antipsychotics + SSRIs Flashcards
(24 cards)
SSRI of choice post MI
sertraline
SSRI of choice in kids / adolescents
fluoxetine
adverse effects of SSRIs
commonest = GI sx
increased GI bleed risk - if also taking NSAID -> give PPI
which SSRI can prolong the QT interval
citalopram ! or escitalopram
SSRI interactions
NSAIDs - dont normally offer, if do, give PPI
warfarin / heparin - give mirtazipine instead
aspirin
increase risk of serotonin syndrome;
- triptans
- monoamine oxidase inhibitors (MAOIs)
review after initiaition of SSRIs
> 25s - 2 weeks
<25s = 1 week - increased risk of suicide
stopping SSRIs
if good response - continue for at least 6months after remission
when stopping - gradually reduce over a 4 week period
(not necessary with fluoxetine)
SSRI discontinuation symptoms
increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
GI sx - pain, cramping, D + V
SSRIs and pregnancy
first tri -> small risk of congenital heart defects
- paroxetine has an increased risk of congenital malformations esp in 1st tri
third tri -> persistent pulmonary hypertension of the newborn
balance risk vs benefit
causes of serotonin syndrome
monoamine oxidase inhibitors
SSRIs
- St Johns wort
- tramadol
ecstasy
amphetamines
serotonin syndrome features
neuromuscular excitation
- hyperreflexia
- myoclonus
- rigidity
autonomic nervous system excitation
- hyperthermia
- sweating
altered mental state, confusion
management of serotonin syndrome
supportive including IV fluids
benzos
serious cases = cyproheptadine + chlorpromazine (serotonin antagonists)
key differences between serotonin syndrome + neuroleptic malignant syndrome
serotonin
- caused by SSRIs, MAOIs etc
- faster onset (hours)
- dilated pupils, hyperreflexia
neuroleptic
- antipsychotics
- slower onset (hours-days)
- decreased reflexes, lead pipe rigidity, normal pupils
examples of SNRIs
venlafaxine
duloxetine
drugs that cause neuroleptic malignant syndrome
antipsychotics !
also in dopaminergic drugs - levodopa
-> when drug suddenly stopped or dose reduced
neuroleptic malignant syndrome features
occurs within hours-days of starting an antipsychotic
- pyrexia
- muscle rigidity
- autonomic lability - hypertension, tachycardia/pnoea
- agitated delirium with confusion
U&Es in neuroleptic malignant syndrome
raised creatine kinase
- AKI secondary to rhabdomyolysis may develop in severe cases
a may leukocytosis (raised WCC) be seen
management of neuroleptic malignant syndrome
stop antipsychotic
IV fluids to prevent renal failure
if severe - dantrolene, or bromocriptine
typical antipsychotics examples + side effects
haloperidol + chlorpromazine
adverse effects;
- extrapyramidal SEs
- hyperprolactinaemia
typical antipsychotics mode of action
Dopamine D2 receptor antagonists, blocking dopaminergic transmission in the mesolimbic pathways
extrapyramidal side-effects + mx
parkinsonism
acute dystonia
- sustained muscle contraction - torticollis, oculogyric crisis
–> mx = procyclidine
akathisia - severe restlessness
tardive dyskinesia (late onset)
-> involuntary movements - chewing + pouting
risks of using antipsychotics in elderly
increased risk of stroke
increased risk of VTE
side effects of antipsychotics
antimuscarinic - dy mouth, blurred vision, urinary retention, constipation
neuroleptic malignant syndrome
weight gain!
raised prolactin
impaired glucose tolerance
reduced seizure threshold
prolonged QT - esp haloperidol
antipsychotic of choice is prolactin elevation
aripiprazole
