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psych drugs Flashcards

1
Q

Side effects of lithium?

A 
Dry mouth 
Diarrhoea 
Metallic taste 
Tremor 
Weight gain 
Water retention 
Hypothyroidism
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2
Q

What safety measure should be taken when starting lithium?

A

Check bloods 5 days after starting

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3
Q

Signs of lithium toxicity?

A 
GI disturbances 
Polyuria 
Muscle weakness 
Tremor 
Confusion / drowsiness / CNS disturbances
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4
Q

What’s the recommended monitoring for lithium?

A 
FBC
TFT 
U and Es
LFTs 
Lithium plasma level

Bloods every week until level has stabilised, then every 3 months

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5
Q

Can you use lithium in renal impairment?

A

Caution in mild / moderate.

Avoid in severe impairment

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6
Q

Can you use lithium in pregnancy?

A

Avoid if possible, esp. in 1st trimester

Dose requirements increase in 2nd and 3rd trimester, but abruptly return to normal after delivery

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7
Q

Can lithium be used in breastfeeding?

A

No.

Present in milk and risk of toxicity to baby.

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8
Q

What’s lithium used for?

A

Bipolar maintenance

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9
Q

Anything to be aware of with stopping lithium?

A

Reduce dose gradually over min. 4 weeks if possible. Risk of relapse if stopped abruptly.

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10
Q

Uses of sodium valproate?

A

Anticonvulsant. First line in primary generalised epilepsy.

Also used for mania in bipolar.

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11
Q

Side effects of sodium valproate?

A 
Teratogenic (NTD)
GI upset
Weight gain 
Tremor 
Unsteadiness
Alopecia
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12
Q

Can sodium valproate be used in liver and renal impairment?

A

Avoid if possible in hepatic impairment.

Reduce dose in renal impairment.

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13
Q

Sodium valproate in pregnancy?

A

AVOID.

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14
Q

Sodium valproate in breast feeding?

A

Small amount present in milk but can still be used

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15
Q

Which SSRI is recommended for under 25s? Why can’t you use the others?

A

Fluoxetine can be used but only in conjunction with psych therapy.

Others cause increase in suicide risk and don’t have sufficient evidence.

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16
Q

Which antidepresants can be used in pregnancy?

A

Sertraline
Fluoxetine
Citalopram

note: avoid in 1st trimester if possible, but sometimes benefit outweighs risk

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17
Q

Risks of SSRis in pregnancy?

A

Cardiac defects

Pulmonary hypertension of the newborn

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18
Q

Which SSRIs are considered safe while breastfeeding?

A

Sertraline and paroxetine

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19
Q

Which antidepressant is best for patients post-MI or with angina?

A

Sertraline

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20
Q

Why are SSRIs better than TCAs for suicidal patients?

A

Safer in overdose

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21
Q

Which drug is mostly to be used in combination with an SSRI?

A

Mirtazepine - it’s the only one that’s used in combo.

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22
Q

When treating mood disoders in older patients, why should you be cautious of SSRIs and SNRIs?

A

HYPONATRAEMIA

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23
Q

Which drugs used for treating mood disorders may cause problems with cognition in older patients?

A

Tricyclics

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24
Q

What should you warn patients about if you’re starting them on a MAOI?

A

CHEESE.
Risky interactions with some foods can cause severe hypertension

(MAOIs are non-selective…patients cannot metabolise products containing tyramine if they’re on the drugs. MAOIs will also potentiate the effect of other drugs by decreasing their metabolism)

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25
Q

How long should patients continue taking antidepressants after their symptoms have subsided?

A

6 months at the same dose

or 2 years if there’s a history of recurrence

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26
Q

What does the enzyme monoamine oxidase do?

What’s the effect of MAOIs?

A

MAO breaks down neurotransmitters. MAOIs inhibit the enzyme, so more monoamine is left in the synaptic cleft

(dopamine and serotonin are both monoamine neurotransmitters)

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27
Q

Examples of MAOIs?

A

Phenelzine

Moclobemide

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28
Q

Examples of tricyclic antidepressants?

A

Imipramine

Amitriptylline

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29
Q

Examples of SSRIs?

A

Fluoxetine
Sertraline
Escitalopram
Citalopram

30
Q

How do SSRIs work?

A

Selectively inhibit the reuptake of 5HT from the synaptic cleft

31
Q

Common side effects of SSRIs?

A 
Nausea 
Headache
Sweating, vivid dreams 
Worsened anxiety 
Sexual dysfunction 
Hyponatraemia (in elderly) 
Transient increase in self-harm (<25y/o)
Discontinuation effects

Remember: serotonin inhibitors can be used as anti-emetics and anti-migraine medication - SSRIs are the opposite, hence the side effects of headache and nausea

32
Q

What’s an SNRI? Give two examples

A

Blocks the reuptake of monoamines (noradrenaline and 5HT) into presynaptic terminals

Examples: duoloxetine, venlafaxine

(similar side effects to SSRIs)

33
Q

How does mirtazepine work?

A

Blocks a mixture of receptors: alpha2, 5HT2 and 5HT3

34
Q

Common side effects of mirtazpine?

When might this be useful?

A

Promotes sleep and increases appetite / weight gain.

Good for insomnia

35
Q

When starting an antidepressant, when should you arrange a review for the patient?

A

after 1-2 weeks

36
Q

How long should patients persevere with a new antidepressant before considering changing the drug?

A

4 weeks

37
Q

How do you treat acute mania in bipolar?

A

Antipsychotics

Olanzapine, quetiapine, risperidone

38
Q

How do you treat acute bipolar depression?

A

Antipsychotics (quetiapine or olanzapine), ECT or lithium

DON’T USE ANTIDEPRESSANTS WITHOUT AN ANTIMANIC DRUG

39
Q

How do benzodiazepines work?

A

Enhance GABA action

40
Q

What is GABA?

A

Inhibitory neurotransmitter.

Gama-aminobutyric acid

41
Q

Examples of benzodiazepines?

A

Lorazepam

Diazepam

42
Q

What would you use to reverse benzodiazepines in overdose?

A

Flumazenil

43
Q

How long does it take for a patient to come off benzodiazepines if they’ve been used long term?

A

Up to 1 year

Reduce dose every 2-3 weeks in steps of 2 - 2.5mg

44
Q

Where are serotonin neurons found?

A

Primarily in the brainstem, in raphe nuclei

45
Q

How does serotonin leave the synaptic clef?

A

Serotonin transporter protein

46
Q

How do typical antipyschotics work?

Give examples.

A

Inhibit D2.

Chlorpromazine, haloperidol, thioridazine

47
Q

What’s the benefit of atypical antipsychotics over typicals?

A

Less likely to cause extra-pyramidal side effects

48
Q

Give examples of extra-pyramidal side effects?

A 
Acute dystonic reaction (muscle spasms) 
Parkinsonism 
Akathisia / restlessness
Tardive dyskinesia e.g. lip smacking, grimacing, pursing lips (takes years to develop) 
Oculogyric crisis
49
Q

What controls secretion of prolactin from the pituitary?

A

Inihibitory control by dopamine (from the hypothalamus)

50
Q

Give examples of atypical antipyschotics

A

Olanzapine
Risperidone
Quetiapine
Clozapine

51
Q

Side effects of atypical antipsychotics?

A 
Metabolic syndrome 
Muscarinic blockade (blurred vision, dry mouth, constipation, urinary retention, confusion)

Olanzepine: sedation and weight gain

52
Q

Side effects of clozepine?

A

Risk of agranulocytosis.

Also cardiotoxicity, myocarditis, weight gain and dry mouth.

53
Q

When can you try using clozepine? And what extra measures must you take?

A

After you’ve tried and failed with two other antipyschotics.

Monitor bloods weekly for the first 6 months, and fortnightly for the next 6 month.

54
Q

What level of white cell count would make you stop clozapine?

A

<3.0 x10^9

55
Q

What level of neutrophils would make you stop clozapine?

A

<1.5 x10^9

56
Q

Agranulocytosis from Clozapine is dose dependent. True or false?

A

False!

57
Q

Side effects of tricyclics?

A 
Lethargy, drowsiness. 
Cardiotoxic in overdose
QT sydrome (do an ECG before) 
They also cause a decrease in smooth muscle activity:
Blurred vision (can't accomodate) 
Dry mouth (less saliva) 
Constipation 
Urinary retention 
Sedation, weight gain
58
Q

Which antipychotic can be used in pregnancy and breast feeding?

A

Olanzepine

59
Q

How would you treat a hypertensive crises due to tyramine in a patient on an MAOI?

A

Treat with alpha blockade (phentolamine infusion)

60
Q

How long does Emergency Detention last in the MHA?

A

72 hours

61
Q

Can emergency detention be appealed?
Can treatment be given?
Who can initiate the detention?

A

Initiated by any medical practitioner (FY2)

No treatment can be given, and cannot be appealed

62
Q

How long does a short term detention order last?

A

28 days

63
Q

Can treatment be given under a short term detention order?

Who can initiate the order? And can it be appealed?

A

Requires consent from approved mental health practitioner (psychiatrist) or mental health officer.

Can be appealed, and treatment can be given.

64
Q

How long does a compulsory treatment order last?

A

6 months

65
Q

Which antipsychotic would you use in a patient with schizophrenia, type 2 diabetes and a high BMI?

A

TYPICAL antipsychotic drugs are less likely to mess with blood sugars than the ATYPICALS.

Of the first-generation antipsychotic drugs, fluphenazine and haloperidol are lowest risk

Amisulpride and aripiprazole have the lowest risk of diabetes of the 2nd gen. antipsychotic drugs

66
Q

Which psych drugs increase risk of VTE?

A

Antipsychotics, esp. olanzepine

67
Q

How would you treat moderate / severe psychosis in a patient with parkinson’s?

A

Treat the cause (e.g. are their drugs causing it?)

If no treatable cause, consider atypical antipsychotic e.g. quetiapine

68
Q

What’s the recommended management of ADHD?

A

Social / educational / parental interventions.

Can use Methylphenidate (ritalin) alongside these interventions.

69
Q

What’s the triad of symptoms associated with ADHD?

A

Inattention
Hyperactivity
Impulsivity

70
Q

What’s symptoms might you see in a child with autism?

A

Communication / language delay or impairment
Decreased social interaction
Repetitive / inflexible behaviour

examples: lack of imaginative play, decreased eye contact, delayed speech

71
Q

What’s PROCYCLIDINE HYDROCHLORIDE used for?

A

Parkinsonism and extrapyramidal effects

it’s an antimuscarinic

72
Q

What’s CHLORPROMAZINE HYDROCHLORIDE used for?

A

It’s a first generation antipsychotic

Used in schizophrenia, mania etc.

drugs (3 decks)

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