Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Psychiatry > Psychiatric drugs > Flashcards

Psychiatric drugs Flashcards

(80 cards)

Start Studying
1
Q

What is the cause of neuroleptic malignant syndrome?

A

Initiation or increase in dose of antipsychotics (D2 antagonist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the signs of neuroleptic malignant syndrome?

A

Fever + triad of NM abnormalities (rigidity + hyporeflexia), ANS dysfunction (tachycardia, HT, labile BP, urinary incontinence), fluctuating LOC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How to investigate neuroleptic malignant syndrome?

A

High CPK
High WCC
LRFT: metabolic acidosis, high ALT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How to manage neuroleptic malignant syndrome?

A

Pharm: dantrolene + lorazepam
Supportive: hydration, O2, lower temperature (cooling blanket, antipyretic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the cause of serotonin syndrome?

A

High serotonin e.g. SSRI overdose, DDI between MAOI & SSRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the signs of serotonin syndrome?

A

Fever + triad of NM abnormalities (myoclonus, tremor, hyperreflexia), altered LOC, ANS dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How to investigate serotonin syndrome?

A

High CPK
High WCC
LRFT: high ALT, metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How to manage serotonin syndrome?

A

Cyproheptadine (serotonin antagonist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the features of EPSE?

A

Acute dystonia: oculagyral crisis, torticollis, tongue protrusion, grimacing, ophisthotonus
Akathisia: restlessness, agitation, suicidal ideation
Parkinsonism: tremor, rigidity, akinesia, stooped posture
Tardive dyskinesia: chewing/sucking movement, grimacing, akathisia, choreoathetoid movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How to manage EPSE?

A

Acute dystonia: parenteral anticholinergic (benzatropin)
Akathisia: reduce dose, propanolol, short term BZD
Parkinsonism: oral anticholinergic (benzatropin)
Tardive dyskinesia: stop drug, give vitamin E / BZD / tetrabenazine, switch to clozapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the SE of typical antipsychotics?

A

EPSE, hyperprolactinemia, neuroleptic malignant syndrome, anti-HAM effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the SE of atypical antipsychotics?

A

Metabolic syndrome
Elevated liver enzyme
Prolonged QT
Anti-HAM, HSR1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the indications of lithium?

A 
Mania (acute, maintenance)
Depressive episode (BAD, resistant depression)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the contraindications of lithium?

A

Pregnancy & breastfeeding

Impaired RFT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the SE of lithium?

A

CV: T wave inversion, Ebstein’s anomaly, mild leucocytosis
GI upset
Hypothyroidism
Renal: NDI, edema
CNS: fine tremor, weakness, impaired conc & memory, sedative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Factors that increase lithium levels

A

NSAID, aspirin
Thiazide diuretics
Dehydration (e.g. V/D, pyrexia), hyponatremia
Impaired RFT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the signs of lithium toxicity?

A

1.5-2mmol/L: N/V/D, coarse tremor, apathy, ataxia, muscle weakness
>2mmol/L: nystagmus, dysarthria, hyperreflexia, oliguria, hypotension, impaired LOC, convulsion, coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How to manage lithium toxicity?

A

Supportive: hydration, RFT, electrolyte, ECG
Stop lithium
+/- anticonvulsants, renal dialysis (for RF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the teratogenic effects of lithium?

A

Ebstein’s anomaly: 20X

Neonatal goitre, arrhythmia, hypotonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How to advice female patient of reproductive age who is on lithium?

A

Advice contraception
Delay pregnancy until taper off
If already pregnant: valproate + folic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the indications of valproate?

A

Acute mania
Bipolar maintenance
Epilepsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the contraindications of valproate?

A

Pregnancy (neural tube defect)

Weak liver function (monitor LFT & hematological function)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the SE of valproate?

A

Common: sedative, dizzy, tremor, N/V
Less common: HBP (hepatotoxicity, pancreatitis), hemat (thrombocytopenia, leukopenia), constitutional (weight gain, hair loss)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the indications of carbamazepine?

A

Mania
Epilepsy
Trigeminal neuralgia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the contraindications of carbamazepine?
Weak liver function (monitor LFT & hematological function) CV: conduction defect, HF On MAOI & lithium (neurotoxicity) HLA-B1502 gene
26
What are the SE of carbamazepine?
``` Common: ataxia, diplopia, dizzy/drowsy, nausea Agranulocytosis, aplastic anemia Water retention Teratogenic (neural tube defect) Liver failure, hepatitis SJS, TEN ```
27
Can valproate and carbamazepine be used in pregnancy?
Risk of neural tube defect -> avoid if possible Valproate higher risk than carbamazepine If necessary: low dose monotherapy + folic acid (5mg daily) for 1m before conception Carbamazepine in 3rd trimester: vitamin K for mother & baby
28
What are the indications of lamotrigine?
Bipolar depression
29
What are the contraindications of lamotrigine?
HLA-B1502 gene Depression Suicidal
30
What are the SE of lamotrigine?
Neuro: ataxia, dizzy/drowsy, diplopia, headache, sedation SJS Teratogenic (cleft palate)
31
Examples of typical antipsychotics
Chlorpromazine, phenothiazine Loxapine Haloperidol
32
Examples of atypical antipsychotics
Olanzapine Risperidone Quetiapine Clozapine
33
Examples of mood stabilizers
Lithium Valproate Carbamazepine Lamotrigine
34
Examples of SSRI
``` Fluoxetine Sertraline Paroxetine Citalopram Escitalopram ```
35
Examples of SNRI
Venlafaxine | Duloxetine
36
Examples of TCA
Clomipramine Imipramine Amitryptiline
37
What are the contraindications of TCA?
Significant CV disease
38
What are the SE of TCA?
Cardiac arrhythmia Postural hypotension Sedation Anticholinergic: dry mouth, blurred vision, nausea, urinary retention
39
What are the indications of clozapine?
TRS, tardive dyskinesia
40
What are the contraindications of clozapine?
Neutropenia | Cardiac, renal & liver problems
41
What are the SE of clozapine?
Common: anticholinergic (constipation), antiadrenergic (hypotension), ANS (hypersalivation, sweating, weight gain), sedation, seizure, prolonged QT Serious: agranulocytosis, HBP (hepatitis, pancreatitis), impaired temperature regulation, neuroleptic malignant syndrome, CV (circulatory collapse, infection)
42
What should you do when initiating clozapine?
CBC weekly for 18w, then every 4w indefinitely for agranulocytosis
43
When should you discontinue clozapine?
Reappearance of psychotic symptoms | Cholinergic rebound: profuse sweating, headache, N/V/D
44
What are the DDI of clozapine?
Lithium & ACEI, caffeine, smoking
45
What are the indications of benzodiazepine?
Short term treatment: insomnia, anxiety, alcohol withdrawal, seizures, acute mania or psychosis Augment antidepressants in first month Maintenance for panic disorder
46
What are the contraindications of benzodiazepine?
Depression, hx of alcohol/SA, pregnancy
47
What are the SE of benzodiazepine?
Sedation, muscle relaxant (fall, respiratory depression), amnesic
48
How to manage benzodiazepine overdose?
Flumazenil
49
What are the concerns of prescribing SSRI to elderly?
SIADH | DDI w/ NSAID & warfarin (CYP ihb -> increased risk of bleeding)
50
What are the contraindications of propanolol?
Asthma, COPD, bradycardia, HB
51
What are indications of ECT?
``` Mania Depression Postpartum psychosis Catatonia (Schizophrenia, NMS, epilepsy) ```
52
What are the contraindications of ECT?
Heart: CVD, recent MI Brain: raised ICP, aneurysm, risk of cerebral bleeding
53
What are the SE of ECT?
Amnesia Myalgia, dislocation Headache, confusion, nausea
54
What are the risks of ECT?
GA: respiratory depression, allergy, aspiration CV: induce arrhythmia, stroke Fracture, supraphysiological bite (bite block)
55
What is the regimen of ECT?
2-3 times per week, once per week for elderly | Usually 6-8 treatments, at most 12
56
What are the risks of MAOI?
``` Cheese effect (HT crisis) Serotonin syndrome ```
57
Which psychiatric drug has the least CV complications?
SSRI
58
What antipsychotic is least likely to cause weight gain?
Aripriprazole, sulphride, trifluoperazine, ziprasidone
59
What antipsychotic is most likely to cause weight gain?
Olanzapine, clozapine, zotepine
60
Which anti-Parkinsonian drug is least likely to precipitate psychosis?
Benzatropin
61
Examples of Anti-Parkinsonian drugs
Amantadine (NMDA antagonist) Bromocriptine (dopamine agonist) Levadopa (dopamine precursor) Selegiline (MAOI)
62
Which antipsychotic is best for treating negative symptoms of schizophrenia?
SGA e.g. clozapine
63
For how long does an antidepressant have to be maintained at an effective dose in order to have optimal effect?
14-28d
64
What are the indications of MAOI?
Atypical depression (refractory to SSRI) Resistant depressant Refractory anxiety states e.g. panic disorder Narcolepsy
65
What are the contraindications of MAOI?
Mania Pheochromocytoma Cerebrovascular disease Liver impairment
66
What drug can trigger rapid cycling of bipolar?
TCA
67
Can antidepressants be used during pregnancy?
Older drugs ok (TCA, sertraline, fluoxetine) 3rd trimester a/w withdrawals SSRI: low birth weight, spontaneous abortion, neonatal pul HT
68
Can antipsychotics be used during pregnancy?
FGA okay | Olanzapine, clozapine: GDM, macrosomia
69
Can mood stabilizers be used during pregnancy?
Li: Ebstein’s anomaly Valproate: neural tube defect Carbamazepine: neural tube defect, cog deficit, craniofacial & limb defect Lamotrigine: cleft palate
70
Can anxiolytics be used during pregnancy?
BZD: cleft lip & palate, floppy baby, withdrawal | Z drug: x recommended
71
What are the contraindications of psychotropic drugs during breastfeeding?
Infant is premature or suffering from renal/cardiac/hepatic/neuro disorders
72
Can antidepressants be used during breastfeeding?
TCA & sertraline OK | Avoid paroxetine
73
Can antipsychotics be used during breastfeeding?
Not clozapine (agranulocytosis)
74
Can mood stabilizers be used during breastfeeding?
Not lithium (narrow TI + infant has immature RF), lamotrigine (SJS)
75
Can BZD be used during breastfeeding?
Prefer short acting (e.g. lorazepam) over long acting (e.g. diazepam)
76
What are the SE of SSRI?
``` GI upset CNS: anxiety/agitation, poor sleep Elderly: SIADH Young: suicide Sexual dysfunction ```
77
How long do you continue treatment after remission for first episode depression?
9m
78
What is the major consideration for maintenance treatment for schizophrenia?
Number of episodes (2nd episode -> lifelong treatment)
79
What are the RF of acute dystonia?
Young, M, high dose antipsychotic (FGA & SGA), hx of dystonia
80
What is delusional perception?
Genuine perception with delusional meaning attached

Psychiatry (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions