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Psychiatry and Neurology > Psych- Medications > Flashcards

Psych- Medications Flashcards

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1
Q

Give 3 examples of typical antipsychotics

A

Chlorpromazine
Haloperidol
Flupentixol

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2
Q

Give 3 examples of atypical antipsychotics

A

Clozapine
Olanzapine
Quetiapine
Risperidone

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3
Q

What are the dopamine related SEs of typical antipsychotics?

A
  1. Hypothalamic-pituitary:
    Galactorrhoea
    Impotence
2. Nigrostriatal:
Parkinsonism
Acute dystonia
Tardive dyskinesia
Akathisia
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4
Q

What are the main symptoms of Parkinsonism?

A

Tremor
Bradykinesia
Shuffling gait
Rigidity

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5
Q

Which group of antipsychotics poses the greatest risk of neuroleptic malignant syndrome?

A

Typical antipsychotics

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6
Q

Other than dopamine related SEs, what are the other SEs of typical antipsychotics?

A
  1. Histamine related: sedation
  2. Anticholinergic: dry mouth, constipation, confusion, blurred vision
  3. alpha 2 related: postural hypotension, impotence
  4. Neuroleptic malignant syndrome
  5. Weight gain
  6. Arrhythmias
  7. Decreased seizure threshold
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7
Q

Which antipsychotic is proven to decrease the negative symptoms of schizophrenia?

A

Clozapine

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8
Q

What are the main side effects of atypical antipsychotics?

A
  1. Weight gain
  2. Decreased seizure threshold
  3. Sedation
  4. Metabolic syndrome
  5. Extra pyramidal SEs at higher doses
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9
Q

What are the side effects of Clozapine?

A
  1. Agranulocytosis
  2. Sedation
  3. Weight gin
  4. Decreased seizure threshold
  5. Anticholinergic SEs
  6. Excess salivation
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10
Q

How often should bloods be monitored in patients in Clozapine?

A
  1. BEFORE commencing
  2. Weekly for 18 weeks
  3. Fortnightly until 1 year
  4. Monthly from 1 year onwards
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11
Q

Which anticholinesterase is used in Alzheimer’s?

A

Donepezil

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12
Q

Disulfiram, Acamprosate and Naltrexone are used for what?

A

Abstinence from alcohol

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13
Q

What are the 3 groups of symptoms for alcohol withdrawal?

A
  1. Simple withdrawal symptoms
  2. Delirium tremens
  3. Seizures
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14
Q

Which 2 main groups of drugs are used for alcohol detox?

A

1, Sedatives- eg. Benzodiazepines or Chlordiazepoxide

2. Vitamin B- Pabrinex

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15
Q

What are the 3 main features of Wernicke’s encephalopathy?

A

Confusion
Ataxia
Ophthalmoplegia (weakness of extra occular eye muscles)

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16
Q

Which drugs can be used for abstinence from alcohol?

A

Disulfiram
Acamprosate
Naltrexone

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17
Q

________ is a GABA analog which reduces cravings for alcohol.

A

Acamprosate

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18
Q

_________ is an aldehyde dehydrogenase inhibitor which gives an unpleasant reaction if patients drink alcohol.

A

Disulfiram

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19
Q

Which drugs are used for neurotic disorders (panic/ anxiety)?

A
  1. SSRIs
  2. SNRIs
  3. TCAs/ Pregabalin
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20
Q

Which drug class is used for OCD?

A

SSRIs

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21
Q

Which drug class is used for bulimia?

A

SSRIs

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22
Q

Which drug classes are used for PTSD?

A

SSRIs

Benzodiazepines

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23
Q

Which drug classes are used for insomnia?

A
  1. Benzodiazepines

2. Z drugs- Zopiclone, Zolpidem

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24
Q

What is the most commonly used class of antidepressants? Give examples

Study These Flashcards
A

SSRIs

Sertraline
Citalopram
Fluoxetine
Paroxetine

25
What are the 1st, 2nd and 3rd line drug treatments for depression?
1st line- SSRI eg. Sertraline 2nd line- Switch SSRI or try SNRI eg. Venlafaxine, or Mirtazapine 3rd line- SNRI or Mirtazapine or TCA
26
What are the key side effects of SSRIs?
1. GI- Diarrhoea, vomit 2. Sweating 3. Insomnia 4. Agitation 5. Hyponatraemia 6. Discontinuation syndrome
27
________ is an SNRI and can cause side effects such as hypertension.
Venlafaxine
28
__________ works as an antidepressant by being an alpha2 antagonist, and is also an antagonist at some post synaptic serotonin receptors.
Mirtazapine or Mianserin
29
What are the potential SEs of Mirtazapine?
Weight gain | Sedation
30
What are the potential SEs of Mianserin?
Blood dyscrasias
31
Give examples of 2 TCAs.
Amitriptyline | Impipramine
32
What are the potential SEs of TCAs?
1. Anticholinergic- dry mouth, constipation, decreased urine, blurred vision 2. Histamine- sedation 3. Alpha1- Postural hypotension, impotence 4. ECG changes and arrhythmias 5. Tremor 6. Serotonin- GI upset, sweating
33
MAOIs such as Rasagiline and Selegiline can prevent breakdown of _________ causing the "cheese reaction"
Tyramine
34
What are the 5 steps of NICE guidelines for treating depression?
1. Recognise and diagnose 2. Treat mild depression in primary care 3. Treat moderate- severe depression in primary care 4. Treatment by specialist mental health services 5. Inpatient treatment for severe or resistant depression
35
What are the NICE guidelines for treating acute mania?
1. Stop any antidepressants 2. Start anti psychotic eg. Olanzapine, Risperidone, Haloperidol, Quetiapine 3. Give lithium if needed/ optimise dose of lithium
36
What are the potential SEs of lithium?
``` Tremor Hypothyroidism/ goitre Weight gain Teratogenicity Renal impairment ```
37
What are the signs of lithium toxicity?
``` Tremor Diarrhoea and vomit Ataxia Slurred speech UMN signs Seizures Can be fatal ```
38
What are the 3 main groups of drugs used for bipolar disorder?
1. Lithium 2. Antipsychotics 3. Anticonvulsants
39
What are the side effects of sodium valproate?
Teratogenicity Weight gain Hirtuism
40
What are the side effects of Lamotrigine?
Steven Johnson's syndrome Headaches Ataxia Diplopia
41
What are the side effects of Carbamazapine?
``` Weight gain Hyponatraemia Skin rash Diplopia Headache ```
42
Which 2nd gen antipsychotic can cause weight gain and metabolic syndrome?
Olanzapine | Quetiapine
43
Which 2nd gen antipsychotic can cause sedation, metabolic syndrome and postural hypotension?
Quetiapine
44
Which antipsychotic can cause akathisia as a SE?
Aripriprazole
45
What are the NICE guidelines for treating bipolar depression?
Mild- psychological therapy | Moderate-severe- SSRIs (Fluoxetine) plus Olanzapine or Quetiapine
46
After one week of use what should lithium blood levels be?
0.5 -1.0 mmol/L
47
What can increase blood lithium levels?
``` ACEIs NSAIDS Diuretics Dehydration Hyponatraemia ```
48
How often should TFTs and U+Es be monitored in patients on lithium?
Every 6 months
49
How often should lithium levels be monitored?
Every 3 months
50
What is the SSRI of choice in children and adolescents?
Fluoxetine
51
What is the SSRI of choice in adultss?
Sertraline
52
When discontinuing a SSRI, the dose should gradually be reduced over what time period?
4 weeks | not necessary with Fluoxetine
53
What are the symptoms of discontinuation syndrome from stopping an SSRI abruptly?
``` Mood changes Sweating Difficulty sleeping GI disturbances Paraesthesia Restlessness ```
54
A 45-year-old man with schizophrenia taking chlorpromazine develops a bilateral resting tremor. What side-effect of antipsychotic medication is this an example of?
Parkinsonism
55
How might smoking cessation affect clozapine blood levels?
Smoking cessation causes INCREASED clozapine levels
56
Which atypical antipsychotic has the highest risk of dyslipidaemia and obesity?
Olanzapine
57
Which atypical antipsychotic has the best side effect profile for prolactin elevation?
Aripiprazole
58
Mirtazapine is an alpha 2 receptor _______ and has a SE of increased appetite.
Antagonist

Psychiatry and Neurology (9 decks)

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