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Year 4 - Psych > Psychiatric Medications > Flashcards

Psychiatric Medications Flashcards

(40 cards)

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1
Q

Anti-depressants
- Common mechanism of action
- Common time needed

A

Anti-depressants
- Common mechanism of action
- Common time needed

  1. Serotonin activity
    - increase activity at post-synaptic receptor
  2. 2-4 weeks
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2
Q

SSRIs
- Mechanism

A

SSRIs
- Mechanism

  1. Reduce pre-synaptic uptake
  2. Increased junction serotonin
  3. Down-regulation of post-synaptic receptors
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3
Q

SSRIs
- ADRs

  1. Short term
  2. Uncommon
  3. Personal sx
  4. Important
A

SSRIs
- ADRs

  1. Short term
    - restlessness/agitation
    - GI/Nausea
    - Headache
  2. Weight change
  3. personal
    Sexual dysfunction
    - low libido
    - failure to orgasm
  4. important
    - Bleeding risk esp when with NSAID (eg. PPI with aspirin)
    - Suicidal ideation
    (Young men, first few weeks)
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4
Q

SSRIs
- 4 commonest (dose)
- Choosing

A

SSRIs
- Commonest & Use

  1. Sertraline (50-200)
    - Safe in heart disease
  2. Citalopram (20-40)
    - QTc prolongation
    - Escitalopram (10-20)
  3. Fluoxetine (20-60) (prozac)
    - Serotonin syndrome when switching
  4. Paroxetine (20-60)
    - Discontinuation syndrome
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5
Q

SNRIs
- Mechanism
- Uses

A

SNRIs

  • Mechanism
    1. Reduce pre-synaptic uptake
    2. Increased junction serotonin (and NA)
    3. Down-regulation of post-synaptic receptors
  • Uses
    1. Evidence for neuropathic pain
    2. Similar to SSRIs
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6
Q

SSRIs vs SNRIs
- Effects

A

SSRIs vs SNRIs
- Effects

SNRI
1. Greater sedation
2. Greater Nausea
3. Greater Sexual dysfunction

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7
Q

SNRIs
- 2 examples (doses)

A

SNRIs
- 2 examples (doses)

  1. Duloxetine (60-120mg)
  2. Venlafaxine (75-375mg)
    - More efficacious
    - Higher dose tolerated
    - Caution in heart disease (BP)
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8
Q

Mirtazepine
- Mechanism
- Activity and ADRs

A

Mirtazepine

  • Mechanism:
    1. A2-Adrenoreceptor antagonist
    Increases noradrenaline and serotonin
  • Activity and ADRs
    1. Strong H1 activity (sedation)
    2. Weight gain
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9
Q

Tricyclic Antidepressants
- ADRs

A

Tricyclic Antidepressants
- ADRs

  1. Muscarinic (dry mouth, constipation, blurred vision, and urinary retention)
  2. Histaminic (sedation)
  3. Overdose
    - QTc prolongation
    - Arrythmias
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10
Q

MAOIs
- Types
- Examples (reversible/irreversible)
- ADRs

A

Monoamine oxidase inhibitors

  • Types
    1. MAOi - A
    More serotonin
    2. MAOi - B
    More on dopamine
  • Examples
    1. Reversible
    Moclobamide
    Tranylcypromine
    2. Irreversible
    Phenelzine
    Isocarboxazid
  • ADRs
    1. Serious interactions
    2. Tyramine reaction
    HTN crisis
    Avoid tyramine foods (cheese, pickled meats, wine)
    3. 6 week washout period before new AD
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11
Q

ADs
- Dose changing

A

ADs
- Dose changing

  1. Depression
    - If no effect, switch, don’t increase
  2. Anxiety
    - If no effect, consider increasing
  3. ADRs
    - May improve in 2 weeks
    - Consider switching if problem
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12
Q

Discontinuation syndrome of AD
- Character
- Causes
- how to avoid

A

Discontinuation syndrome

  • Character
    1. Shakes,
    2. Agitation, insomnia
    3. Headaches, N&V
    4. Paresthesia, clonus
  • Causes
    1. Short half lives
    2. Paroxetine & Venlafaxine
  • how to avoid
    1. Slow taper
    2. Consider Fluoxetine cover
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13
Q

Serotonin syndrome
- Cognitive
- Autonomic
- Somatic
- Treatment

A

Serotonin syndrome

  • Cognitive
    1. Headaches, agitation
    2. Hypomania, confusion
    3. Coma
  • Autonomic
    1. Shivering, sweating
    2. Hyperthermia, tachycardia
    3. N&D
  • Somatic
    1. Myoclonus, hyper-reflexia
    2. Tremor
  • Treatment
    0. Stop treatment
    1. Fluids
    2. Monitoring
    3. Seizure Meds
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14
Q

Antipsychotics
- receptor
- Pathways
- Unwanted pathways

A

Antipsychotics

  • receptors
    1. D2 receptors (typical)
    2. D2, D3, D4, 5-HT (atypical)
  • Pathways
    1. Mesocortical
    2. Mesolimbic
  • Unwanted pathways
    1. Nigrostriatal
    2. Tuberoinfundibular (HPA)
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15
Q

Antipsychotics
ADRs
- EPSE (ADAPT)
- elderly
- other
- serious

A

Extrapyramidal side-effects (EPSEs)
ADAPT:
- Acute Dystonia
- Akathisia
- Parkinsonism
- Tardive dyskinesia

elderly patients:
- increased risk of stroke
- increased risk of VTE

other:
- antimuscarinic
- sedation, weight gain
- raised prolactin
- impaired glucose tolerance

serious:
- neuroleptic malignant syndrome
- reduced seizure threshold
- prolonged QT interval

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16
Q

Antipsychotics
- Typical vs Atypical
- ADRs

A

Antipsychotics

  • Typical
    1. Extrapyramidal
  • Atypical
    1. weight gain
    3. metabolic e.g lipid, glucose,
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17
Q

Antipsychotics
- 3 Typicals
- 5 Atypicals

Study These Flashcards
A

Antipsychotics

  • 3 Typicals
    1. Haloperidol
    2. Chlorpromazine
    3. Flupenthixol
  • 5 Atypicals
    1. Clozapine
    2. Olanzapine
    3. Risperidone
    4. Quetiapine
    5. Aripiprazole
    D2 partial agonist
    No QTC
18
Q

Tardive dyskinesia
- Signs

Study These Flashcards
A

Tardive dyskinesia
- Signs

  1. Involuntary mouth movements
    - Chewing
    - Tongue movements
  2. Sometimes throat
19
Q

Akathisia

Study These Flashcards
A

Akathisia - inability to remain still
- Signs

  1. Involuntary movements
  2. Especially leg movements
20
Q

acute dystonia
- 2 examples
- Mx

Study These Flashcards
A

torticollis:
- involuntary muscle contractions in the neck, leading to abnormal postures and movements

oculogyric crisis:
- involuntary upward eye movement
- often accompanied by other symptoms such as neck extension and facial grimacing

  • procyclidine
21
Q

Antipsychotic monitoring

  1. Baseline
  2. Weekly
  3. Three months
  4. 6m
  5. Yearly
Study These Flashcards
A

Antipsychotic monitoring

  1. Baseline
    - HR & BP
    - Weight, ECG
    - FBC, Lipids, LFT, HbA1C
  2. Weekly
    - Weight
  3. Three months after starting
    - As baseline
  4. Six months after starting
    - prolactin
  5. Yearly
    - As baseline
22
Q

Clozapine
- Indication
- ADRs
- Monitoring

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A

Clozapine

  • Indication
    1. Schizophrenia
    2. After 2 others (3rd line)
  • ADRs
    1. Agranulocytosis 1% (3% neutropenia)
    2. Gastrointestinal hypomobility
    3. Seizures
  • Baseline
    0. BMI, ECG, HR, BP
    1. FBCs
    2. U&E, LFT, Trop, and Prolactin
  • FBC
    1. Weekly to 18 weeks
    2. Fortnightly from 18 weeks
    3. Monthly from 1 year
23
Q

Extra-pyramidal ADRs
- cause
- Mx
- Dx ADRs

Study These Flashcards
A

Extra-pyramidal ADRs
- Mx

  1. Nigrostriatal pathway
    - Dopamine: ACh
  2. Anticholinergics
    - Procyclidine
  3. ADRs of Tx
    - anticholinergic SEs
24
Q

Anxiety
- Tx (Drugs)

Study These Flashcards
A

Anxiety
- Tx (Drugs)

  1. Beta blockers for physical sx
  2. Benzos
  3. ADs
  4. Pregabalin
25
Benzos - Common half lives - Mechanism - Max use
Benzos - Common half lives 1. Longer - Diazepam 2. Shorter - Lorazepam - Mechanism 1. Positive allosteric modulator of GABA 2. Bind to receptor and reduce excitability - Max use 1. 2-4 Weeks
26
Paradoxical disinhibition - Drug - Effect
Paradoxical disinhibition 1. Drug - Benzos 2. Effect - Increased agitation - At low doses
27
Pregabalin - Mechanism - Indications - Abuse
Pregabalin - Mechanism 1. GABA synthesis catalyst - Indications 1. Anxiety 2. Neuropathic pain 3. Epilepsy - Abuse 1. Dependence 2. Sedation 3. CNS depressant
28
ADs in Anxiety - Groups - OCD
ADs in Anxiety - Groups 1. SSRIs OCD: 2. High doses required
29
sedatives - Types - Use
Psych Hypnotics Types 1. Benzos (potent) - Temazepam - Lormatazepam - Nitrazepam 2. Non-benzos - Z Drugs - Zopiclone, Zolpidem Use 1. 5 days a week max 2. only two weeks - Rebound insomnia
30
Lithium - Mechanism - Monitoring - Indication
Lithium - Mechanism 1. Unknown 2. NA release reduced 3. Serotonin synthesis - Monitoring 1. Narrow window 2. Kidney excretion 3. Take bloods 12hrs after last dose 4. check weekly at first then 3 months once dose established - Indication 1. Mood stabilisation 2. Augment ADs
31
Lithium - instructions to patient
- Instructions 1. Plenty of water 2. Same time daily - better at night (can take bloods in morning) 3. Don't stop suddenly - Talk to doctor about changing dose 4. Leave missed dose
32
Lithium - ADRs
Lithium - ADRs SEs 1. GI 2. Taste 3. Fine tremor 4. Polydipsia/polyuria 5. Weight gain Long-term 1. Hypothyroid - Anual TFTs 2. Renal - Irreversible impairment - Anual U&Es
33
Lithium - Toxicity - Interactions - Mx
Lithium - Toxicity 0. Dehydration 1. Confusion, coarse tremor 2. N&V 3. Ataxia and seizures - Interactions (all affect kidney function) 1. NSAIDs 2. Loop Ds 3. ACEis - Mx 1. Hydration 2. Fluids 3. Dialysis
34
AEDs as mood stabilisiers - Action - Common choices - ADR and monitoring
AEDs as mood stabilisiers - Action 1. GABA 2. Ca&Na - Common choices 1. Valproate (LFTs) 2. Carbamazepine 3. Lamotrigine (SJS) 4. Pregabalin - ADR and monitoring 1. Thrombocytopenia (FBC) 2. Sedation 3. Weight gain
35
ADD and ADHD - Classes - ADRs
ADD and ADHD - Stimulants 1. Methylphenidate 2. Lisdexamphetamine 3. Monitor weight and height - NA re-uptake inhibitor 1. Atomoxetine 2. Used in previous dependence
36
Depression first line meds - CAMHS - Adult - Older persons
Depression first line meds - CAMHS 1. Fluoxetine - Adult 2. SSRIs - Older persons 3. SSRIs and monitor sodium
37
LITHIUM - Mnemonic
LITHIUM - Mnemonic L - lethargy I - Insipidus (DI) T - Tremor H - Hypothyroidism I - Insides (GI) U - Urine M - Metallic taste
38
Lithium counseling - Pregnancy
Lithium counseling - Pregnancy 0. Evidence not entirely clear 1. First trimester - Birth defects increased 2. Fetal heart defect increased 3. Breastfeeding - Not safe 4. Contraception - Sub Dermal - IUS - Birth defects
39
Extrapyrimidal SEs - Timeline 1. Hours 2. Days to weeks 3. Months 4. Years
Extrapyrimidal SEs - Timeline 1. Hours - Acute dystonia Eg. Eye movements 2. Days to weeks - Bradykinesia Eg. Slowing 3. Months - Akathisia Eg. Jumping out of skin 4. Years - Tardive dyskinesia Eg. Tongue or lip smacking
40
Dopaminergic effects - Prolactin pathway
Dopaminergic effects - Prolactin pathway 1. Tuberoinfundibular

Year 4 - Psych (12 decks)

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