcaemia
29
Q

Examples of extra-pyramidal side effects

A
  • Parkinsonism
  • Acute dystonia
    • Torticollis (neck stuck downwards)
    • Oculogyric crisis (eyes stuck upwards)
  • Akathisia (restlessness)
  • Tardive dyskinesia
    • chewing
    • jaw pouting
    • tongue poking
    • excessive blinking
    • lip smacking
30
Q

Management of tardive dyskinesia

A

Tetrabenazine

31
Q

Examples of anti-muscarinic side effects

A
  • Dry mouth
  • blurred vision
  • urinary retention
  • constipation
32
Q

2 classes of Antipsychotics

A

Typical and Atypical

33
Q

General side effects of antipsychotics

A

Increased VTE risk
Sedation

More common in Typicals:

  • Extra-pyramidal side effects
  • Hyperprolactinaemia
  • Anti-muscarinic side effects
34
Q

Side effect of being on long-term atypical antipsychotics

A

glucose dysregulation > diabetes

35
Q

3 examples of typical (1st Gen) anti-psychotics

A
  • Haloperidol
  • Chlopromazine
  • Zuclopenthixol decanoate (IM)
36
Q

5 examples of atypical (2nd Gen) anti-psychotics

A
  • Clozapine
  • Olanzapine
  • Quetiapine
  • Risperidone
  • Amisulpride
37
Q

Name a 3rd Gen antipsychotic

A

Aripiprazole

38
Q

Specific side-effect for haloperidol

A

increased QT

39
Q

Relationship between Clozapine and smoking

A
  • smokers will require a higher dose

- therefore smoking cessation will increase clozapine levels

40
Q

Specific side-effects of Clozapine

A
  • Agranulocytosis (neutropenia)
  • Decreased WBC (leukocytes + neutrophils)
  • Reduced seizure threshold
  • Myocarditis
  • Hyper-salivation
  • Constipation
41
Q

Specific side-effects of Risperidone

A
  • Extra-pyramidal side effects
  • Postural hypotension
  • Sexual dysfunction
42
Q

Specific side-effects of Olanzapine

A
  • Dyslipidaemia (hypercholesterolaemia) > obesity

- Sedation

43
Q

Specific side-effects of Quetiapine

A
  • Weight gain

- Dyslipidaemia

44
Q

Management for acute dystonia

A

Procyclidine (anti-cholinergic)

45
Q 
Altered mental status
- agitated 
- confusion
Autonomic dysfunction
- hyperthermia
- HTN 
- Tachycardia
Neuromuscular abnormality 
- tremor
- clonus
- hyperreflexia
A

Serotonin Syndrome

46
Q

Onset of serotonin syndrome

A

hours

47
Q

Causes of serotonin syndrome

A

SSRIs
MAOIs
Ecstacy
Psychoactive stimulants

48
Q

Management of serotonin syndrome

A

Cyproheptadine

Chlorpromazine

49
Q
  • Pyrexia
  • “lead pipe rigidity” of muscles
  • Autonomic features
  • Delirium
A

Neuroleptic malignant syndrome

50
Q

Causes of neuroleptic malignant syndrome

A
  • antipsychotics

- levodopa (if suddenly stopped/reduced in Parkinsons)

51
Q

Pathophysiology of neuroleptic malignant syndrome

A 
dopamine blockade (induced by antipsychotics) triggers massive glutamate release 
> neurotoxicity + muscle damage
52
Q

Investigation findings in neuroleptic malignant syndrome

A

^ CK from muscle damage
Leukocytosis
AKI (from rhabdomyolysis)

53
Q

Management of neuroleptic malignant syndrome

A

Stop antipsychotics
IV Fluids to prevent AKI
Dantrolene (muscle relaxant)
Bromocriptine (dopamine agonist)

54
Q

MoA of Benzodiazepines

A

Enhance GABA by increasing the frequency of chloride channels

55
Q

7 examples of short acting benzodiazepines

A

ATOMZ

Alprazolam
Triazolam
Oxazepam
Midazolam
Zopiclone
Zolpidem
Zaleplan
56
Q

3 examples of intermediate acting benzodiazepines

A

TLC

Temazepam
Lorazepam
Clonazepam

57
Q

4 examples of long acting benzodiazepines

A

Clorazepate
Clordiazepoxide
Diazepam
Flurazepam

58
Q

Benzodiazepines used in liver failure

A

OUT THE LIVER

Oxazepam
Temazepam
Lorazepam

59
Q

MoA of carbamazepine

A

Binds to Na channels

Increases refractory period

60
Q

Side effects of carbamazepine

A 
Dizziness
Ataxia
Diplopia
Hyponatraemia
Agranulocytosis
Leucopenia 
Steven Johnson Syndrome
61
Q

Tricyclic antidepressants are contraindicated in

A

Dementia

- worsens cognitive function

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