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Psychiatry SB > Drugs > Flashcards

Drugs Flashcards

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1
Q

examples of SSRIs

A

fluoxetine
paroxetine
citalopram
sertraline

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2
Q

SSRI used in < 18

A

fluoxetine

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3
Q

S.E of SSRI

A

N+V, diarrhoea, constipation
Abdomen pain
Weight loss

restlessness, insomnia, drowsiness
tremor, headache

SIADH

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4
Q

what is a contraindication of a SSRI/drugs they shouldn’t be used with

A

Mania

NSAIDs [would need to prescribe PPI as well]
Warfarin
Aspirin
Triptans

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5
Q

what are examples of TCAs

A

Amitrityline, Clomipramine, Dosulepin, Doxepin, Lofepramine

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6
Q

what are anti-cholinergic side effects of TCAs

A

weight gain
dry mouth, nose
urinary retention
blurred vision

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7
Q

what are anti-adrenergic side effects of TCAs

A

postural hypotension

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8
Q

what are cardiac Side effects seen in TCA

A

tachycardia
arrhythmias
heart block
syncope

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9
Q

what changes on an ECG can be seen in TCA

A

QT interval prolongation

ST segment elevation

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10
Q

what are contraindications in TCAs

A 
recent MI
arrhythmias 
severe liver disease
mania
high risk of over dose
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11
Q

what group should anti-depressants be used with cautions

A

patients with epilepsy

> they lower seizures threshold

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12
Q

what drug class is used in atypical depression

A

MOAI

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13
Q

what are examples of MOAI

A

phenelzine, isocarboxazid, tranylcypromine

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14
Q

what are side effects of MOAI

A

hypertensive crisis

serotonin syndrome

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15
Q

what leads to a hypertensive crisis with the use of MOAI

A
  • large amounts of tyramine (from diet) increases norepinephrine causing vasoconstriction
  • MAO would normally destroy excess NE
  • hypertensive crisis
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16
Q

what are Sx of a hypertensive crisis

A

flushing, headache, increased BP, CVA

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17
Q

what is the Tx of hypertensive crisis

A

alpha blockade e.g. phentolamine, chlorpromazine

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18
Q

what causes serotonin syndrome

A

if MOAI combined with another anti-depressant

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19
Q

what are Sx of serotonin syndrome

A

neuromuscular abnormalities, altered consciousness level and autonomic instability

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20
Q

what are contraindications of MOAI

A

phaechromocytoma
cerebrovascular disease
hepatic impairment
mania

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21
Q

what are examples of SNRI

A

e.g. Venlafaxine, Duloxetine

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22
Q

what anti-depressant causes the least sedation

A

SSRI

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23
Q

what is an example of an NaSSA

24
Q

what are Side effects of Mirtazapine

Study These Flashcards
A 
increased appetite, weight gain
sedation
headache
dry mouth
dizziness, postural hypotension

tremor
peripheral oedema

25
what drugs should be avoided/prescribed with caution when a patient is on lithium
NSAIDs ACEi Diuretics
26
what is the mnemonic for lithium side effects
LITHIVM (side effects) ``` Leukocytosis Insipidus (diabetes) Tremor Hypothyroidism Increased weight Vomiting (and nausea) Miscellaneous ```
27
what are the other side effects seen in lithium
- confusion, headache, concentration problems - constipation - dry mouth, polydipsia - muscle weakness - nephrotoxic
28
what side effects of lithium are seen on an ECG
T-wave flattening or inversion
29
what are signs go lithium toxicity
- worsening vision, nystagmus - diarrhoea, N+V - decreased potassium - ataxia, myoclonus - coarse tremor - dysarthria, slurred speech - convulsions, coma
30
contraindications of lithium
``` pregnancy breastfeeding impaired renal function thyroid disease cardiac conditions neurological conditions (e.g. Parkinson’s or Huntington’s disease) ```
31
what are the side effects of Lamotrigine
N/V, diarrhoea ataxia, dizziness, diplopia, headache agression, irritability somnolence and sedation skin rash (risk of Stevens-Johnson Syndrome)
32
what are side effects of Carbamazepine
Agranulocytosis, aplastic anaemia N/V, diarrhoea, ataxia, dizziness, slurred speech, nystagmus, diplopia drowsiness, confusion raised liver enzymes, hepatic toxicity hyponatraemia, fluid retention
33
what are side effects of valproate
increased appetite, weight gain, hair loss, N+V sedation, dizziness, tremor ankle swelling haematological abnormalities (thrombocytopenia, leucopenia)
34
what are the first generation anti-psychotics
Typical Chlorpromazine Haloperidol Sulpiride
35
what are the second generation anti-psychotics
Atypical Clozapine Olanzapine Risperidone
36
contraindications to anti-psychotics
``` reduced consciousness level pheochromocytoma Parkinson’s disease epilepsy cardiac disease metabolic syndrome ```
37
what are side effects of anti-psychotics
prolonged QT interval, arrhythmias, myocarditis, sudden death photosensitivity, skin rashes lowers seizures threshold hepatotoxic pancytopenia, agranulocytosis hyperprolactinaemia extrapyramidal side-effects
38
what causes extra-pyramidal side effects (EPSE)
excessive of acetylcholine and relative deficiency of dopamine
39
what are EPSE
parkinsonism motor Sx acute dystonia akathisia tardive dyskinesia
40
Tx for parkinsonism motor Sx as EPSE of anti-psychotics
Anticholinergics | e.g. procyclidine
41
what is acute dystonia
involuntary sustained muscular contractions or spasm usually occurs 72 hours into treatment
42
what is akathisia
feeling of inner restlessness and muscular discomfort | occurs with 6-10 days
43
what its the Tx for akathisia in EPSE
Tx = Propranolol or short term benzodiazepines
44
what is tardive dyskinesia
rhythmic involuntary movement of head, limbs and trunk | e.g. chewing, grimacing, darting movements of the tongue
45
what dangerous side effects are associated with clozapine
agranulocytosis, myocarditis and cardiomyopathy
46
what general side effects are seen with clozapine
sedation, weight gain, metabolic syndrome, hypersalviation
47
when is clozapine reserved for
treatment-resistant schizophrenia
48
what odd side effect does chlorpromazine cause
blue-grey discolouration in the sun
49
how do benzodiazepines work
- bind to specific benzodiazepine receptors on the GABAa receptor complex, - an increased affinity of the complex for GABA - causes increased flow of chloride ions into the cell, - hyper polarising the post-synaptic membrane - reduces neuronal excitability
50
what are the Z drugs and how do they work
e.g. Zaleplon, Zolpidem, Zopiclone act at a different site on the benzodiazepine receptors in the GABAa receptor complex, also potentiating chloride entry
51
what are side effects of Benzos and Z drugs
developing dependence potential dangerous driving due to drowsiness, ataxia and reduced motor coordination can lead to falls or delirium can cause depress respiration in patients with COPD can make dissociation worse anterograde amnesia impaired co-ordination
52
what are indications for ECT
severe depression established mania certain types of schizophrenia
53
what is suggestive of severe depression
life threatening poor fluid intake strong suicidal intent psychotic features or stupor antidepressants ineffective
54
what types of schizophrenia can be treated with ECT
catatonic states positive psychotic symptoms schizoaffective disorder
55
what are side effects of ECT
loss of memory (particularly before and after ECT) confusion, headache, nausea, muscle pain
56
true or false - patients do not need any more treatment after ECT
false | - they still need to continue medication

Psychiatry SB (23 decks)

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