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BNPH700 > Psychiatric Medications > Flashcards

Psychiatric Medications Flashcards

1
Q

What are some examples of Benzodiazepines?

A

alprazolam, diazepam, lorazepam, clonazepam

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2
Q

What is the indicator for Benzodiazepines? (Why are they used?)

A
  • used for anxiety, alcohol withdrawal, panic disorder (to calm aggressive patients), seizure, muscle spasm, sleep disorders (short term treatment for insomnia)
  • Increases effect of GABA in CNS (GABA is a neurotransmitter)
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3
Q

What is the Mechanism of Action (MOA) for Benzodiazepines?

A

Action occurs in the limbic system, causes the GABA to be more effective. This decreases the excitability of neuron and has a sedative anxiolytic or relaxant effect.

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4
Q

What are some adverse drug reactions with benzodiazepines?

A

All benzodiazepines can cause CNS depression, dependence and neurological dysfunction.

  • Fatigue/drowsiness
  • muscle weakness
  • blurred vision
  • sedation, amnesia
  • respiratory depression
  • Tolerance or dependency develop readily (Short-term use is advised)
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5
Q

What is the antidote for Benzodiazepines?

A

flumazenil

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6
Q

What are some contraindications for benzo?

A
  • in people with severe respiratory disease or liver disease
  • People with dependence on other substances
  • Cautioned in patients with impaired kidney or liver function as they are metabolised extensively in the liver, therefore need to be used very cautiously with people with liver disease, depression, or psychosis
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7
Q

What is an interaction in benzodiazepines?

A

has addictive CNS depressant effects

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8
Q

What is the pharmacokinetics for benzodiazepines?

A

diazepam is one of the longest benzodiazepines as it is very lipid soluble and has active metabolites. Half-life is between 2-60 hours.

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9
Q

What are some monitoring and patient education regarding benzodiazepines?

A
  • Monitor RR as can have sedative effects
  • Signs of tolerance or dependence
  • For short-term use only as can be highly addictive
  • Do not discontinue abruptly due to dependency
  • Adverse reaction includes fatigue, tolerance or dependence, muscle weakness, blurred vision or neurological dysfunction
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10
Q

What are some symptoms of Benzo Withdrawal?

A

Insomnia, agitation/irritability, fearfulness, muscle spasm/tremors, gastric problems, sweating

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11
Q

How would you answer this question:
Half-lives of Benzodiazepines range from 2-60 hours, think about how knowledge of the half-life will determine the choice of benzodiazepine prescribed.

A

Be aware of using in susceptible population and elderly as the long half-lives means longer time for body to remove the drug. Increased drug accumulation might occur in elderly and people with hepatic/renal impairment. Dose adjustment is required and close monitor for ADRs, i.e sedation, CNS depression, fall preventions

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12
Q

How would you answer this question:
When benzodiazepines are taken with other CNS depressants the result is an enhanced sedative and CNS depressant effects. What other CNS depressants should patients be educated to avoid?

A

Alcohol, MAO inhibitors (Monoamine oxidase inhibitor), TCAs (Tricyclic antidepressants), antipsychotic, opioids, antihistamines, anaesthetics, sedatives

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13
Q

What type categories of antipsychotics are there?

A
  • Typical
  • Atypical
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14
Q

What are some examples of typical antipsychotics?

A

haloperidol, zuclopenthixol

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15
Q

What are some examples of atypical antipsychotics?

A

olanzapine, risperidone, clozapine, Quetiapine

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16
Q

What is the indication for use with antipsychotics?

A

used to treat serious mental illnesses such as schizophrenia, drug induced psychosis, depression and autism. Antipsychotics are also used to treat extreme mania (as an adjunct to lithium), bipolar disorder, certain movement disorders (e.g. Tourette’s syndrome), and certain other medical conditions (e.g. nausea, intractable hiccups).

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17
Q

What is the mechanism of action overall for antipsychotics?

A

block dopaminergic receptors, especially D2 receptors. Antagonism of dopamine receptors.

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18
Q

What is the specific MOA for Typical antipsychotics?

A

the main action is blocking dopaminergic receptors, especially. D2 receptors, they also exert other synaptic effects on alpha, muscarinic and Histamine receptor sites and have more side effects.

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19
Q

What is the specific MOA for Atypical antipsychotics?

A

Atypical antipsychotics block D2 and 5-HT receptors.

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20
Q

Why are atypical antipsychotics favoured over typical antipsychotics?

A

A typical antipsychotics have major advances over typical antipsychotics due to its less EPS (extrapyramidal symptoms), it also suppresses negative symptoms of schizophrenia

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21
Q

What are some ADR’s with typical antipsychotics?

A

include dry mouth, urinary hesitancy (and even retention), constipation and visual disturbance, extrapyramidal symptoms

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22
Q

What are some ADR’s associated with typical antipsychotics on noradrenergic mechanisms?

A

lead to postural hypotension, disturbances of sexual functions and nasal congestion.

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23
Q

What are some ADR’s associated with typical antipsychotics on the antihistamine system?

A

cause sedation and prolonged use may lead to weight gain.

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24
Q

What are some ADR’s with Atypical antipsychotics?

A

The biggest problem with atypical anti-psychotics is the increased risk of diabetes and metabolic syndrome causing weight gain, high blood pressure, decreased HDL cholesterol and elevated triglycerides.

  • weight gain, drowsiness, constipation, dizziness and hyper-salivation, sexual dysfunction and postural hypotension
25
Q

What are the monitoring/patient education associated with Atypical antipsychotics?

A
  • careful monitoring of weight and BGL
  • Fasting glucose and lipid testing on admission
  • Waist measurement
  • Education related to lifestyle factors
  • Adverse effects: weight gain, drowsiness, constipation, dizziness and hyper-salivation, sexual dysfunction and postural hypotension
26
Q

Which category does Metabolic Syndrome Occur in?

A

Atypical Antipsychotics

27
Q

What are the monitoring requirements with metabolic syndrome?

A

Weight, insulin levels and blood glucose and lipid levels are essential for anyone prescribed an atypical anti-psychotic medication and is education related to life-style factors.

28
Q

What are Extrapyramidal side effects and which category do these occur in?

A

Typical antipsychotics:

  • Involuntary abnormal motor movements including. Acute dystonia, Akathisia (a sense of inner restlessness), Parkinsonism (tremor, rigidity), Tardive dyskinesia. Benztropine or diazepam is sometimes required to reduce excessive motor stimulation
29
Q

What baseline recordings should be taken prior to someone starting on an antipsychotic medication?

A

Weight, waist measurement, BMI, BGL, insulin level, lipids; vitals, blood test WBC, liver and renal function test.

30
Q

What information would you include in an education session for someone who is prescribed clozapine?

A
  • It may cause seizures and drowsiness. Caution patient to avoid driving or other activities requiring alertness while taking clozapine.
  • Inform patient the risk of developing metabolic syndrome and importance of healthy lifestyle, and regular check-up for weight, BMI, BGL, lipids, BP
  • Inform patient the side effect of constipation and ways to prevent it i.e. adequate fluid and fibre intake, regular exercise, proper toilet routines and use of laxatives. Instructs patient to notify dr if developing symptoms of N&V (Nausea and Vomiting), abdominal pain and distention.
  • Inform patient the risk of developing neutropenia, and symptoms to watch for and notify dr., regular blood test for WBC count.
31
Q

What are three classes of antidepressants?

A
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Tricyclic antidepressants (TCAs)
  • Monoamine oxidase inhibitors (MAOIs)
32
Q

What are some examples of SSRI’s?

A

Citalopram, Paroxetine, Fluoxetine, Sertraline, Venlafaxine

33
Q

What is the indication for use of SSRI’s?

A

anxiety, depression, OCD, PTSD

34
Q

What is the MOA for SSRI’s?

A

SSRIs inhibit reuptake of serotonin leading to increase neurotransmitter levels in the synaptic cleft and increased stimulation of postsynaptic receptors

35
Q

What is the pharmacokinetics for SSRI’s?

A

they are well absorbed in GI tract, metabolised in the liver and excreted in urine and faeces. Half-lives about 24 hours. They are able to cross the placenta and enter breast milk.

36
Q

What are come common adverse reactions to SSRI’s?

A

drowsiness, insomnia, sexual dysfunction, nausea and vomiting, reduced appetite, anxiety, diarrhoea, tremor, weight loss, increased heart rate, shivering, sweating, dilated pupils, myoclonus (intermittent tremor or twitching), as well as hyperreflexia.

37
Q

What is a rare and potential threatening adverse effect associated with SSRI’s?

A

Serotonin syndrome

38
Q

What are some examples of Tricyclic antidepressants (TCAs)?

A

Amitriptyline, Doxepin, Imipramine, Nortriptyline

39
Q

What is the indication for use of TCA’s?

A

major depression, anxiety, neuropathy

40
Q

What is the MOA for TCA’s?

A

block the reuptake Norepinephrine (NE) and serotonin leading to increase neurotransmitter levels in the synaptic cleft and increased stimulation of postsynaptic receptors

41
Q

What are the pharmacokinetics for TCA’s?

A

well absorbed in GI tract and reach peak levels in 2-4 hours. They are metabolised in the liver and excreted in urine. Their half-lives range from 8 to 46 hours. They are able to cross the placenta and enter breast milk.

42
Q

What are some adverse drug reactions associated with TCA’s?

A

sedation, drowsiness, dry mouth, blurred vision, constipation, urinary retention, weight gain. (Anti-cholinergic side effects), headache, nausea, palpitations, postural hypotension, sexual dysfunction, sweating, heart block, arrhythmia

43
Q

What are some examples of Monoamine oxidase inhibitors (MAOi’s)

A

Phenelzine, Tranylcypromine

44
Q

What is the indication for use of MAOi’s?

A

treat depression, panic disorder, eating disorder, PTSD

45
Q

What is the MOA of MAOi’s?

A

inhibit Monoamine Oxidase (MOA), an enzyme in the nerves that breaks down noradrenaline, dopamine and serotonin. This allows these neurotransmitters to accumulate in the synaptic cleft, causing increased stimulation of the postsynaptic receptors

46
Q

What is the pharmacokinetics of MAOi’s?

A

They are well absorbed from the gastrointestinal (GI) tract and reach peak levels in 2-3 hours. They are metabolised in the liver and excreted in urine. They are able to cross the placenta and enter breast milk.

47
Q

What are some adverse drug reactions associated with MAOi’s?

A

postural hypotension, constipation, drowsiness, dry mouth, fatigue, headache, insomnia, sexual dysfunction, blurred vision, oedema, skin rashes, sweating, urinary retention

48
Q

What is an important patient information to provide to someone taking MAOi’s?

A

Do not consume food high in tyramine - activates noradrenaline receptors when in excess (aged cheese, red wine, avocado, chocolate, beer).

49
Q

What is an example of a mood stabiliser?

A

Lithium

50
Q

What is the indication for use with mood stabilisers?

A

used for bipolar disorder and schizoaffective disorder

51
Q

What is the MOA for mood stabilisers?

A

mimics effect of sodium. Thereby compromises the ability of the neurons to release, activate and respond to neurotransmitters.

52
Q

What is the pharmacokinetics associated with mood stabilisers?

A

It is readily absorbed from the gastrointestinal (GI) tract and reaches peak levels in 30 mins-3 hrs, it has long half-life and steady state is not reached for 5-7 days. It follows the same distribution path in the body as water (where water goes lithium follows).

53
Q

What is important to understand about Lithium and how it is excreted?

A

Lithium is excreted unchanged from the kidneys, although 80 % is reabsorbed, if the person has low sodium levels or is dehydrated then the kidneys will absorb more lithium which can lead to toxic levels

54
Q

What are some adverse drug reactions associated with mood stabilisers?

A

tremor, stomach upset, polyuria, polydipsia, weight gain, oedema, hypothyroidism, skin rashes.

55
Q

What are some signs of lithium toxicity?

A

blurred vision, drowsiness, confusion, slurred speech, increased polyuria or polydipsia, vomiting, dizziness, unsteadiness, clumsiness, severe tremor.

56
Q

Why is it important to monitor lithium levels?

A

Need to monitor lithium levels in blood due to low therapeutic index so can become toxic 1.5 < = lithium toxicity, hand tremors, tinnitus.

57
Q

What are some important patient education associated with mood stabilisers?

A
  • Take with food, drink adequate water
  • Need 3 monthly tests to determine lithium level
  • Inform doctors any Rx or OTC medications
  • If develop any signs of lithium toxicity dee Dr, immediately.
58
Q

What is the MOA for anti-convulsants?

A

stabilise nerve membranes throughout CNS, thereby reducing excitability and hyperexcitability.

59
Q

What are some adverse drug reactions associated with anti-convulsants?

A

gastric irritation/nausea (take with food), increased appetite and weight gain

BNPH700 (8 decks)

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