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Mental Health > Drug Management > Flashcards

Drug Management Flashcards

1
Q

What is serotonin syndrome?

A

Life threatening complication of increased serotonin which occurs within minutes of taking the medication

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2
Q

How does serotonin syndrome present?

A

Clonus + increased reflexes + dilated pupils

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3
Q

How is serotonin syndrome managed?

A

Withdraw agent

Can give activated charcoal if OD
Chlorpromazine

Severe cases need aggressive treatment - sedation, neuromuscular paralysis and ventilatory support

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4
Q

What drugs can be used as anxiolytics?

A 
Benzodiazepine
Beta-blockers
SSRI's can be used
Pregablin
Z drugs
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5
Q

Give examples of benzodiazepines and their duration of action.

How do Benzodiazepines work?

A

Diazepam - long acting (>24hr)
Lorazepam - short acting (<12hr)

They are GABA agonists and increase the frequency of chloride channels to hyperpolarise the cell and reduce excitability.

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6
Q

What are the main side effects of benzodiazepines?

A 
Drowsy
Confusion
Anterograde amnesia
Ataxia
Muscle weakness

Dependence and Tolerance

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7
Q

What are the contraindications for benzodiazepines?

A

Respiratory depression

Hepatic impairment

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8
Q

How do you reduce benzodiazepine dose?

What symptoms would make you think someone was suffering from withdrawal?

A

If not on diazepam switch to equivalent dose of diazepam. Then reduce dose by 2mg every 2 weeks

Insomnia, irritable, sweating, tremor, tinnitus, reduced appetite

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9
Q

How is Benzodiazepine OD managed?

A

IV Flumazenil

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10
Q

Which beta blockers are used in anxiety and why?

A

Propranolol

Treat somatic symptoms associated with anxiety - tachycardia, palpitations and tremor

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11
Q

When is pregablin used?

A

GAD - generalised anxiety disorder not responding to sertraline

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12
Q

What are the side effects associated with pregablin use?

A 
Dizzy, drowsy
Blurred vision, diplopia
Confusion
Vivid dreams
Weight gain
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13
Q

Give an example of a Z drug, what are the risks associated with them?

A

Zopiclone

misuse
dependence
rebound insomnia
++risk of falls in elderly

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14
Q

Give examples of typical antipsychotics

A 
Haloperidol
Chlorpromazine
Flupentixol
Sulpiride
Zuclopenthixol
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15
Q

Give examples of atypical antipsychotics

A 
Aripiprizole
Olanzapine
Risperidone
Quetiapine
Clozapine - treatment resistant schizo
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16
Q

When are antipsychotics prescribed and what is important about time for efficacy and length of treatment?

A

Patients suffering with psychotic symptoms - delusions and hallucinations

Take several weeks to become effective

Continued 1-2 years post psychotic episode

Start at lowest dose then titrate

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17
Q

How do antipsychotics work?

A

Block dopamine receptors (D2) to reduce abnormal dopamine transmission in the:

  • Mesolimbic
  • Mesocortical
  • Nigrostriatal
  • Tuberoinfundibular pathways

Atypical also have affinity for other receptors
- anti-histaminergic, serotonergic, anti-adrenergic, anti-muscarinic

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18
Q

What are the side effects of antipsychotics

A 
Extrapyramidal 
Weight gain and sedation
Impaired glucose tolerance
Dry mouth, dry eyes, urinary retention, constipation
Raised prolactin = galactorrhoea
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19
Q

What side effects are more prominent in atypical vs typical?

A

Atypical:
lower seizure threshold
weight gain
galactorrhoea

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20
Q

When is clozapine prescribed?
What are the side effects of clozapine?
When is the clozapine dose adjusted?

A

Trial of 2 other antipsychotics for 8 weeks each

Agranulocytosis and neutropenia
Constipation
Lower seizure threshold

If the patient starts or stops smoking

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21
Q

What are the cautions and contraindications for antipsychotics? Why?

A

Epilepsy: lower seizure threshold
Elderly: increased risk of stroke and VTE

CVS disease
Parkinson's
Myasthenia gravis
CNS depression
Phaeochromocytoma
22
Q

What monitoring is req. for anti-psychotics? Why?

A 
Blood glucose: impair glucose tolerance
ECG: long QT (particularly haloperidol) 
Prolactin: hyperprolactinaemia 
Weight: weight gain 
CK: neuroleptic malignant syndrome
23
Q

What are the extrapyramidal side effects?

A

Tardive dyskinesia

Akathisia

Acute dystonia

Pseudoparkinsonism

24
Q

How does tardive dyskinesia present?

A

Abnormal, involuntary movements occurring years after treatment
Most commonly chewing, lip smacking, tongue protrusion

25
Q

How does akathisia present?

A

Restless
Trouble standing still
Pace
Feet rocking

26
Q

How does acute dystonia present?

How is it managed?

A

Torticollis
Upward eye movement - oculogyric crisis
Facial grimace
Muscle spasm of tongue, face, neck, back, larynx

Procyclidine

27
Q

What are the symptoms of pseudoparkinism?

A 
Stooped posture
Shuffling gait
Rigidity
Bradykinesia
Tremors at rest
Pill rolling motion
28
Q

How are antipsychotics prescribed to improve adherence?

A

Depot - 1 to 4 weeks

29
Q

What is neuroleptic malignant syndrome?

A

Rare life threatening condition occurring in patients on anti-psychotics

Occur within hours to days

30
Q

How does neuroleptic malignant syndrome present?

A

Pyrexia
Lead pipe rigidity and reduced reflexes
Confusion, agitation, delirium, LOC
Autonomic instability - BP and HR

31
Q

What would you see on investigations for suspected neuroleptic malignant syndrome?

A

Raised CK and AKI

Leucocytosis

32
Q

How is neuroleptic malignant syndrome managed?

A 
Stop antipsychotic
Monitor vital signs
IV fluids
Dantrolene
Bromocriptine - dopamine agonist
33
Q

What complications are associated with neuroleptic malignant syndrome?

A

PE
Renal failure
Shock

34
Q

What SSRI is particularly risky in pregnancy and what are the risks of taking SSRI’s in pregnancy?

A

Paroxetine

1st trimester - increased risk of congenital heart defects
3rd - persistent pulmonary hypertension

35
Q

When is sertraline or fluoxetine used over citalopram?

A

sertraline: post MI
fluoxetine: in adolescents

36
Q

What are specific side effects of citalopram?

A

Prolongs QT

SIADH so hyponatraemia

37
Q

What are general side effects of SSRIs?

A

GI upset
Sedation
Sweating
Sexual dysfunction

38
Q

What are some cautions/CIs of SSRIs?

A
  • NSAIDs: need PPI alongside else GI bleed
  • Warfarin/heparin
  • Triptans and MAOIs: cause serotonin syndrome
  • Congenital long QT/ other QT prolonging drugs
39
Q

How do you stop taking SSRIs?

A

Stop over a period of 4 weeks after being symptom free for 6 months

40
Q

Give examples of TCAs

What are the ADRs of TCAs?

A

Amitriptyline and Clomipramine

  • Dry eyes, dry mouth, retention, constipation
  • Long QT
  • Drowsy
41
Q

What are SNRIs and what are some examples?

A

Serotonin and noradrenaline reuptake inhibitors

Venlafaxine and Duloxetine

42
Q

What drug class if Mirtazapine? When is it used in depression and why?

A

Alpha-2 receptor antagonist

Used in elderly who may be underweight or struggling with sleep because it causes sedation and increased appetite

43
Q

Give some examples of MAOIs, when are they used?

A

Phenelzine and Tranylcypromine

Atypical depression

44
Q

What are the side effects of MAOIs?

A 
Dry eyes, dry mouth, retention, constipation 
Hypertensive crisis (cheese, marmite, liver, red wine)
45
Q

What antidepressant would you prescribe to someone on anticoagulants?

A

Mirtazapine

46
Q

What are the indications for lithium?

A

First line for bipolar

Can be used as an adjunct in refractory depression

47
Q

What are the side effects of lithium?

A 
Fine tremor 
Nephrotoxic
Diabetes insipidus = polyuria and dypsia
Hypothyroidism 
Hyperparathyroidism = hypercalcaemia
Intracranial hypertension 
Weight gain 
Leucocytosis
48
Q

How is lithium monitored?

A

Levels taken 12 hours post-dose

Should be taken weekly until stable on a dose (this includes after any adjustments)

49
Q

Compare the tremor in therapeutic vs toxic levels of lithium

A 
Therapeutic = fine
Toxicity = coarse
50
Q

What can precipitate lithium toxicity?

A

Dehydration
Renal failure
Drugs: ACE-I, NSAIDs, Thiazide diuretics

51
Q

How does lithium toxicity present?

A 
Coarse tremor 
Hyper-reflexia 
Polyuria and renal failure
Convulsions
Coma
52
Q

How is lithium toxicity managed?

A

IV fluid rehydration

May need haemodialysis

Mental Health (12 decks)

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