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3a Psych > Common Medications > Flashcards

Common Medications Flashcards

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1
Q

What is the first line class of drugs for depression?

A

SSRIs
(Inhibit the reuptake of serotonin from presynaptic serotonin pumps)

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2
Q

What are common side effects of SSRIs?

A

Constipation
Diarrhoea
Sexual dysfunction
Hyponatraemia
Anxiety
Insomnia
Sweating
Increased suicidality

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3
Q

What may occur is you stop SSRIs rapidly?

A

Discontinuation syndrome

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4
Q

What are symptoms of discontinuation syndrome?

A

GI upset
Restlessness, agitation and tremor
Flu-like symptoms (fever, sweatiness, headache)

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5
Q

How do SNRIs work and when are they used?

A

Serotonin-norepinephrine Reuptake inhibitors block the reuptake of noradrenaline and serotonin of presynaptic side.

Used in depression and anxiety

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6
Q

Give some examples of SNRIs

A

Duloxetine
Venlafaxine

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7
Q

What are common side effects of SNRIs?

A

Dizziness
Dry mouth
Constipation
Hot flushes

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8
Q

Name a Noradrenergic and Specific Serotonergic antidepressant (NaSSA)

A

Mirtazapine
(used off-license for depression and anxiety. Works by blocking presynaptic a2-adrenergic receptors, stopping the normal “brake” and therefore increasing release of noradrenaline and serotonin. Also blocks certain serotonin receptors which enhances mood. However, blocks H1 histamine receptor causing sedation and weight gain.

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9
Q

Name a tricyclic antidepressant

A

Amitriptyline

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10
Q

How do tricyclic antidepressants work?

A

Block noradrenaline and serotonin reuptake pumps affecting muscarinic, histaminergic and alpha-adrenergic receptors.

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11
Q

What are some contraindications of using tricyclic antidepressants?

A

Ischaemic Heart Disease
Arrhythmias
Severe liver disease
Risk of overdose

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12
Q

What are common side effects of tricyclic antidepressants?

A

Think Triple A:
Anticholinergic effects (muscarinic block - dry mouth, constipation, blurred vision, urinary retention)

Antiadrenergic effects (postural hypotension, dizziness, syncope)

Antihistaminergic effects (sedation, weight gain)

Also, cardiac effects - prolonged QT, heart block, arrhythmias, palpitations

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13
Q

What does MAOIs stand for?

A

Monoamine Oxidase Inhibitors

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14
Q

What do MAOIs do and what are they used for?

A

Inhibit the enzyme monoamine oxidase A&B (breaks down neurotransmitters like serotonin, norepinephrine, dopamine)
Used to help depression (increases levels of neurotransmitters like dopamine)

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15
Q

What are side effects of MAOIs?

A

Tyramine cheese reaction (hypertensive crisis after patient eats food high in tyramine like cheese. Tyramine not broken down as enzymes inhibited by MAOIs, causes hypertension).
Overdose risk

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16
Q

What medication is reserved for treatment-resistant schizophrenia?

A

Clozapine

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17
Q

When should clozapine be given?

A

After 2+ antipsychotic drugs have been tried each for at least 6 weeks, one of these being a second-generation antipsychotic.

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18
Q

What are the side effects of clozapine?

A

Think SCAM
Seizures
Constipation
Agranulocytosis
Myocarditis

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19
Q

How does smoking affect clozapine?

A

Smoking is an enzyme inducer, so promotes clozapine break down so dose needs adjusting if patient starts or stops smoking.

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20
Q

After what time period of missing a dose of clozapine does it have to be restarted on low dose and titrated back up?

A

48 hours

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21
Q

Which antipsychotic is best for reducing risk of hyperprolactinaemia?

A

Aripriprazole

(think: ar-nip-razole, stops lactation)

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22
Q

Name some typical antipsychotics

A

Haloperidol
Chlorpromazine

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23
Q

Name some atypical antipsychotics

A

Clozapine
Olanzapine
Risperidone
Quetiapine
Aripiprazole

(CORQA)

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24
Q

Which receptors do typical antipsychotics work on?

A

D2

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25
Which receptors do atypical antipsychotics work on?
D2 and 5HT2A receptor
26
Name a common side affect of atypical antipsychotics
Weight gain
27
Procyclidine is an anticholinergic medication that can help with acute _____
dystonias (muscle contraction)
28
What medication can help akathisia (inability to remain still)?
Propranolol
29
Which medication can help with Tardive dyskinesia?
Tetrabenazine
30
What is tardive dyskinesia?
Neuro disorder caused by long-term use of antipsychotics (appears months/years of treatment). Face and/or body makes sudden, irregular movements. Side effects of antipsychotics.
31
How is tardive dyskinesia managed?
Stop/reduce antipsychotic Swith to lower-risk atypical antipsychotic (eg tetrabenazine). Reduce dopamine release with VMAT2 inhibitors like tetrabenazine).
32
What are signs of both neuroleptic malignant syndrome and serotonin syndrome?
Fever Tachycardia Hypertension
33
What would blood test show in neuroleptic malignant syndrome?
Raised creatinine kinase (due to muscle breakdown) High WCC (leukocytosis) Also raised LFTs, and may impair renal function causing AKI. Myoglobinuria on urine dipstick from muscle breakdown.
34
What group of medications can cause neuroleptic malignant syndrome?
Antipsychotics
35
What group of medications can cause serotonin syndrome?
Antidepressants
36
What are classic features of neuroleptic malignant syndrome?
FARM Fever Autonomic instability Rigidity Mental status changes
37
What medication is a dopamine agonist and used in cases of neuroleptic malignant syndrome?
Bromocriptine
38
When may neuroleptic malignant syndrome occur?
Days/weeks after starting or increasing dose of a D2 receptor blocker (antipsychotic). (Think: NMS, No reflexes, Muscle rigidity, slow onset).
39
True or false, reflexes are normal in neuroleptic malignant syndrome?
False Reflexes are decreased
40
When may serotonin syndrome occur?
Within hours of a dose increase or interaction of medications causing excess serotonin eg. SSRIS, MAOIs, tramadol, MDMA
41
True or false: serotonin syndrome presents with lead-pipe rigidity
False That is true for NMS Serotonin syndrome presents with clonus, tremor and hyperreflexia
42
True or false: serotonin syndrome often presents with dilated pupils
True (mydriasis) (Think: SS, Shaky, Speedy, Spontaneous clonus)
43
How is serotonin syndrome managed?
Act quickly! Stop all serotonergic drugs asap IV fluids for hydration Monitor vitals Give benzodiazepines (diazepam, lorazepam) to reduce agitation, tremors and clonus. Active cooling to treat hyperthermia In severe cases, give cyproheptadine (an antihistamine with serotonin antagonist).
44
When is lithium indicated?
Mania (both acute and prophylactic) Mood stabilisation Treatment-resistant depression Aggression Impulsivity
45
Lithium is _____ metabolised and excreted avoid NSAIDs, ACEi, diuretics.
renally
46
What is essential when prescribing lithium?
Regular monitoring as has narrow range of therapeutic index. Weekly blood tests until stable levels, then every 3 months. Check renal and thyroid too
47
What are side effects of lithium?
Polyuria Polydipsia Weight gain Oedema Fine tremor Serious side effects: Coarse tremor ECG changes Arrythmias Nystagmus Dysarthria Brisk reflexes Impaired consciousness Teratogenic
48
What is sodium calproate indicated for?
Mood stabiliser Anticonvulsant Migraines
49
Why should sodium valproate be prescribed carefully?
Highly teratogenic. Only prescribe in women under 55 with a pregnancy prevention program in place. Counsel men. Should only be prescribed to men and women under 55 with 2 specialists signing prescription.
50
What are side effects of sodium valproate?
Weight gain Dizziness Hair loss N+V Tremor Deranged LFTs
51
How do benzodiazepines work and when are they indicated?
Bind to GABA receptors causing neuronal inhibition. Used for: Anxiety (only short term for extreme cases) Mania Psychosis Alcohol withdrawal Acute agitation/aggression Epilepsy Acute back pain
52
Why should caution be taken when prescribing benzodiazepines?
Can be addictive long term Respiratory and CNS depressant effects so check for other CNS depressants prescribed (eg. alcohol, antipsychotics) Avoid in neuro or severe resp disease
53
What are benzo withdrawal symptoms?
Think I (can't) STAND benzos Insomnia Sweating Tremor Appetite loss Nightmares Dizziness
54
How do benzodiazepines affect chloride channels?
Increase the frequency
55
How do barbiturates affect chloride ion channels?
Increases the duration channels open for
56
What are Z-drugs used for?
Initiating sleep by stimulating GABA receptors. Eg Zopiclone
57
When should caution be taken in prescribing z-drugs
Can become dependent Caution in respiratory and neuro disease
58
What does acute dystonia look like (extrapyramidal side effect of typical antipsychotics)
Painful involuntary contraction of muscles in neck/jaw/eyes
59
Name 3 important extrapyramidal side effects to be aware of when prescribing typical antipsychotics?
Parkinsonism (resting tremor, rigidity, bradykinesia) Acute dystonia (painful involuntary contraction of muscles in neck/jaw/eyes) Tardive dyskinesia (rhythmic movements of tongue/face/limbs/trunk. Happens after years of taking antipsychotics)
60
how do typical antipsychotics work?
Antagonise D2 receptors eg in mesolimbic pathway to reduce delusions and hallucinations in mesocortical pathway to reduce negative symptoms In substantia nigra which can cause extrapyramidal side effects In tuberoinfundibular pathway causing increased prolactin secretion.
61
How do atypical antipsychotics work?
Block 5HT2 receptor Causes metabolic side effects like weight gain, impaired glycaemic control, lipid elevation.
62
What is used as an opiate receptor antagonist to help in addiction?
Methadone (risk of respiratory depression)
63
What is a partial opiate receptor agonist which is also an oral substitution in opiate dependence?
Buprenorphine (However, patient needs to already be in state of withdrawal or it will cause withdrawal).
64
What are AChE inhibitors used for?
Mild-moderate Alzheimer's disease Must do baseline ECG and check PR interval (as risk of bradycardia)
65
What are some examples of AChE (acetylcholinesterase) inhibitors?
Donepezil, rivastigmine
66
What are common side effects of AChE inhibitors (used for mild-moderate Alzheimer's)
Fatigue GI issues Bradycardia
67
What medication is used for ADHD management?
Methylphenidate
68
How does Methylphenidate work?
It blocks the reuptake of dopamine and norepinephrine into presynaptic neurons, increasing the concentration of these neurotransmitters in the synaptic cleft, enhancing activity. This helps improve attention, focus and impulse control.
69
What are common side effects of methylphenidate (ADHD medication)?
Anxiety Increased blood pressure Arrhythmias Appetite loss

3a Psych (9 decks)

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