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Psychiatric Medications Flashcards

(42 cards)

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1
Q

What are some antidepressant classifications?

A

SSRI’s ; selective serotonin re-uptake inhibitors

Tricyclic antidepressants

Monamine Oxidase inhibitors

Serotonin/Noradrenaline Reuptake Inhibitors (SNRIs)

Novel antidepressants

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2
Q

What are indications for antidepressants?

A

Unipolar and bipolar depression

Organic mood disorders

Schizoaffective disorder

Anxiety disorders; OCD, panic, social phobia, PTDS

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3
Q

Describe TCA side effects

A

Very effective but potentially unacceptable side effect profile

  • antihistaminic (sedation and weight gain)
  • anticholinergic (dry mouth, eyes, constipation, memory deficits)
  • antiadrenergic (orthostatic hypotension, sedation, sexual dysfunction)

Lethal in overdose

Can cause QT lengthening

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4
Q

Describe tertiary TCAs

A

Have tertiary amine side chains

Side chains are prone to cross react with other types of receptors

Act predominantly on serotonin receptors

Examples; imipramine, amitriptyline, doxepin, clomipramine

Have active metabolites including desipramine, nortriptyline

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5
Q

Describe secondary TCAs

A

Are often metabolites of tertiary amines

Primarily block noradrenaline

Side effects are same as tertiary TCAs but generally less severe

Examples; desipramine, nortryptiline

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6
Q

Describe monoamine oxidase inhibitors (MAOIs) method of action

A

Bind irreversibly to monoamine oxidase thereby preventing inactivation of amines i.e. norepinephrine, dopamine and serotonin

V effective for depression

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7
Q

Describe the side effects of MAOIs

A 
Orthostatic hypotension
Weight gain
Dry mouth
Sedation
Sexual dysfunction
Sleep disturbance

Hypertensive crisis can occur when MAOIs taken with tyramine rich foods or sympathomimetics

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8
Q

What are symptoms of serotonin syndrome and when can it occur?

A

Can occur if MAOI taken with meds that increase serotonin or have sympathimomimetic actions

  • abdo pain
  • diarrhoea
  • sweats
  • tachycardia
  • HTN
  • myoclonus
  • irritability
  • delirium

Can lead to hyperpyrexia, CV shock and death

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9
Q

How can serotonin syndrome be avoided?

A

Wait two weeks before switching from SSRI to MAOI

Exception of fluoxetine where need wait 5 weeks due to long half-life

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10
Q

Describe the action of SSRIs

A

Block presynaptic serotonin reuptake

Treat both anxiety and depressive symtpoms

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11
Q

Describe side effects of SSRIs

A

GI upset, sexual dysfunction, nervousness, insomnia, fatigue, sedation, dizzyness

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12
Q

What are some SSRIs?

A 
Fluoxetine
Sertraline
Paroxetine
Citalopram
Escitalopram
Fluvoxamine
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13
Q

Describe the action of SNRIs

A

Inhibit both serotonin and noradrenergic reuptake like TCAs but without antihistamine, antiadrenergic or anticholinergic side effects

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14
Q

What are some SNRIs?

A

Venlafaxine

Duloxetine

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15
Q

What are some novel antidepressants?

A

Mirtazapine

Buproprion

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16
Q

What are side effects of lithium?

A

GI distress; reduced appetite, nausea/vom, diarrhoea

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17
Q

How long do you keep someone on their medication for depression?

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A

First episode : 6 months if provides remission

Second episode : 2 years

> Third episode : discuss lifelong prophylaxis

18
Q

What are indications for mood stabilisers?

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A

Bipolar
Cyclothymia
Schizoaffective

19
Q

What are the main classes of mood stabilisers?

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A

Lithium
Anticonvulsants
Antipsychotics

20
Q

What are signs of mild lithium toxicity?

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A

Levels 1.5-2.0

vomiting
diarrhoea
ataxia
dizziness
slurred speech
nystagmus
21
Q

What are signs of moderate lithium toxicity?

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A

2.0-2.5

Nausea
Vomiting
Anorexia
Blurred vision
Clonic limb movements
Convulsions
Delirium
Syncope
22
Q

What are signs of severe lithium toxicity?

Study These Flashcards
A

> 2.5

Generalised convulsions
Oliguria
Renal failure

23
Q

What is the first line agent for acute mania and mania prophylaxis?

Study These Flashcards
A

Carbamazepine

24
Q

What are side effects of carbamazepine?

Study These Flashcards
A 
Rash
Nausea, vomiting, diarrhoea
Sedation, dizziness, ataxia, confusion
AV conduction delays
Aplastic anaemia and agranulocytosis
Water retention due to vasopressin-like effect; hyponatremia
Drug-drug interactions
25
When is lithium given and when is depakote (valproic acid)?
Lithium; long term prophylaxis both manic and depressive episodes in BAD Depakote; as effective as lithium for mania, but not for depression prophylaxis Factors predicting good response - rapid cycling - comorbid substance issues - mixed patients - patients with co-morbid anxiety disorders
26
What are indications for antipsychotic use?
Schizophrenia, schizoaffective disorder, bipolar disorder (mood stabilisation and/or psychotic features present), psychotic depression, augmenting agent in treatment resistant anxiety disorders
27
Describe the mesocortical pathway
Projects from ventral tegmentum (brainstem) to cerebral cortex Pathway felt to be where negative symptoms and cognitive disorders arise Problem in a psychotic patient is TOO LITTLE dopamine
28
What key pathways in the brain are affected by dopamine?
Mesocortical Mesolimbic Nigrostriatal Tuberoinfundibular
29
Describe the mesolimbic pathway
Projects from the dopaminergic cell bodies in ventral tegmentum to limbic system Pathway is where positive symptoms arise (hallucination, thought disorder etc.) Problem in a psychotic patient is TOO MUCH dopamine
30
Describe the nigrostriatal pathway
Projects from dopaminergic cell bodies in sybstantia nigra to basal ganglia Involved in movement regulation; remember dopamine suppresses acetylcholine activity Dopamine hypoactivity can cause Parkinsonian movements
31
Describe the tuberoinfundibular pathway
Projects from hypothalamus to AP Doamine inhibits/blocks prolactin release Blocking dopamine in this pathway will predispose patient to hyperprolactinemia - gynecomastia, galactorrhoea, decreased libido, menstrual dysfunction
32
Describe typical antipsychotics
D2 domapine receptor antagonists High potency typical antipsychoics bind to D2 receptor with high affinity - Higher risk of extrapryamidal side effects - Includes Fluphenazine, Haloperidol, Pimozide Low potentcy less affinity for D2 receptors but interact with nondopaminergic receptors resulting in more cardiotoxic aand aticholinergic adverse effects; sedation and hypotension - examples include Chloropromazine, thioridazine
33
Describe atypical antipsychotics
Serotonin-dopamine 2 antagonists (SDAs) Considered atypical in that they affect dopamine and serotonin neurotransmission examples - risperidone - olanzapine - quetiapine - aripiprazole
34
What is the drug of choice in psychotic treatment resistance?
Clozapine
35
What are adverse effects of antipsychotics?
Tardive dyskinesia; invol muscle movements that may not resolve with drug discontinuation Neuroleptic Malignant Syndrome; severe muscle rigidity, fever, altered mental status, autonomic instability, elevated WBC, CPK and lfts. potentially fatal Extrapyramidal side effects; acute dystonia, parkinson syndrome, akahisia
36
What is akathisia?
Feeling of inner restlessness and inability to stay still
37
What are agents for EPS?
Extrapyramidal side effects Anticholinergics i.e. benztropine Dopamine facilitators i.e. amantadine Blockers propranolol Need to watch for anticholinergic SE
38
What bloods do you need in a treatment naive psychotic person?
Antipsychotics may cause dyslipidaemia, abnormal LFTs and elevated blood sugars Need; - LFTs - fasting lipid profile - fasting blood sugar - CBC
39
What treatement can be given for akathisia?
Need to treat as higher risk of suicide - anxiolytic - propranolol
40
What are anxiolytics?
Used to treat many diagnoses incl. panic disorder, general anxiety, substance related, insomnia and parasomnia In anxiety disorders often use in combo with SSRIs or SNRIs
41
Name some anxiolytics
Buspirone | Benzos
42
What are side effects of benzos?
``` Somnolence Cognitive deficits Amnesia Disinhibition Tolerance Dependence ```

Psychiatry (16 decks)

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