psychdrugs

Question 1

which receptor do SSRIs work on?

Answer 1

5HT

Question 2

what are the side effects of SSRIs?

Answer 2

nausea
vomiting
diarrhoea
agitation
insomnia

Question 3

how to prevent serotonin syndrome?

Answer 3

stop ssris 2 weeks before starting maois

Question 4

what is the triad of symptoms for serotonin syndrome?

Answer 4

autonomic instability - fever, hypotherm, sweating, bp
neuromuscular excitability
altered mental status

Question 5

how is serotonin syndrome treated?

Answer 5

stop drug
anti-hypertensives
benzodiazepines

Question 6

how is severe serotonin syndrome treated?

Answer 6

chlorpromazine / cyproheptadine

Question 7

How long does it take for SSRIs to work?

Answer 7

4-6 weeks

Question 8

when to review SSRIs?

Answer 8

2 weeks

1 week if suicidal/under 30

Question 9

which receptors does TCA bind to?

Answer 9

H1 histamine receptor - sedation
Muscarinic ACh inhibitor - cholinergic SEs
alpha-adrenergic - postural hypotension

Question 10

which arrhythmias does TCA cause?

Answer 10

tachy, then wide complex tachy, then ventricular arrhythmias
prolonged QRS (>2 small boxes)

Question 11

what is the main cardiovascular risk of TCAs?

Answer 11

prolonged qrs

Question 12

how is prolonged qt treated in tcas?

Answer 12

iv sodium bicarbonate

Question 13

what are the side effects of TCAs

Answer 13

arrhythmias
sedation
postural hypotension
dry mouth
constipation
blurred vision

Question 14

what are the side effects of lithium?

Answer 14

Lethargic
Insides - GI disturbance
Tremor (fine, if tox, coarse)
Hypothyroidism
Insipidus - polyuria, dipsia, normal glucose!
Urine - as above
Metallic taste

Question 15

which tremor is seen as a side effect of lithium?

Answer 15

fine tremor

Question 16

which tremor is seen as a side effect of lithium toxicity?

Answer 16

coarse tremor

Question 17

what pathways is dopamine involved in?

Answer 17

mesolimbic

mesocortical

nigrostriatal

tuberoinfundibular

Question 18

how is the mesolimbic pathway affected in psychosis?

Answer 18

increased dopamine leads to positive symptoms of psychosis

Question 19

how is the mesocortical pathway affected in psychosis?

Answer 19

decreased dopamine in mesocortical - negative symptoms - apathy, etc

Question 20

how is the nigrostriatal pathway affected in psychosis?

Answer 20

nigrostriatal is responsible for initiating movement

not affected in psychosis

Question 21

how is the tuberoinfundibular pathway affected in psychosis?

Answer 21

dopamine inhibits prolactin

normal in psychosis

Question 22

how do antipsychotics affect the tuberoinfundibular pathway?

Answer 22

decreased dopamine - increased prolactin - galactorrhoea

Question 23

how do antipsychotics affect the nigrostriatal pathway

Answer 23

decreased dopamine, parkinsonism and EPSEs

Question 24

why do first gen antipsychotics have more side effects?

Answer 24

less selective, affect the tuberoinfundibular and nigrostriatal pathways too.

Question 25

list some typical antipsychotics?

Answer 25

haloperidol flupentixol zuclopenthixol chlorpromazine

Question 26

list some atypical antipsychotics

Answer 26

olanzipine risperidone quetiapine aripiprizole

Question 27

what class of drug is clozapine?

Answer 27

atypical atypical

Question 28

which two antipsychotics are most associated with weight gain?

Answer 28

olanzipine and clozapine

Question 29

what are the side effects of antipsychotics

Answer 29

``` weight gain reduced seizure threshold anticholinergic side effects prolonged QT neuroleptic malignant syndrome ```

Question 30

How is NLMS differenitated from serotonin syndrome

Answer 30

``` nlms = has raised CK, slower onset Serotonin = has hyperreflexia, dilated pupils, faster onset ```

Question 31

what are the symptoms of nlms?

Answer 31

``` rigidity increased wcc increased CK variable bp fever tachy sweating altered mental state ```

Question 32

what is the treatment for nlms?

Answer 32

stop antipsychotic, supportive

Question 33

what triggers serotonin syndrome?

Answer 33

mix SSRI cocaine ecstasy

Question 34

what are the side effects of clozapine?

Answer 34

agranulocytosis constipation - paralytic ileus myocarditis - chest pain

Question 35

what do you monitor for clozapine/

Answer 35

fbc | ecg

Question 36

which drugs interact with antipsychotics?

Answer 36

levodopa cancels out metoclopramide increases EPSEs antiepileptics, antibiotics (clarithromycin) drugs that prolong qt - citalopram