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Toni's Psych > Pharmacological Therapy > Flashcards

Pharmacological Therapy Flashcards

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1
Q

What are the TCAs?

A 
Amitriptyline - most tox, sed
Imipramine - less sed
Lofepramine - least tox in OD, less sed 
Clomipramine - sed
Dosulepin - most tox, sed 
Trazodone - sed
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2
Q

SSNRIs

Selective serotonin and noradrenaline reuptake inhibitor

A

Venlafaxine

Duloxetine

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3
Q

What are Mirtazapine’s SEs?

A

Increased appetite/weight gain
Sedation
Oedema

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4
Q

What are the SSRIs?

A 
Sertraline
Paroxetine
Citalopram
Fluoxetine
Fluvoxamine
Escitalopram
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5
Q

What are the atypical antipsychotics?

A 
Dopamine D2 receptor blockade
Olanzapine +ve sx
Risperidone
Clozapine
Aripiprazole red EPSE
Quetiapine
Amisulpride
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6
Q

What are the typical antipsychotics?

A

Dopamine D2 receptor blockade
Haloperidol
Chlorpromazine
Flupentixol decanoate - depot assoc with v severe EPSEs
Tend to cause distressing EPSEs at normal treatment doses

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7
Q

What are SEs of typical antipsychotics?

A 
EPSE: extra pyramidal side effects
Hyperprolactinaemia
Weight gain, dyslipidaemia + increased risk diabetes
Sedation
Anticholinergic SE
Arrhythmias
Seizures
Neuroleptic malignant syndrome
Hypotension
Tachycardia
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8
Q

Clozapine

A

Most common side effect= hypersalivation
1-2% Agranulocytosis rate
Myocarditis
Arrhythmia

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9
Q

Quetiapine

A

Diabetes
Weight gain
Lipid abnormalities

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10
Q

Risperidone

A

Increased prolactin levels

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11
Q

Olanzapine

A

Diabetes
Weight gain
Lipid abnormalities

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12
Q

What are the benzodiazepines?

A

Incr Cl channel freq = enhance GABA

Diazepam
Clonazepam
Alprazolam

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13
Q

What are the MAOIs?

A

Irreversible MAO inhibition
Phenelzine
Moclobemide: reversible inhibition
Trancypromine

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14
Q

How would you counsel patients regarding SSRIs?

A

Avoid drinking alcohol whilst in antidepressants due to increased sedation
Never drive if feeling drowsy on antidepressants
Onset of action is delayed
Outline side effects

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15
Q

What are common side effects of SSRIs?

A 
Nausea, vomiting
Appetite, weight change
Blurred vision
Anxiety + agitation
Insomnia, tremor, dizziness
Headache
Sweating
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16
Q

What are common side effects for SSNRIs

A

Same as SSRIs plus
Constipation
Hypertension
Raised cholesterol

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17
Q

NASSAs

Noradrenergic and Specific Serotonin Antidepressant

A

Mirtazapine

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18
Q

What are the SEs of TCAs?

A 
Tachycardia, arrhythmia
Dry mouth, blurred vision, 
Constipation, urinary retention
Postural hypotension
Sedation
Nausea, weight gain
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19
Q

What are the common side effects of MAOIs?

A 
Hypertensive crisis "cheese reaction"
Postural hypotension, dizziness
Drowsiness, insomnia
Headache, blurred vision
Nausea, vomiting
Constipation
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20
Q

What are the side effects of St John’s Wort?

A

As effective as TCAs for mild-mod depression
Photosensitivity
Anxiety dizziness
GI symptoms
Fatigue, headache
Induces P52 risks drug interactions: reduces warfarin, ciclosporin, COCP

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21
Q

What are discontinuation symptoms?

A

Occur when antidepressant stopped suddenly:
Flu like sx, electric shock sensations, headaches, vertigo, irritability
To avoid withdraw over a few weeks

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22
Q

What should you be careful of when swapping antidepressants?

A

If of different classes they might interact dangerously: check!
SSRI-> TCA: cross-taper
Drug free washout period: fluoxetine 1 wk
Start venlafaxine v slowly 37.5mg each day

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23
Q

What is serotonin syndrome?

A

Excess serotonin
Potentially life-threatening
Sx: restlessness, sweating, myoclonus, confusion, fits

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24
Q

Buspirone

A

Acts on 5HT1a receptor
Anxiolytic
No antidepressant action alone
May synergistic effect in combination with SSRIs

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25
What are the mood stabilisers?
Lithium Sodium valproate Carbamazepine ?action on Na channels / GABA
26
Lithium
Unknown mech of action ? cAMP inhibition Therapeutic range: 0.6-1mmol/L >1.2 mmol/L = toxic Monitored weekly after start/ dose change until a steady therapeutic level achieved U+Es & TFTs every 3-6 months Can cause renal impairment + hypothyroidism
27
Valproate
Active drug= valproic acid An anticonvulsant Plasma levels don't require monitoring Dose related toxicity not an issue
28
Carbamazepine
``` 2nd line, less effective than lithium Anticonvulsant Can cause toxicity at high doses Induces liver enzymes Levels must be carefully monitored ```
29
Lithium SEs
``` Mild tremor Nausea + vomiting Polyuria, polydipsia Arrhythmia Hypothyroidism Weight gain ```
30
Valproate SEs
``` Nausea, vomiting, diarrhoea Liver failure Thrombocytopenia Hair loss Weight gain ```
31
Carbamazepine SEs
``` Rash Leukopenia Dizziness, ataxia Drowsiness, fatigue Nausea, vomiting Oedema, weight gain, hyponatraenia ```
32
Lithium toxicity
Presents: GI disturbance, sluggishness, giddiness, ataxia, gross tremor, fits, renal failure Triggers: salt balance changes, drugs affecting lithium excretion (NSAIDs, diuretics, ACEi), OD Management: stop lithium, medics: rehydration, osmotic diuresis
33
Mood stabilisers and pregnancy, what are the risks and how are they mitigated?
Lithium: Ebstein's anomaly Valproate + Carbamazepine: spina bifida Teratogenic risk must be weighed against harm of a manic relapse! Women of childbearing age: contraceptive advice + folate supplement If medications are used during pregnancy close monitoring of fetus req
34
What are the EPSEs associated with antipsychotics?
Dystonia: involuntary painful sustained muscle spasm - within hours - torticolis, oculogyric spasms Akathisia: unpleasant feeling of restlessness -> pacing/jiggling - hours to weeks Parkinsonism: resting tremor, rigidity, bradykinesia - days to weeks Tardive dyskinesia: rhythmic involuntary movements, often grimacing, sucking or chewing movements - months to years
35
How are EPSEs of antipsychotics treated?
``` Dystonia = anticholinergics e.g. Procyclidine Akathisia = decr dose/change antipsychotic, add propanolol or benzos Parkinsonism = decr dose/change antipsychotic, anticholinergic Tardive dyskinesia (oft irreversible) = stop antipsychotic/decr dose avoid anticholinergics, switch to atypical / clozapine ```
36
What factors are associated with increased risk of violence in schizophrenics?
``` Past Hx violence Substance misuse Acute psychotic symptoms Non-concordance with treatment Access to weapons Specific threats to a victim Comorbid personality disorder ```
37
What risk is a schizophrenic to themself?
Lifetime suicide risk= 10% Self neglect Social decline Risk highest in early years after diagnosis, following 1st admission or where there are depressive symptoms
38
What is the prognosis in schizophrenia?
25% experience no further issues after one episode 66% remain liable to relapse 10% seriously and continuously disabled
39
What SSRI is preferred post MI?
Sertraline
40
What SSRI is preferred in children + young adults?
Fluoxetine
41
Which SSRI should be avoided in those with known long QT or taking other drugs which could prolong QT
Citalopram Also assoc with sexual dysfunction
42
If prescribing SSRI to a patient on NSAIDs what must you also prescribe?
PPI!
43
If prescribing SSRIs what might give you cause to reconsider?
Warfarin/heparin - avoid SSRIs -> mirtazapine NSAIDS - avoid/ coprescribe PPI! Triptans - avoid SSRIs Renal impairment -> incr risk SIADH: monitor renal function + U + Es
44
When should SSRI use be reviewed?
In
45
How do you avoid discontinuation symptoms following SSRI use?
Gradually reduce dose over 4 wks when stopping Except fluoxetine which can be stopped straight away Incr risk of sx with paroxetine
46
What are the discontinuation sx seen following abrupt end to SSRI use?
``` Mood changes Restlessness Difficulty sleeping Unsteadiness Sweating GI sx Paraesthesia ```
47
When would clozapine be offered?
With treatment resistant schizophrenia Only after: 2 other antipsychotics, one being an atypical Which were trialled for 6-8 wks without effect
48
What increased risks are associated with antipsychotic use on the elderly?
Incr stroke risk | Incr VTE risk
49
What are the non EPSEs of antipsychotics?
Anti muscarinic sx Sedation Weight gain Incr prolactin: galactorrhoea, red glucose tolerance Neuroleptic malignant syndrome: pyrexia muscle stiffness Red seizure threshold Prolonged QT
50
Causes of long QT syndrome
Normal=
51
How do you treat TCA overdoses presenting with widened QRS complexes
IV bicarbonate
52
How do you treat lithium OD?
Mild/mod: fluid resus with IV normal saline | Severe: haemodialysis
53
How do you treat benzo OD?
Flumazenil
54
How do you treat opiate OD?
Naloxone
55
How do you treat paracetamol OD?
Ingestion
56
How do you treat salicylate OD
Haemodialysis (Urine alkalinisation if mild but CI in cerebral + pulm oedema
57
How do you treat warfarin OD?
Vit K | Prothrombin complex
58
How do you treat heparin OD?
Protamine sulphate
59
How do you treat beta blocker OD?
If bradycardic give atropine | If resistant give glucagon
60
How do you treat ethylene glycol OD?
Fomepizole
61
How do you treat methanol poisoning
Fomepizole or ethanol | Haemodialysis
62
How do you treat organophosphate poisoning?
Atropine
63
How do you treat digoxin OD
Digoxin specific antibody fragments | Aka digibind
64
How do you treat iron overload?
Desferrioxamine
65
How do you treat lead poisoning?
Dimercaptol | Calcium edatate
66
How do you treat cyanide poisoning?
Hydroxycobalamin | Amylnitrite, sodium nitrite + sodium thiosulphate
67
What is neuroleptic malignant syndrome?
Oft just commenced antipsychotics ATN + renal failure | 10% mortality
68
How do you manage neuroleptic malignant syndrome?
Stop antipsychotics IV fluids to prevent renal failure Dantrolene Bromocriptine
69
TCA CIs
Recent MI Prostatic hypertrophy Narrow angle glaucoma
70
How do you withdraw benzodiazepines?
1/8 of daily dose reduction every fortnight Difficulty: Or switch to equivalent dose diazepam and reduce 2-2.5 mg fortnightly May take 4 wks to a year to withdraw
71
Sx of benzo withdrawal
``` Up to 3 wks after stopping: Insomnia Irritability Anxiety Tremor Loss of appetite Tinnitus Perspiration Perceptual disturbances Seizures ```
72
Barbituates
Enhance GABA by incr duration of Cl channel opening
73
Rapid tranquilisation
Only after failure of non pharm methods and refusal of oral meds With sufficient risk to themselves / others With sufficient flumazenil on site 2mg IM lorazepam 10mg IM haloperidol
74
Medication which can cause priapism
Trazodone | Chlorpromazine

Toni's Psych (14 decks)

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