Psych drugs Flashcards
(43 cards)
Someone with BPAD has tried quetiapine but it’s been ineffective. What’s the next step?
Try another of the oral antipsychotics from quetiapine, olanzapine, risperidone, haloperidol
Which TCA is commonly used for neuropathic pain and headache prophylaxis?
amitriptyline
Presentation of serotonin syndrome
- Tachycardia, HTN, fever
- Rigidity, clonus
- Increased reflexes
- Dilated pupils
Mx of neuroleptic malignant syndrome
- stop antipsychotic
- admit to medical ward / ICU
- IV fluids (monitor U+Es as risk of AKI from rhabdomyolysis)
- Dantrolene / bromocriptine if severe
Give 4 side effects on starting lithium
Initially: nausea, diarrhoea, vertigo, muscle weakness, ‘dazed’ feeling, fine tremor, polyuria, polydipsia
Can you breastfeed if you have BPAD?
Yes except if taking lithium
What 3 things need monitoring specifically if taking clozapine / olanzapine and why?
FBC for clozapine bc of neutropenia / agranulocytosis
Smoking bc stopping can increase the doses
At 1 month measure plasma glucose / HbA1c
Give 2 examples of SNRIs
Duloxetine
Venlafaxine
What are the - hyperprolactinaemia Sx seen from antipsychotics?
Galactorrhoea, amenorrhoea, gynaecomastia, hypogonadism, sexual dysfunction, osteoporosis
What are the extrapyramidal Sx seen from antipsychotics? Which types of antipsychotics have these side effects more often?
dystonic reactions, akathisia, tardive dyskinesia, oculogyric crisis, pseudoparkinsonism
More common with 1st generation (typicals)
Give 3 examples of when to avoid lithium
o Cardiac rhythm disorders o Sig. renal impairment o Untreated/untreatable hypothyroidism o Low sodium o Hx of DI o Addison's disease o Brugada syndrome o Breastfeeding o High risk of overdose o Refuse regular blood tests
Which antipsychotics are good if someone’s getting prolactin side effects?
aripiprazole, clozapine, quetiapine, olanzapine
What drugs cause serotonin syndrome?
SSRIs
MAOIs
Ecstasy / novel psychoactive stimulants
Which TCA is best if high risk of overdose?
lofepramine
What are the signs of lithium toxicity and at what levels might you see toxicity?
Signs occur at >1.5mmol/L
D&V, anorexia, muscle weakness, lethargy, dizziness, ataxia, lack of coordination, tinnitus, blurred vision, coarse tremor of extremities and jaw, muscle hyper-irritability, choreoathetoid movements, dysarthria, drowsy
Severe toxicity at >2mmol/L
Hyperreflexia, hyperextended limbs, syncope, toxic psychosis, seizures, polyuria, renal failure, electrolyte imbalance, dehydration, circulatory failure, coma, death
Who shouldn’t take sodium valproate and why?
NICE/MHRA recommend women of childbearing age:
DON’T take sodium valproate
• Unless very severe and no effective alternative
• Risks of fetal malformation, adverse neurodevelopment
Wean off it over 4w if already taking
• BUT only do this after speaking to a specialist
If taking, they should be enrolled in a preg prevention plan
Which antipsychotics are good if someone’s getting lots of sedation?
Amisulpride, Aripiprazole
What drug should you advise pts on lithium to avoid?
NSAIDs
What’s the antidote to lithium?
There isn’t one!
Supportive care
Possibly alkaline diuresis / dialysis
What do you give someone presenting with 9 days of persistently elevated mood who’s lost their job and started gambling? Presume you’re in secondary care
Manic episode
Oral antipsychotic from quetiapine, olanzapine, risperidone, haloperidol
How is lithium monitored?
ECG before starting if risk of/existing CVD
Measure lithium levels:
12 hours post-dose
Aim for plasma level 0.6-0.8mmol/L (0.8-1.0mmol/L if still sub-threshold Sx or previously relapsed)
1w after staring and 1w after every dose change
Weekly until levels stable, then every 3m
Measure BMI, U&Es, eGFR, Ca, TFTs every 6m
Which antipsychotics should be avoided if someone’s at increased risk of stroke and they’re elderly?
Risperidone
Olanzapine
Common side effects of TCAs
drowsiness dry mouth blurred vision constipation urinary retention lengthening of QT interval
What medication for OCD?
SSRI e.g. fluoxetine
