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Psychiatry and Neurology > Psych- Medications > Flashcards

Psych- Medications Flashcards

1
Q

Give 3 examples of typical antipsychotics

A

Chlorpromazine
Haloperidol
Flupentixol

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2
Q

Give 3 examples of atypical antipsychotics

A

Clozapine
Olanzapine
Quetiapine
Risperidone

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3
Q

What are the dopamine related SEs of typical antipsychotics?

A
  1. Hypothalamic-pituitary:
    Galactorrhoea
    Impotence
2. Nigrostriatal:
Parkinsonism
Acute dystonia
Tardive dyskinesia
Akathisia
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4
Q

What are the main symptoms of Parkinsonism?

A

Tremor
Bradykinesia
Shuffling gait
Rigidity

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5
Q

Which group of antipsychotics poses the greatest risk of neuroleptic malignant syndrome?

A

Typical antipsychotics

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6
Q

Other than dopamine related SEs, what are the other SEs of typical antipsychotics?

A
  1. Histamine related: sedation
  2. Anticholinergic: dry mouth, constipation, confusion, blurred vision
  3. alpha 2 related: postural hypotension, impotence
  4. Neuroleptic malignant syndrome
  5. Weight gain
  6. Arrhythmias
  7. Decreased seizure threshold
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7
Q

Which antipsychotic is proven to decrease the negative symptoms of schizophrenia?

A

Clozapine

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8
Q

What are the main side effects of atypical antipsychotics?

A
  1. Weight gain
  2. Decreased seizure threshold
  3. Sedation
  4. Metabolic syndrome
  5. Extra pyramidal SEs at higher doses
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9
Q

What are the side effects of Clozapine?

A
  1. Agranulocytosis
  2. Sedation
  3. Weight gin
  4. Decreased seizure threshold
  5. Anticholinergic SEs
  6. Excess salivation
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10
Q

How often should bloods be monitored in patients in Clozapine?

A
  1. BEFORE commencing
  2. Weekly for 18 weeks
  3. Fortnightly until 1 year
  4. Monthly from 1 year onwards
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11
Q

Which anticholinesterase is used in Alzheimer’s?

A

Donepezil

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12
Q

Disulfiram, Acamprosate and Naltrexone are used for what?

A

Abstinence from alcohol

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13
Q

What are the 3 groups of symptoms for alcohol withdrawal?

A
  1. Simple withdrawal symptoms
  2. Delirium tremens
  3. Seizures
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14
Q

Which 2 main groups of drugs are used for alcohol detox?

A

1, Sedatives- eg. Benzodiazepines or Chlordiazepoxide

2. Vitamin B- Pabrinex

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15
Q

What are the 3 main features of Wernicke’s encephalopathy?

A

Confusion
Ataxia
Ophthalmoplegia (weakness of extra occular eye muscles)

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16
Q

Which drugs can be used for abstinence from alcohol?

A

Disulfiram
Acamprosate
Naltrexone

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17
Q

________ is a GABA analog which reduces cravings for alcohol.

A

Acamprosate

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18
Q

_________ is an aldehyde dehydrogenase inhibitor which gives an unpleasant reaction if patients drink alcohol.

A

Disulfiram

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19
Q

Which drugs are used for neurotic disorders (panic/ anxiety)?

A
  1. SSRIs
  2. SNRIs
  3. TCAs/ Pregabalin
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20
Q

Which drug class is used for OCD?

A

SSRIs

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21
Q

Which drug class is used for bulimia?

A

SSRIs

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22
Q

Which drug classes are used for PTSD?

A

SSRIs

Benzodiazepines

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23
Q

Which drug classes are used for insomnia?

A
  1. Benzodiazepines

2. Z drugs- Zopiclone, Zolpidem

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24
Q

What is the most commonly used class of antidepressants? Give examples

A

SSRIs

Sertraline
Citalopram
Fluoxetine
Paroxetine

25
Q

What are the 1st, 2nd and 3rd line drug treatments for depression?

A

1st line- SSRI eg. Sertraline
2nd line- Switch SSRI or try SNRI eg. Venlafaxine, or Mirtazapine
3rd line- SNRI or Mirtazapine or TCA

26
Q

What are the key side effects of SSRIs?

A
  1. GI- Diarrhoea, vomit
  2. Sweating
  3. Insomnia
  4. Agitation
  5. Hyponatraemia
  6. Discontinuation syndrome
27
Q

________ is an SNRI and can cause side effects such as hypertension.

A

Venlafaxine

28
Q

__________ works as an antidepressant by being an alpha2 antagonist, and is also an antagonist at some post synaptic serotonin receptors.

A

Mirtazapine

or Mianserin

29
Q

What are the potential SEs of Mirtazapine?

A

Weight gain

Sedation

30
Q

What are the potential SEs of Mianserin?

A

Blood dyscrasias

31
Q

Give examples of 2 TCAs.

A

Amitriptyline

Impipramine

32
Q

What are the potential SEs of TCAs?

A
  1. Anticholinergic- dry mouth, constipation, decreased urine, blurred vision
  2. Histamine- sedation
  3. Alpha1- Postural hypotension, impotence
  4. ECG changes and arrhythmias
  5. Tremor
  6. Serotonin- GI upset, sweating
33
Q

MAOIs such as Rasagiline and Selegiline can prevent breakdown of _________ causing the “cheese reaction”

A

Tyramine

34
Q

What are the 5 steps of NICE guidelines for treating depression?

A
  1. Recognise and diagnose
  2. Treat mild depression in primary care
  3. Treat moderate- severe depression in primary care
  4. Treatment by specialist mental health services
  5. Inpatient treatment for severe or resistant depression
35
Q

What are the NICE guidelines for treating acute mania?

A
  1. Stop any antidepressants
  2. Start anti psychotic eg. Olanzapine, Risperidone, Haloperidol, Quetiapine
  3. Give lithium if needed/ optimise dose of lithium
36
Q

What are the potential SEs of lithium?

A 
Tremor
Hypothyroidism/ goitre
Weight gain
Teratogenicity
Renal impairment
37
Q

What are the signs of lithium toxicity?

A 
Tremor
Diarrhoea and vomit
Ataxia
Slurred speech
UMN signs
Seizures
Can be fatal
38
Q

What are the 3 main groups of drugs used for bipolar disorder?

A
  1. Lithium
  2. Antipsychotics
  3. Anticonvulsants
39
Q

What are the side effects of sodium valproate?

A

Teratogenicity
Weight gain
Hirtuism

40
Q

What are the side effects of Lamotrigine?

A

Steven Johnson’s syndrome
Headaches
Ataxia
Diplopia

41
Q

What are the side effects of Carbamazapine?

A 
Weight gain
Hyponatraemia
Skin rash
Diplopia
Headache
42
Q

Which 2nd gen antipsychotic can cause weight gain and metabolic syndrome?

A

Olanzapine

Quetiapine

43
Q

Which 2nd gen antipsychotic can cause sedation, metabolic syndrome and postural hypotension?

A

Quetiapine

44
Q

Which antipsychotic can cause akathisia as a SE?

A

Aripriprazole

45
Q

What are the NICE guidelines for treating bipolar depression?

A

Mild- psychological therapy

Moderate-severe- SSRIs (Fluoxetine) plus Olanzapine or Quetiapine

46
Q

After one week of use what should lithium blood levels be?

A

0.5 -1.0 mmol/L

47
Q

What can increase blood lithium levels?

A 
ACEIs
NSAIDS
Diuretics
Dehydration
Hyponatraemia
48
Q

How often should TFTs and U+Es be monitored in patients on lithium?

A

Every 6 months

49
Q

How often should lithium levels be monitored?

A

Every 3 months

50
Q

What is the SSRI of choice in children and adolescents?

A

Fluoxetine

51
Q

What is the SSRI of choice in adultss?

A

Sertraline

52
Q

When discontinuing a SSRI, the dose should gradually be reduced over what time period?

A

4 weeks

not necessary with Fluoxetine

53
Q

What are the symptoms of discontinuation syndrome from stopping an SSRI abruptly?

A 
Mood changes
Sweating
Difficulty sleeping
GI disturbances
Paraesthesia
Restlessness
54
Q

A 45-year-old man with schizophrenia taking chlorpromazine develops a bilateral resting tremor. What side-effect of antipsychotic medication is this an example of?

A

Parkinsonism

55
Q

How might smoking cessation affect clozapine blood levels?

A

Smoking cessation causes INCREASED clozapine levels

56
Q

Which atypical antipsychotic has the highest risk of dyslipidaemia and obesity?

A

Olanzapine

57
Q

Which atypical antipsychotic has the best side effect profile for prolactin elevation?

A

Aripiprazole

58
Q

Mirtazapine is an alpha 2 receptor _______ and has a SE of increased appetite.

A

Antagonist

Psychiatry and Neurology (9 decks)

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