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Flashcards in Drugs Deck (95):
1

Another name for typical/1st generation antipyschotics

Neuroleptics

2

Uses for antipyschotics

- Schizophrenia
- Mood disorders with/without psychosis
- Violent behaviour
- Autism
- Tourette's
- Somatoform disorder
- Dementia
- OCD

3

Time for antipsychotics to have other effects

2-4 weeks

4

What substance is added to an antipsychotic to make it long-acting and injectable?

Oil

5

General mechanism of action - antipsychotics

Blockade of dopamine receptors (to varying degrees and in the CNS)

6

What does dopamine cause in schizophrenia?

Positive symptoms

7

Which receptors does typical antipsychotics block?

D2 - post-synaptic

8

What receptors does atypical antipsychotics antagonise?

D2 and 5HT2 (pre-synaptic)

9

Name some metabolic side effects

- weight gain
- hyperglycaemia
- lipid abnormalities

10

Name 7 TYPICAL antipsychotics

- Haloperidol
- Fluphenazine
- Zuclopenthixol
- Perphenazine
- Loxapine
- Chlorpromazine

11

Name 8 ATYPICAL antipsychotics

- Risperidone
- Paliperidone
- Olanzapine
- Asenapine
- Ziprasidone (HCl/Decanoate/Acetate)
- Aripiprazole
- Quetiapine
- Clozapine

12

Generic name for Haloperidol

Haldol

13

Generic name for Zuclopenthixol HCl

Clopixol

14

Generic name for Zuclopenthixol acetate

Acuphase

15

Generic name for Perphenazine

Trilafon

16

Generic name Loxapine HCl

Loxitane

17

Generic name for Chlorpromazine

Largactil

18

Generic name for Risperidone

Risperdal

19

Generic name for Paliperidone

Invega

20

Generic name for Olanzapine

Zyprexa

21

Generic name for Asenapine

Saphris

22

Generic name for Ziprasidone

Zeldox

23

Generic name for Aripiprazole

Ablilfy

24

Generic name for Quetiapine

Seroquel

25

Generic name for Clozapine

Clozaril

26

Advantages of Risperidone (Risperdal)

- Lower incidence of EPS compared to typicals
- Less weight gain
- Quick dissolve
- LA available

27

Risperidone side effects

- Insomnia
- Agitation
- Anxiety
- Postural hypotension
- Constipation
- Dizzy

28

Advantages of Olanzapine

- Well tolerated
- More effective than Haloperidol
- Minimal anticholinergic SE
- Quick dissolve (ED)
- IMI available

29

Olanzapine side effects

- Mild sedation
- Insomnia
- Dizzy
- AST/ALT elevation
- Restlessness
- Metabolic effects

30

Advantages of Quetiapine (Seroquel)

- Less weight gain
- Mood stabilising

31

Quetiapine side effects

- Sedation
- Constipation

32

Advantages of Clozapine (Clozaril)

- Most effective --> especially for resistant schizophrenia
- Do not worsen tardive symptoms

33

Clozapine side effects

- Drowsy
- Sedation
- Hypersalivation
- Increased HR
- Dizzy
- Myocarditis
- Cardiomyopathy
- *** 1% agranulocytosis

34

Special tests needed for patients on Clozapine

- Weekly blood counts for the first 6 months

35

Contraindications with Clozapine

- Drugs that cause bone suppression

36

Advantages of Aripiprazole

- Less weight gain
- Less risk of metabolic syndrome
- Less EPS

37

Aripiprazole side effects

- Agitation
- Insomnia
- Anxiety
- Weight gain
- Decreased serum prolactin

38

Ordered drugs - risk of weight gain

Clozapine > Olanzapine > Quetiapine > Risperidone

39

Anticholinergic side effects

** greatest in typical psychotics
- Dry mouth (spit)
- Constipation (shit)
- Urinary retention (pee)
- Blurred vision (see)

- Severe cases - anticholinergic delirium

40

General side effects of antipsychotics

- Anticholinergic side effects
- Reduced seizure threshold
- Hypotension (orthostatic) (due to alpha-receptor blockage) (most common with Risperidone and low potency drugs)
- Agranulocytosis
- Cardiac (QT prolongation (Ziprasidone, Risperidone))
- Myocarditis
- Metabolic side effects
- Movement disoder (dystonia, EPS, akathisia, neuroleptic malignant syndrome, tardive dyskinesia)
- Skin and ocular pigmentation
- Photosensitivity
- Increased prolactin
- Cataracts

41

What causes Neuroleptic malignant syndrome

Massive dopamine blockade

42

Symptoms of Neuroleptic Malignant syndrome

- Mental state change
- Fever
- Autonomic reactivity
- Rigidity

- Increased creatinine phosphokinase
- Leukocytosis
- Myoglobinuria

43

Treatment for Neuroleptic Malignant syndrome

- Supportive treatment
- Cool and hydrate
- DA agonist (Bromocriptine)

44

Acronym for features of NMS

F - Fever
A - Autonomic changes (increased HR, BP, sweat)
R - Rigidity of muscles
M - Mental status changes/confusion

45

4 features of Extrapyramidal Side Effects

- Dystonia
- Akathisia
- Pseudoparkinsonism
- Dyskinesia

46

Antipsychotics that require cardiac monitoring

- Chlorpromazin
- Haloperidol
- Ziprasidone
- Clozapine

47

All BZDs are .......

Sedating

48

BZD - Mechanism of action

Potentiate binding of GABA to its receptor --> leads to decreased neuronal activity

49

All anxiolytics have similar efficacies - what determines which one you use (3 reasons)

- Half life
- Metabolites
- Administration route

50

Onset of withdrawal from anxiolytics (time period)

1-4 days

51

Symptoms of low dose withdrawal - anxiolytics

- Tachycardia
- HTN
- Panic
- Insomnia
- Impaired memory/concentration
- Perceptual disturbance

52

Symptoms of high dose withdrawal - anxiolytics (note: similar to alcohol withdrawal)

- Hyperpyrexia
- Seizure
- Psychosis
- Death

53

Anxiolytics - short-term uses

- Insomnia
- Alcohol withdrawal
- Agitation (mania/delirium/psychosis)
- Catatonia

54

Avoid alcohol with anxiolytics: y/n

yes (similar CNS depression)

55

Anxiolytic side effects

- Drowsy
- Cognitive impairment
- Decreased motor coordination
- Memory impairment

56

Anxiolytics are safe in liver impairment: y/n

yes (not metabolised by the liver)

57

Name 4 long-acting BZD

- Clonazepam
- Diazepam
- Chlordiazepoxide
- Fluazepam

58

Name 5 short-acting BZD

- Alprazolam
- Lorazepam
- Oxazepam
- Temazepam
- Triazolam

59

Contraindications for use of anxiolytics

- Severe respiratory depression
- Severe hepatic impairment
- Myasthenia gravis

60

Route of metabolism - anxiolytics

- Some oxidation
- Some conjugation

61

Xanax = ......

Alprazolam

62

Valium = ....

Diazepam

63

4 BZD general side effects

- Behavioural disinhibition (hostile, irritable)
- Psychomotor impairment (dysarthria, ataxia, drowsy)
- Cognitive impairment
- Withdrawal phenomena (flu-like, psychotic, seizures)

64

BZD antagonist

Flumazenil (Anexate)

65

Main indication for use of Buspirone (Buspar)

GAD

66

Buspirone - mechanism of action

5HT1A agonist (with some D2 antagonist effect)

67

Features of Buspirone

- Long lag time/takes weeks to work
- Not sedative
- Cannot treat insomnia
- Cannot treat BZD or alcohol withdrawal (no GABA effects)

68

Use of SSRIs for depression

First line - Panic, social anxiety, OCD, GAD, PTSD
- Need greater dose than used for depression
- For GAD = combine with Venlafaxine and Buspirone

69

Hypnotics - 2 examples

Z drugs - Zolpidem, Zolpiclone
- Act similar to BZD

70

Define euthymia

normal mood, not depressed, reasonably positive

71

Time lag for full effects of mood stabilisers

- 2-4 weeks before full effect

72

Name 3 anti-convulsants

- Valproate
- Lamotrigine
- Carbamazepine

73

Mechanism of action - mood stabilisers

Unclear
- Many NT influenced

74

Indications for lithium use

- Acute mania
- Bipolar 1 depression
- Bipolar disorder maintenance

75

Neurotransmitters influenced by lithium in the CNS

- Noradrenaline
- Serotonin

76

Clearance mechanism - lithium

Renal

77

Monitoring needed for people on lithium

- Serum concentration
- Thyroid function

78

Lithium daily dosing

600-1500mg/day

79

Lithium side effects

- N/V
- Diarrhoea
- Stomach pain
- Weight GAIN
- Psoriasis
- Polyuria/dypsia
- Renal failure
- Fine tremor
- Lethargy
- Oedema
- ECG changes
- Fatigue
- Headache
- Reversible leucocytosis
- Muscle weakness

80

Affect on thyroid with lithium

Hypothyroidism
- 5% users
- Interferes with thyroid hormone production

81

What increases risk of lithium toxicity?

- Impaired renal function
- Dehydration

82

Symptoms of lithium toxicity

- Severe N/V
- Diarrhoea
- Ataxia
- Slurred speech
- Lack of coordination
- Drowsy
- Myoclonus
- Tremour
- Seizure
- Delirium
- Coma

83

Interventions/treating lithium toxicity

- Saline infusion
- Haemodialysis

84

Indications for Lamotrigine use

- Bipolar 1 depression
- Bipolar maintenance
--> Most effective when combined with lithium

85

Mechanism of action of Lamotrigine

Inhibit voltage-gated sodium channels - modulate pre-synaptic excitatory NT release

86

Generic name for Lamotrigine

Lamictal

87

What is Lamotrigine NOT indicated for

Acute use

88

Dose-related allergic reaction to Lamotrigine

Steven-Johnson syndrome (skin rash)

89

Lamotrigine side effects

- N/V
- Diarrhoea
- Ataxia
- Dizziness
- Diplopia
- Headache
- Somnolence
- Rash (SJS) - 10%
- Anxiety

90

Lamotrigine - most useful for....

Bipolar depression (as non-manic inducing)

91

Unlike other anticonvulsants, Lamotrigine.....

Has no effect on folate levels - safer for pregnancy

92

Other name for Sodium Valproate

Divalproex

93

Generic name for sodium valproate

Epival

94

Indications for Sodium Valproate

- Acute mania
- Bipolar depression - with SSRI or Lithium
- Bipolar disorder maintenance
- Impulse dyscontrol

95

Sodium valproate is well-tolerated as a _____ therapy

Long-term