Psych medication Flashcards by Finlay Strivens

Name 6 categories of antidepressants

Selective serotonin reuptake inhibitor (SSRI)
Noradrenergic and specific serotonergic antidepressant (NASSA)
Serotonin and noradrenaline reuptake inhibitors (SNRI)
Tricyclic Antidepressants (TCA)
Monoamine oxidase inhibitors (MAOI)
Serotonin 2 antagonist/reuptake inhibitors (SARI)

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When should SSRIs be used?

Depression- 1st Line
Bipolar
Anxiety- Panic disorders, social anxiety, PTSD, OCD, chronic pain, eating disorders.

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How do SSRIs work?

Selectively inhibits synaptic 5-HT reuptake transporters, thereby increasing synaptic 5-HT concentration

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Give some side effects of SSRIs

‘Hangover’- N+V, diarrhoea, headache GI bleeds with NSAID Anxiety Insomnia Sexual dysfunction Hyponatraemia Increased suicide risk Seizures in epileptics Serotonin syndrome

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Who should you be cautious giving SSRIs to?

Epileptics- lowers seizure threshold
Congenital long QT syndrome, bradycardia, hypokalaemia, hypomagnesemia, recent acute myocardial infarction, or uncompensated heart failure

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Give some example agents of SSRIs

Fluoxetine
Sertraline
Citalopram
Escitalopram
Paroxetine

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What is paroxetine used as first line for?

Anxiety

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What can discontinuation of SSRIs cause?

Shivering, anxiety, dizziness, ‘electric shocks’, headache and nausea

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What are NASSAs used for?

Depression- 1st line if have insomnia or poor appetite. 2nd line if SSRI failed. 3rd line in combo with SSRI.

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How do NASSAs work?

Increases activity in the NA and 5-HT systems by blocking the negative feedback (presynaptic DA) of NA on presynaptic alpha-2 receptors.

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What are some side effects of NASSAs?

Agranulocytosis
Constipation
Dizziness Falls Dry mouth GI upset with alcohol
Sedation
Weight gain

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What should NASSAs not be taken with ?

Don’t take with MAOI

Be careful with other sedatives

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Give an example of NASSAs

Mirtazapine

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What is a potentially useful side effect of mirtazapine?

Sedation

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What are SNRIs used for?

Depression- Not 1st line due to SE. Second line if SSRI and NASSA don’t work.

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How do SNRIs work?

Potently block 5-HT and NA reuptake but do not block cholinergic receptors

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What are some side effects of SNRIs?

Arrhythmias                                  
GI bleeds with NSAID                        
Hypertension                      
Insomnia                             
Sexual dysfunction      
Hyponatraemia                          
Increased suicide risk         
Cardiac arrhythmias       
Seizures in epileptics    
Serotonin syndrome

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Who should SNRIs NOT be given to?

Do NOT give to those with hypertension or arrhythmias

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Who should venlafaxine not be given to?

Do NOT give to those with hypertension or arrhythmias

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Give an example SNRI agent

Venlafaxine

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What drug does venlafaxine work well with?

Mirtazapine

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What are TCAs used for?

Depression- Not 1st line due to SE and lethal in OD. Use if intolerant or unresponsive to SSRI. Rapid anxiolytic effects

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How do TCAs work?

Inhibit presynaptic NA and 5-HT transporters therefore increase concentrations.
Anti-muscarinic.

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What are some side effects of TCAs?

Sedation                     
Confusion                     
Dizziness                           
Sexual dysfunction           
Constipation                            
Tremour                           
Blurred vision               
Postural hypotension                          
Weight gain                           
Arrhythmias (Long QT)

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Who should TCAs not be given to?

``` Cardiac problems Elderly Suicidal intent (cardiotoxic in OD) Epilepsy (lower seizure threshold) Bipolar- can cause mania ```

Give some example TCA agents

``` Amtitriptyline Clomipramine Imipramine Lofepramine Dosulepin ```

What does cloipramine act on?

5-HT

What are MOAI used for?

Depression- Effective but only use in treatment resistant due to side effects. Don't use in bipolar due to ability to cause mania.

How do MOAI work?

MAO breaks down: NA and 5-HT (MAO1) and DA (MAO2). Inhibitors prevent this therefore increased levels.

Give some side effects of MOAI

``` Postural hypertension Drowsiness Insomnia Nausea Tiredness Constipation ```

What should MOAI not be taken with?

Causes dangerous hypertension when combined with tyramine

What foods contain tyramine?

Cheese, alcohol, red meat, caffeine

What can taking MOAI with tyramine cause?

Hypertensive crisis

What are some symptoms of a hypertensive crisis?

Headache, SOB, epistaxis, anxiety

Give some example agents of MOAI

Phenelzine Tramylcypromine Isocarboxazid Moclobemide

When are SARI used?

Depression- When sedation is needed or as an add on to others

How do SARI work?

Block serotonin R and transporter

What are some side effects of SARI?

``` GI upset Dizziness Sedation Tiredness Headache Hypotension Oedema Priapism- Painful erection ```

Give an example SARI agent

Trazodone

Name three mood stabalisers

Lithium carbonate Sodium valproate Lamotrigine

What is Li2CO3 used for?

Bipolar- Relapse prevention. Good for both mania and depression. Depression- Add to antidepressants in treatment resistant depression.

How does Li2CO3 work?

Decreases NA release and increases serotonin release

What are some side effects of Li2CO3

``` N+D Dry mouth Feeling of weakness Sedation Weight gain Fine tremor Polydipsia + polyuria Ankle swelling Renal impairment Arrhythmias Hypothyroidism and hypoparathyroidism ```

What is an issue for Li2CO3?

Therapeutic dose close to toxic dose. Causes Li toxicity

How do you treat Li toxicity?

Stopping Li and starting IV fluids

What are some symptoms of Li toxicity?

``` GI Upset Blurred vision Coarse tremor Ataxia Drowsiness Confusion Loss of consciousness Seizures Coma Death ```

How long does Li2CO3 take to have full effect?

18 months

What is sodium valproate used for?

Bipolar- Fast acting so good when rapid treatment needed or for cycling between mania and depression. Good when Li is ineffective, contraindicated or not tolerated.

How does sodium valproate work?

Blocks voltage sensitive sodium channels. Increase levels of GABA

What are some side effects of sodium valproate?

``` Sedation Tremour Dizziness GI Upset Tiredness Weight Gain ```

When must a woman NOT get sodium valproate?

When pregnant or trying to get pregnant.

What should you do before starting sodium valproate?

Check platelets and LFTs

What is lamotrigine used for?

Bipolar- Treatment and prophylaxis of depressive episodes.

How does lamotrigine work?

Blocks voltage sensitive sodium and calcium channels, and decreases glutamate release

Give some examples of lamortigine

``` Rash GI Upset Insomnia Sedation Dizziness Ataxia Stevens Johnson syndrome- Life threatening skin condition ```

What must you NEVER combine lamotrigine with and why?

Carbamazepine as causes neurotoxicity

What are the two categories of antipsychotics?

Typical | Atypical

What are the two categories of typical antipsychotics?

Phenothiazines | Butyrophenones

Name the most common phenothiazine

Chlorpromazine

Name the most common butyrophenone

Haloperidol

What are typical antipsychotics used for?

Bipolar- Treatment and prophylaxis of hypo/manic and depressive episodes. Depression- Adjunct to antidepressants Psychosis- Acute positive symptoms

How do typical antipsychotics work?

Block DA1+2R thus reducing DA activity

Give some side effects of antipsychotics

``` Extrapyramidal- (Parkinsonism- Akinesia (inability to initiate movement), Akathisia (inability to remain motionless), bradykinesia, dystonia) Sedation Dizziness QT prolongation Neuroleptic Malignant Syndrome (Fever, muscle rigidity, altered mental state) Hypotension Dry mouth Urine retention Constipation Blurred vision Weight gain Glaucoma Arrhythmias Seizures ```

What kind of drug is chlorpromazine?

Phenothiazine typical antipsychotic

What is chlorpromazine used for?

Use for acute treatment resistant psychosis

What is a drawback of chlorpromazine?

Severe extrapyramidal symptoms

What kind of drug is haloperidol?

Butyrophenone typical antipsychotic

What is a benefit of butyrophenones over phenothiazine?

Less sedation

What are butyrophenone good for?

Acute psychosis and mania

What is haloperidol used for?

Use for alcohol withdrawal, delirium and acute psychosis

What should you prescribe along with antipsychotics?

Anticholinergics- to treat extrapyramidal symptoms

How do you treat the extrapyramidal symptoms in antipsychotics?

Antipsychotics

What are atypical antipsychotics used for?

Bipolar- Treatment and prophylaxis of hypo/manic and depressive episodes. Depression- Adjunct to antidepressants Psychosis- First line chronic

How do atypical antipsychotics work?

Block DA1R thus reducing DA activity

What are some side effects of atypical antipsychotics?

``` Sedation Weight Gain Metabolic syndrome Diabetes Mellitus Extrapyramidal Stroke Constipation QT prolongation Neuroleptic Malignant Syndrome ```

Give some example agents of atypical antipsychotics

``` Olanzapine Risperidone Quetiapine Clozapine Amisulpride ```

What is olanzapine additionally used for?

Also used in PTSD

What are some additional side effects of olanzapine?

Bad for weight gain and hyperglycemia (T2DM)

What is a benefit of risperidone?

Low extrapyramidal SE

What is clozapine used for?

Use for treatment resistant schizophrenia, aggression and suicidal

What are some additional side effects of clozapine?

Bad for weight gain and hyperglycemia (T2DM). Agranulocytosis

What do you need to check before and after starting clozapine?

Full check (BP, FBC, U&E etc) prior to initiation, at 1 month and yearly thereafter.

Give some examples of anxiolytics?

Benzodiazepines | Beta Blockers

What are bzd used for?

Anxiety, panic disorder, phobic anxiety and insomnia- Relief Acute psychosis- Sedation Alcohol withdrawal and delirium

How do bzd work?

GABAR Agonist

What are some side effects of bzd?

``` Drowsiness 'Hangover' Nausea Delirium Aggression ```

What is a major issue with bzd?

Sedation can interfere with driving.

What should you not do while on bzd?

Drive

Give some example agents of bzd

Diazepam | Lorazepam

How should you stop bzd?

Tapper down dose to prevent withdrawal symptoms: insomnia, anxiety, twitching, visual hallucinations, hypersensitivity

What are BB used for?

Anxiety- Relief somatic symptoms

Who should you not give BB to?

Avoid in asthmatics

What is the most widely used BB in psych?

Propranolol

What are some symptoms of serotonin syndrome?

* Tachycardia * Shivering * Sweating * Hyperthermia * Hyperreflexia * Renal failure * Shock

Combinations of which drugs can cause serotonin syndrome?

SSRI MAOIs Lithium St John Wort

What is agranulocytosis?

Severely low WCC

Give some symptoms of extrapyramidal side effects

- Acute dystonia – painful contraction of muscles in the neck, jaw or eyes - Parkinsonism – decreased facial movements, shuffling gait, stiffness and sometimes tremor. Common in early weeks of treatment - Akathisia – a feeling of restlessness and a need to walk around - Tardive dyskinesia – uncontrollable grimacing movements of the face, tongue or upper body

What can Parkinsonism be mistaken for?

Negative symptoms in Schizophrenia

How do you treat Akathisia?

Reduce dose or give BB

What drugs can cause neuroleptic malignant syndrome?

Antipsychotics

What are some symptoms of neuroleptic malignant syndrome?

Pyrexia Stiffness Autonomic Instability (tachycardiac, fluctuating blood pressure) Seizures

What are some signs of neuroleptic malignant syndrome?

Raised serum creatine kinase Metabolic acidosis Leukocytosis

When should you suspect NMS?

Fever without obvious cause

Which antipsychotic is closely associated with NMS?

Haloperidol

Which antidepressants are safe in pregnancy?

SSRI TCA ECT

Which mood stabilizers should not be used in pregnancy?

Lithium carbonate | Sodium valproate

How should antidepressants be stopped in an episode of mania?

Abruptly.

What neurotransmitter is closely associated with bipolar and schizophrenia?

Dopamine

What neurotransmitter is closely associated with depression and anxiety?

Serotonin

Which antipsychotic is good in pregnancy?

Olanzapine

What is the LD50 of diazepam?

2g/70kg

How should you decrease diazepam levels?

By 1mg per week

Psych medication Flashcards

(112 cards)