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Psychiatry IMP1 > Drugs > Flashcards

Drugs Flashcards

Names, uses, SE, contraindications, other

1
Q

Another name for typical/1st generation antipyschotics

A

Neuroleptics

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2
Q

Uses for antipyschotics

A
  • Schizophrenia
  • Mood disorders with/without psychosis
  • Violent behaviour
  • Autism
  • Tourette’s
  • Somatoform disorder
  • Dementia
  • OCD
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3
Q

Time for antipsychotics to have other effects

A

2-4 weeks

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4
Q

What substance is added to an antipsychotic to make it long-acting and injectable?

A

Oil

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5
Q

General mechanism of action - antipsychotics

A

Blockade of dopamine receptors (to varying degrees and in the CNS)

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6
Q

What does dopamine cause in schizophrenia?

A

Positive symptoms

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7
Q

Which receptors does typical antipsychotics block?

A

D2 - post-synaptic

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8
Q

What receptors does atypical antipsychotics antagonise?

A

D2 and 5HT2 (pre-synaptic)

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9
Q

Name some metabolic side effects

A
  • weight gain
  • hyperglycaemia
  • lipid abnormalities
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10
Q

Name 7 TYPICAL antipsychotics

A
  • Haloperidol
  • Fluphenazine
  • Zuclopenthixol
  • Perphenazine
  • Loxapine
  • Chlorpromazine
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11
Q

Name 8 ATYPICAL antipsychotics

A
  • Risperidone
  • Paliperidone
  • Olanzapine
  • Asenapine
  • Ziprasidone (HCl/Decanoate/Acetate)
  • Aripiprazole
  • Quetiapine
  • Clozapine
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12
Q

Generic name for Haloperidol

A

Haldol

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13
Q

Generic name for Zuclopenthixol HCl

A

Clopixol

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14
Q

Generic name for Zuclopenthixol acetate

A

Acuphase

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15
Q

Generic name for Perphenazine

A

Trilafon

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16
Q

Generic name Loxapine HCl

A

Loxitane

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17
Q

Generic name for Chlorpromazine

A

Largactil

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18
Q

Generic name for Risperidone

A

Risperdal

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19
Q

Generic name for Paliperidone

A

Invega

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20
Q

Generic name for Olanzapine

A

Zyprexa

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21
Q

Generic name for Asenapine

A

Saphris

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22
Q

Generic name for Ziprasidone

A

Zeldox

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23
Q

Generic name for Aripiprazole

A

Ablilfy

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24
Q

Generic name for Quetiapine

A

Seroquel

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25
Q

Generic name for Clozapine

A

Clozaril

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26
Q

Advantages of Risperidone (Risperdal)

A
  • Lower incidence of EPS compared to typicals
  • Less weight gain
  • Quick dissolve
  • LA available
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27
Q

Risperidone side effects

A
  • Insomnia
  • Agitation
  • Anxiety
  • Postural hypotension
  • Constipation
  • Dizzy
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28
Q

Advantages of Olanzapine

A
  • Well tolerated
  • More effective than Haloperidol
  • Minimal anticholinergic SE
  • Quick dissolve (ED)
  • IMI available
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29
Q

Olanzapine side effects

A
  • Mild sedation
  • Insomnia
  • Dizzy
  • AST/ALT elevation
  • Restlessness
  • Metabolic effects
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30
Q

Advantages of Quetiapine (Seroquel)

A
  • Less weight gain

- Mood stabilising

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31
Q

Quetiapine side effects

A
  • Sedation

- Constipation

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32
Q

Advantages of Clozapine (Clozaril)

A
  • Most effective –> especially for resistant schizophrenia

- Do not worsen tardive symptoms

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33
Q

Clozapine side effects

A
  • Drowsy
  • Sedation
  • Hypersalivation
  • Increased HR
  • Dizzy
  • Myocarditis
  • Cardiomyopathy
  • *** 1% agranulocytosis
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34
Q

Special tests needed for patients on Clozapine

A
  • Weekly blood counts for the first 6 months
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35
Q

Contraindications with Clozapine

A
  • Drugs that cause bone suppression
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36
Q

Advantages of Aripiprazole

A
  • Less weight gain
  • Less risk of metabolic syndrome
  • Less EPS
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37
Q

Aripiprazole side effects

A
  • Agitation
  • Insomnia
  • Anxiety
  • Weight gain
  • Decreased serum prolactin
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38
Q

Ordered drugs - risk of weight gain

A

Clozapine > Olanzapine > Quetiapine > Risperidone

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39
Q

Anticholinergic side effects

A
    • greatest in typical psychotics
  • Dry mouth (spit)
  • Constipation (shit)
  • Urinary retention (pee)
  • Blurred vision (see)
  • Severe cases - anticholinergic delirium
40
Q

General side effects of antipsychotics

A
  • Anticholinergic side effects
  • Reduced seizure threshold
  • Hypotension (orthostatic) (due to alpha-receptor blockage) (most common with Risperidone and low potency drugs)
  • Agranulocytosis
  • Cardiac (QT prolongation (Ziprasidone, Risperidone))
  • Myocarditis
  • Metabolic side effects
  • Movement disoder (dystonia, EPS, akathisia, neuroleptic malignant syndrome, tardive dyskinesia)
  • Skin and ocular pigmentation
  • Photosensitivity
  • Increased prolactin
  • Cataracts
41
Q

What causes Neuroleptic malignant syndrome

A

Massive dopamine blockade

42
Q

Symptoms of Neuroleptic Malignant syndrome

A
  • Mental state change
  • Fever
  • Autonomic reactivity
  • Rigidity
  • Increased creatinine phosphokinase
  • Leukocytosis
  • Myoglobinuria
43
Q

Treatment for Neuroleptic Malignant syndrome

A
  • Supportive treatment
  • Cool and hydrate
  • DA agonist (Bromocriptine)
44
Q

Acronym for features of NMS

A

F - Fever
A - Autonomic changes (increased HR, BP, sweat)
R - Rigidity of muscles
M - Mental status changes/confusion

45
Q

4 features of Extrapyramidal Side Effects

A
  • Dystonia
  • Akathisia
  • Pseudoparkinsonism
  • Dyskinesia
46
Q

Antipsychotics that require cardiac monitoring

A
  • Chlorpromazin
  • Haloperidol
  • Ziprasidone
  • Clozapine
47
Q

All BZDs are …….

A

Sedating

48
Q

BZD - Mechanism of action

A

Potentiate binding of GABA to its receptor –> leads to decreased neuronal activity

49
Q

All anxiolytics have similar efficacies - what determines which one you use (3 reasons)

A
  • Half life
  • Metabolites
  • Administration route
50
Q

Onset of withdrawal from anxiolytics (time period)

A

1-4 days

51
Q

Symptoms of low dose withdrawal - anxiolytics

A
  • Tachycardia
  • HTN
  • Panic
  • Insomnia
  • Impaired memory/concentration
  • Perceptual disturbance
52
Q

Symptoms of high dose withdrawal - anxiolytics (note: similar to alcohol withdrawal)

A
  • Hyperpyrexia
  • Seizure
  • Psychosis
  • Death
53
Q

Anxiolytics - short-term uses

A
  • Insomnia
  • Alcohol withdrawal
  • Agitation (mania/delirium/psychosis)
  • Catatonia
54
Q

Avoid alcohol with anxiolytics: y/n

A

yes (similar CNS depression)

55
Q

Anxiolytic side effects

A
  • Drowsy
  • Cognitive impairment
  • Decreased motor coordination
  • Memory impairment
56
Q

Anxiolytics are safe in liver impairment: y/n

A

yes (not metabolised by the liver)

57
Q

Name 4 long-acting BZD

A
  • Clonazepam
  • Diazepam
  • Chlordiazepoxide
  • Fluazepam
58
Q

Name 5 short-acting BZD

A
  • Alprazolam
  • Lorazepam
  • Oxazepam
  • Temazepam
  • Triazolam
59
Q

Contraindications for use of anxiolytics

A
  • Severe respiratory depression
  • Severe hepatic impairment
  • Myasthenia gravis
60
Q

Route of metabolism - anxiolytics

A
  • Some oxidation

- Some conjugation

61
Q

Xanax = ……

A

Alprazolam

62
Q

Valium = ….

A

Diazepam

63
Q

4 BZD general side effects

A
  • Behavioural disinhibition (hostile, irritable)
  • Psychomotor impairment (dysarthria, ataxia, drowsy)
  • Cognitive impairment
  • Withdrawal phenomena (flu-like, psychotic, seizures)
64
Q

BZD antagonist

A

Flumazenil (Anexate)

65
Q

Main indication for use of Buspirone (Buspar)

A

GAD

66
Q

Buspirone - mechanism of action

A

5HT1A agonist (with some D2 antagonist effect)

67
Q

Features of Buspirone

A
  • Long lag time/takes weeks to work
  • Not sedative
  • Cannot treat insomnia
  • Cannot treat BZD or alcohol withdrawal (no GABA effects)
68
Q

Use of SSRIs for depression

A

First line - Panic, social anxiety, OCD, GAD, PTSD

  • Need greater dose than used for depression
  • For GAD = combine with Venlafaxine and Buspirone
69
Q

Hypnotics - 2 examples

A

Z drugs - Zolpidem, Zolpiclone

- Act similar to BZD

70
Q

Define euthymia

A

normal mood, not depressed, reasonably positive

71
Q

Time lag for full effects of mood stabilisers

A
  • 2-4 weeks before full effect
72
Q

Name 3 anti-convulsants

A
  • Valproate
  • Lamotrigine
  • Carbamazepine
73
Q

Mechanism of action - mood stabilisers

A

Unclear

- Many NT influenced

74
Q

Indications for lithium use

A
  • Acute mania
  • Bipolar 1 depression
  • Bipolar disorder maintenance
75
Q

Neurotransmitters influenced by lithium in the CNS

A
  • Noradrenaline

- Serotonin

76
Q

Clearance mechanism - lithium

A

Renal

77
Q

Monitoring needed for people on lithium

A
  • Serum concentration

- Thyroid function

78
Q

Lithium daily dosing

A

600-1500mg/day

79
Q

Lithium side effects

A
  • N/V
  • Diarrhoea
  • Stomach pain
  • Weight GAIN
  • Psoriasis
  • Polyuria/dypsia
  • Renal failure
  • Fine tremor
  • Lethargy
  • Oedema
  • ECG changes
  • Fatigue
  • Headache
  • Reversible leucocytosis
  • Muscle weakness
80
Q

Affect on thyroid with lithium

A

Hypothyroidism

  • 5% users
  • Interferes with thyroid hormone production
81
Q

What increases risk of lithium toxicity?

A
  • Impaired renal function

- Dehydration

82
Q

Symptoms of lithium toxicity

A
  • Severe N/V
  • Diarrhoea
  • Ataxia
  • Slurred speech
  • Lack of coordination
  • Drowsy
  • Myoclonus
  • Tremour
  • Seizure
  • Delirium
  • Coma
83
Q

Interventions/treating lithium toxicity

A
  • Saline infusion

- Haemodialysis

84
Q

Indications for Lamotrigine use

A
  • Bipolar 1 depression
  • Bipolar maintenance
  • -> Most effective when combined with lithium
85
Q

Mechanism of action of Lamotrigine

A

Inhibit voltage-gated sodium channels - modulate pre-synaptic excitatory NT release

86
Q

Generic name for Lamotrigine

A

Lamictal

87
Q

What is Lamotrigine NOT indicated for

A

Acute use

88
Q

Dose-related allergic reaction to Lamotrigine

A

Steven-Johnson syndrome (skin rash)

89
Q

Lamotrigine side effects

A
  • N/V
  • Diarrhoea
  • Ataxia
  • Dizziness
  • Diplopia
  • Headache
  • Somnolence
  • Rash (SJS) - 10%
  • Anxiety
90
Q

Lamotrigine - most useful for….

A

Bipolar depression (as non-manic inducing)

91
Q

Unlike other anticonvulsants, Lamotrigine…..

A

Has no effect on folate levels - safer for pregnancy

92
Q

Other name for Sodium Valproate

A

Divalproex

93
Q

Generic name for sodium valproate

A

Epival

94
Q

Indications for Sodium Valproate

A
  • Acute mania
  • Bipolar depression - with SSRI or Lithium
  • Bipolar disorder maintenance
  • Impulse dyscontrol
95
Q

Sodium valproate is well-tolerated as a _____ therapy

A

Long-term

Psychiatry IMP1 (3 decks)

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