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Psych Flashcards

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1
Q

First line treatments for depression?

A

Mild: CBT, Supportive and monitoring

Mod to severe or depressed over 2 years: antidepressants and CBT

severe: ECT /rEMT

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2
Q

First line antidepressants

A 
SSRIs
- sertraline
- citalopram
- fluoxetine
- paroxetine
In elderly: mirtazapine should be considered
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3
Q

Second line antidepressants and reasons when used?

A

NSRIs e.g. venlafaxine can go to higher doses, also inhibits NA uptake. Low doses affect serotonin, high doses affect noradrenaline.
Duloxetine- lower dose range,

Similar side effects to SRIS but more sedation, nausea and sexual dysfunction.
Caution with venlafaxine at high dose

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4
Q

Last resort antidepressants? Name them

A

MAOIs- isocarboxid (irreversible)
- trancylyopromine
- phenelzine
Use - atypical depression, Parkinson’s.

TCAs - lometraine and nortryptyline
Triazone in dementia for agitation

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5
Q

Side effects of trancylpromide and phelyzine

A

SE: postural hypotension, dizzy. Can cause hallucinations. Uncommon- change in behaviour, and agitation
Can’t eat cheese and wine
Risk: tyramine reaction potential causing HTN crisis

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6
Q

What can TCAs be used for

A

Amitriptyline- neuropathic pain

Triazone- agitation in dementia

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7
Q

New antidepressants

A

Vortioxetine- well tolerated

Agomelatine- regulates melatonin and boosts NA and dopamine

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8
Q

Side effects of SSRIs

A

Weight loss, sexual dysfunction, anorexia, nausea, restlessness and agitation
Less common- suicidal thoughts, bleeding, headache
Rare- neurological , mania, extrapyramidal e.g. Tremor

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9
Q

Risks of using SSRIs with specific examples for each

A

Sertraline. General se
Citalopram- QT prolongation
Fluoxetine- serotonin syndrome
Paroxetine - discontinuation syndrome

All some cardiac risks but sertraline safest

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10
Q

What is mirtazapine and what are its side effects

A

Non selective SRI
Strong H1 activity so sedation, weight gain (2 stones)
Postural hypotension
Helps sleep sedation

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11
Q

Uses of MAOIS

A

MAOI- A e,g, trancylopromide. Atypical depression

MAOI B rasagiline anti Parkinson’s

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12
Q

Name first line drugs for schizophrenia

A 
Atypical antipsychotics 
Olanzapine
Quatiapine
Rispiridone
Paliperidone
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13
Q

How do antipsychotics work?

A

Majority block dopamine receptors. Block mesocorticol and mesolimbic pathways but also affect the nigostriatal and tuberoinfundibular pathways

Atypicals e.g olanzapine also block alpha adrenoreceptors therefore antihistamine like effect e.g, drowsy

clozapine- seratonin ,a1aR and M aswell (ANTAGONIST)

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14
Q

Describe side effects of atypical antipsychotics

A

All antipsychotics
Sedation
Extrapyramidal- dyskinesia, akathisia, bradykinesia, muscle stiffness, tremor,
Endocrine- weight gain, hyperprolactinaemia, pigmentation

Atypical- more endocrine weight gain and serotinergic than extrapyramidal. Caution with prolactin in rispiridone
Typical- more extrapyramidal and less endocrine weight gain and reduced DM risk

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15
Q

Why do side effects occur with antipsychotics

A

The antipsychotic targets not only mesocorticol and mesolimbic pathways but also the nigostriatal (movement ) and tuberoinfundibular pathways (HPO axis)

Typical anticholinergic SE
- can’t pee
Can’t see
Can’t shit

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16
Q

When would you avoid olanzapine? Rispiridone.

A

Not working

Acute MI
Severe problems with oedema or weight

Rispiridone- women who are planning pregnancies or any younger women really caution with prolactin–> sterile

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17
Q

What is amisulphride used for?

A

Antipsychotic, blocks d receptors.
Least risk of weight gain and diabetes in antipsychotics

Schizophrenia, mania, psychosis

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18
Q

Side effects of clozapine

A

Sever neutropenia and leukocytosis
Severe constipation and potentially fatal bowel obstruction

More common: weight gin, anortedia, cvs risks, postural hypotension
Hyperprolactinaemia

Regular monitoring and 1-2 weeks to withdraw

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19
Q

Name a typical antipsychotic, it’s use and SE

A 
Haloperidol
Used in emergencies, short term, occasionally long term 
Causes more extrapyramidal side effects
Less sedation and antimuscurinic,
Can cause over excitement

Risk- neuroleptic malignant syndrome
Toxic- CNS depression, cardiac, risk of sudden death

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20
Q

Other typical antipsychotics

A

Haloperidol
Zuclopenthixol
Chlorpromazine
Pericyazine

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21
Q

Name some antipsychotics available as depot

A 
Rispiridone
Paliperidone
Olanzapine, needs 3hr wait period post injections
Zuclopenthixol
Haloperidol
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22
Q

How do you treat anxiety

A

CBT, psychoeducation, management techniques and mindfulness
Treat coexisting conditions e,g, depression
Pharmacological

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23
Q

First line pharmacology for anxiety

Study These Flashcards
A

SSRIs

Similar and slightly higher dose than depression,in OCD increase the dose

24
Q

Alternative anxiety treatments, pharm

Study These Flashcards
A

Beta blockers e.g, propranolol

Pregablin- neuropathic pain

Antipsychotics
Not really benzodiazepines e.g. Diazepam, lorezepam

25
Mechanisms of pregablin
Bind to VGCC in neurones , increase concentration of the enzyme needed to produce GABA CNS depressant so reduces neuronal activity Use. Neuropathic pain, anxiety, epilepsy
26
Name some mood stabilisers
``` Lithium Sodium valproate Carbamazepine Lamotrigene Antipsychotics ```
27
Side effects of lithium (not toxic)
Hypoparathyroidism Hypothyroidism Renal impairment ``` Se: memory problems Confusion, fine tremor, n&vom, ataxia, seizures, anorexia Metallic taste Rash, Inc seratonin- so polyuria and dipsa ```
28
Toxic effects of lithium what should you monitor
Thyroid toxicity Risk of hypoparathyroidism and hypothyroidism (Tingling, muscle ache, spasm) and (Stones moans and groans) Renal toxicity- hypokalaemia Early, constipation, fatigue,muscle weakness and spasms dysrhythmia, Toxic- Convulsions, coarse tremor, n and vom, ataxia, seizures, anorexia, Emergency- convulsions, dehydration, collapse
29
Se of valporic acid
Aggression, confusion, deafness, Extrapyramidal, convulsion, headaches, memory GI- anaemia, diarrhoea irritation Menstrual disturbance
30
Toxic effects of sodium valproate
Liver toxicity | Tetatrogenic
31
Interactions of sodium valproate
Is a P450 inhibitor Therfore can affect drugs such as OCP, warfarin, corticosteroids and statins Other inhibitors can decreases the levels Other inducers e,g, carbamazepine increase levels
32
Name p450 inducers
``` CRAPS out drugs Carbamazepine Rifampicin bArbituates Phenytoin St Johns wort ```
33
Name p450 inhibitors
Some certain silly compounds annoyingly inhibit enzymes grrr ``` Sodium valproate Ciprofloxacin Sulphonamide Cimetidine, omeprazole Antifungals, amiodarone Isoniazid Erythromycin, clarinthromycin Grapefruit juice ```
34
Se of carbamezapine
Cardiac toxicity Allergic skin disease, dermatitis, fatigue, drowsy, anaemia, leukopenia, vomiting oedema
35
Interactions of carbamazepine
P450 induced so decreases levels of OCO, warfarin, TCAs, other anticonvulsants
36
Toxicity of carbamazepine
Cardiac diseas,e | Liver disease, caution needed
37
Function of lamotrigene and its side effects
Mood stabilisers, that can be used in bipolar Dizzy postural hypotension, blurred vision, coordination, rash Risk of Steven Johnson Monitor liver
38
What can be given in acute manic episodes
Check mood stabilisers levels Antipsychotics Olanzaoine, rispiridone, aripriprazole
39
Acute depressive enzymes
Check medication serum levels Other medications hypothyroidism? Add ssri or quituapine
40
Medications for dementia. Which type of dementia do they treat
Acetyl cholinesterase inhibitors Donepezil Rivastigmine ((Lewy body) Galantamine Mild to mod dementia and Lewy body NMDA antagonist, memantadine. Severe Alzheimer's
41
Alternative medications for people with dementia
TCAs for agitations | Trazadone
42
First line pharmacology for ADHD And its side effects Other uses
Methylphenidate CNS stimulants Growth defect in children, monitor Monitor pulse, Nausea appetite loss insomnia, headaches, Other uses: Tourette's, anxiety, conduct disorders ,tics
43
Alternative ADHD medications
Atomoxetine, non stimulatnnCNS More anorexia, less growth suppression, fatigue dry mouth Dexamphetamine - CNS stimulant Not first line but if atypical Stunted growth so only give to improve concentration E.g term time
44
Antidepressants with sedative action
Mitrazipine | Trazodone
45
Antipsychotics with sedative action
Promethazine | Has antihistamine ad antimuscurinc effects
46
Sleeping tablets
Non benzos Zopiclone and zopliedem Benzos- lormetezepam,
47
Drugs that can cause serotonin syndrome
``` MAOIs Other antidepressants Analgesics Antiemetics, metoclopramide Recreations, MDMA,coke Others linozoid, tryptophan ```
48
Features of seratonin syndrome
Autonomic hyperactivity. HTN, hyperthermia, excessive sweating Neuromuscular abnormality, tremor, clonus, hyperreflexia Mental state changes, anxiety, agitation, confusion, coma Presents after increasing medication or adding an additional one . Within 6hrs
49
Early and late signs of seratonin syndrome
Early- tremor akathsia (can't sit still) diahorrhea Late- agitation, hyper vigilance, pressure speech, acute delirium
50
Differences between neuroleptic malignant syndrome and serotonin syndrome
NMS- hypoventilation from muscle rigidity, shuffling gait and difficulty walking Potential oculogyric crisis (eyes rolled up) or seizure Occurs over longer time over 10 days not 6 hrs.
51
Causes of NMS
Drop in dopamine Blocking receotirs Stopping Parkinson's treatments - block dop levels Starting anypsychotics, and Antiparkinsons: anticholinergics, levodopa, amantadine Antidepressants , venlafaxine, clopramine Oral contraceptives , lithium, carbamezapine
52
Pharmacological treatments for PTSD
Short term hypnotics ``` Antidepressants if severe - mitrazipine - paroxetine Amitryptiline Phenelzine ```
53
First line treatments for PTSD
Trauma focused CBT EMDR- eye movement desensitisation and reprocessing Psychoeducation Peer support
54
First line pharmacology for depression
SSRIs - fluoxetine - sertraline (not bipolar ) Venlafaxine Metizapine
55
First line pharmacology for depression
SSRIs - fluoxetine - sertraline (not bipolar ) Venlafaxine Metizapine
56
First line pharmacology for depression
SSRIs - fluoxetine - sertraline (not bipolar ) Venlafaxine Metizapine

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