11) Psychopharmacology Flashcards
(40 cards)
Describe neuroleptic malignant syndrome.
Adverse reaction to antipsychotic drug where there is muscle rigidity, fever, autonomic instability and cognitive changes such as delirium.
Which enzyme is raised in neuroleptic malignant syndrome?
Creatinine phosphokinase
Suggest some of the features of neuroleptic malignant syndrome.
- Muscle rigidity
- Hyperpyrexia
- Tachycardia
- Sweating
- Flucuating blood pressure
Describe serotonin syndrome.
Excess serotonin on the CNS and/or peripheral nervous system due to a drug reaction.
Suggest some possible ADRs of mirtazapine.
- Weight gain
Suggest some possible ADRs of lithium.
- Polydypsia and polyuria
- Nausea
- Diarrhoea
- Weight gain
Describe tardive dyskinesia and explain why it occurs.
Tardive dyskinesia is the choreo-athetoid movements of lips, tongue and mouth (and sometimes hands) caused by dopamine blockade such as performed by antipsychotics.
Suggest THREE neurological or psychiatric conditions in which sodium valproate may be used.
- Epilepsy
- Bipolar affective disorder
- Acute mania
How can antipsychotics raise plasma prolactin?
Blockade of the tubero-infundibular dopaminergic system reduces the inhibition on prolactin.
Suggest how a patient with lithium toxicity may present.
- Coarse tremor
- Reduced conciousness
- Convulsions
- Renal failure
Suggest how a patient with benzodiazepine toxicity may present.
- Drowsy
- Respiratory depression
Suggest some possible ADRs of SSRIs.
- GI (nausea, diarrhoea, dyspepsia, bloating)
- Weight loss
- Sexual dysfunction
- Headaches
- Fatigue
- Hyponatraemia
- Increased risk of bleeding (especially when given with NSAIDs)
- Discontinuation symptoms
After the first episode of depression, how long should patients continue on antidepressants after recovery?
6 months
Suggest TWO pharmacological interventions that may help a patient suffering from obsessive-compulsive disorder.
- SSRI’s
- TCAs (commonly Clomipramine)
What is the first line medication for most/all anxiety disorders?
SSRIs
Which benzodiazepine is commonly used in the treatment of alcohol withdrawal?
Chlordiazepoxide
Suggest some drugs which can cause serotonin syndrome.
- Antidepressants
- Opioids
- CNS stimulants
Suggest some of the features of serotonin syndrome.
- Hypotension and tachycardia
- Shivering
- Sweating
- Dilated pupils
- Myoclonus (intermittent jerking or twitching)
- Hypereflexia
- Hypervigilance, anxiety
Compare and contrast serotonin syndrome and neuroleptic malignant syndrome.
- Serotonin syndrome is caused by excessive serotonin, NMS is caused by a dopamine blockade
- Serotonin toxicity has a rapid onset after the administration of a serotonergic drug, NMS has a slow onset and typically evolves over several days after administration of a neuroleptic drug
- Serotonin syndrome responds to serotonin blockade via drugs like chlorpromazine/cyproheptadine, whereas NMS responds to dopamine agonists such as bromocriptine
Described how serotonin syndrome may be managed.
- Serotonin antagonists such as cyproheptadine/chlorpromazine
- Activated charcoal if there is serotonin still being digested
- BZDs for the myoclonus
- Supportive measures for hyperthermia
What is the first line treatment for Alzheimer’s disease?
Acetylcholinesterase inhibitors (ACHEIs)
Suggest TWO ways in which adverse drug reactions from acetylcholinesterase inhibitors (ACHEIs) can be made less likely.
- Take with food
- Titrate them up slowly
Give TWO examples of acetylcholinesterase inhibitors. (ACHEIs)
- Donepezil
- Rivastigmine
Suggest a mechanism for how acetylcholinesterase inhibitors (ACHEIs) may improve memory in patients with dementia.
As acetylcholine is reduced in dementia and plays a significant role in memory/attention/mood the prevention of its degradation leads to an improvement in this dimensions.
