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Year 4 > Psychiatric Meds > Flashcards

Psychiatric Meds Flashcards

1
Q

What are some of the common muscarinic side effects?

A
  • Dry mouth
  • Difficulty swallowing
  • Thirst
  • Urinary retention
  • Hot and flushed skin
  • Dry skin
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2
Q

What are some of the common histamine medication side effects?

A
  • Dry mouth
  • Drowsiness
  • Dizziness
  • N+V
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3
Q

What are some of the common side effects of SSRIs?

A
  • Restlessness and agitation
  • N&V / GI disturbance
  • Headache
  • Weight changes (up or down, usually down)
  • Sexual dysfunction
  • Less common = bleeding
  • Increasing suicidal ideation in first 2 weeks
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4
Q 
What class of drugs should be prescribed with caution if taking SSRI? 
Why?
What can be taken alongside?
A
  • NSAIDs
  • Risk of GI bleed
  • Co-prescribe PPI
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5
Q

Which SSRI do you need to watch for QTc prolongation with?

A

Citalopram

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6
Q

Which SSRI is safest in cardiac disease

A

Sertraline

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7
Q

Name 2 SNRIs

A

Venlafaxine

Duloxetine

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8
Q

What are the side effects of SNRIs?

A

Same as SSRIs but greater potential for sedation, nausea and sexual dysfunction

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9
Q

What class of drug is Mirtazapine?

A

Noradrenergic and Specific Serotonergic Antidepressant

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10
Q

What are the major side effects of mirtazipine? How can this be utilised to therapeutic advantage?

A
  • Sedation
  • Weight gain

Take at night to help with sleep
Good if underweight

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11
Q

Name 3 Tricyclic Antidepressants

A
  1. Lofepramine
  2. Nortriptyline
  3. Amitriptyline (used for for low dose neuropathic pain)
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12
Q

What are the main side effects of TCAs?

A

Muscarinic and Histaminic side effects

  • Dry mouth
  • Difficulty swallowing
  • Thirst
  • Urinary retention
  • Hot and flushed skin
  • Dry skin
  • Dizziness
  • Drowsiness
  • N&V
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13
Q

Why can TCAs be fatal in overdose?

A

Due to QTc prolongation causing fatal arrhythmia

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14
Q

What are the 2 types of monoamine oxidase inhibitors and which pathways do they each work on?

A

MAOI- A = works on serotonin

MAOI-B = works more on dopamine

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15
Q

What serious complication do patients on MAOI need to be warned about

A 
Potential for tyramine reaction leading to hypertensive crisis
Need to avoid tyramine rich foods:
- Cheese
- Pickled meats
- Wine
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16
Q

What washout period is required if switching from an MAOI to another antidepressant?

A

6 weeks due to long t 1/2

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17
Q

What is the usual antidepressant of choice to start a patient on?

A

SSRI unless struggling with sleep/ major weight loss then choose mirtazipine

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18
Q

What should be done if an SSRI has no effect?

A
  • Switch to a different SSRI
  • If still no effect switch to an SNRI
  • If there is a partial effect then increase the dose
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19
Q

How long should you wait for an antidepressant to consider whether it’s had an effect or not

A

4 weeks (but can usually tell in 3 weeks)

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20
Q

What is discontinuation syndrome?

A

Sweating, weakness, shakes, agitation, insomnia, headaches, irritability, N&V, paraesthesia and clone
Caused by stopping antidepressants

Worse with Paroxetine and Venlafaxine due to short t 1/2

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21
Q

What is serotonin syndrome?

A

Vague presentation of:

  • Cognitive - headaches, agitation, hypomania, confusion or coma
  • Autonomic - shivering, sweating, hyperthermia, tachycardia, nausea and diarrhoea
  • Somatic - myoclonus, hyper-reflexia and tremor
22
Q

How is serotonin syndrome treated?

A

Supportive management: fluids and monitoring

23
Q

Which dopaminergic pathways do antipsychotics target?

A

Mesocortical and mesolimbic

24
Q

Which dopaminergic pathways are responsible for the unwanted side effects of antipsychotics?

A

Nigrostriatal (movement) and Tuberoinfundibular (HPA axis)

25
Q

What are the common side effects of all antipsychotics?

A
  • sedation
  • extrapyramidal side effects
  • weight gain
  • QTc prolongation

Can all cause

  • acute dystonia
  • oculogyric crisis
26
Q

What is the difference between ariprazole and other anti-psychotics?

A

It is a partial D2 agonist (not an antagonist)

Sits at the receptor site of dopamine but less effective than dopamine therefore fewer side effects

27
Q

Which side effects are more common from typical antipsychotics?

A
  • EPSE (bradykinesia, muscle stiffness, rigidity, tardive dyskinesia
  • Dizziness
  • Sexual Dysfunction
28
Q

Which side effects are more common from atypical antipsychotics?

A
  • weight gain

- dyslipidaemia and diabetes

29
Q

What are the monitoring requirements of antipsychotics?

A

FBC , LFTs, HbA1c, ECG, BP and pulse to be done at baseline, 3 months and then yearly

Weight ideally done weekly

30
Q

What are the features of neuroleptic malignant syndrome?

A
  • Fever
  • Confusion
  • Muscle rigidity (usually lead pipe)
  • Sweating
  • Autonomic dysfunction
31
Q

What typically causes death in neuroleptic malignant syndrome?

A
  • Rhabdomyolysis
  • Renal failure
  • Seizure
32
Q

What are the risk factors for developing neuroleptic malignant syndrome?

A
  • Typical antipsychotics
  • Antipsychotic naiive patients
  • High doses of antipsychotics
  • Young men
33
Q

How should neuroleptic malignant syndrome be managed?

A
  • Emergency A&E referall
  • Stop antipsychotics
  • Benzos for acute behavioural disturbance
  • fluid resuscitation
  • reduce temperature (cooling blankets)
  • O2
  • Rhabdomyolysis - give fluids and sodium bicarb to alkalise urine
  • To relax muscles: 1st line lorazepam, 2nd line bromocriptine
34
Q

How can extra pyramidal side effects be managed?

A

Anticholinergics: reduces amount of acetylcholine to improve the acetylcholine: dopamine ratio
Procyclidine (most common) - use with caution as potential for misuse
Benzatropine
Trihexphenidyl

35
Q

When is clozapine used?

A

For Schizophrenia where 2 other antipsychotics has not been effective

36
Q

What are the serious side effects of clozapine?

A
  • Agranulocytosis

- Gastrointestinal hypo-mobility ; constipation leading to potentially fatal bowel obstruction

37
Q

What are the monitoring requirements of clozapine?

A
  • FBC monitored weekly for 1st 18 weeks then fortnightly for up to 1 year then monthly
  • Monitor vital signs for autonomic dysregulation
  • Weight as causes central weight gain
38
Q

How should clozapine induced agranulocytosis be treated?

A
  • stop clozapine
  • stop any other marrow suppressing drugs e.g sodium valporate
  • avoid other antipsychotics for a few weeks if possible
  • avoid sources of infection - consider prophylactic abx
  • Lithium sometimes used to increase WCC and neutrophil count
39
Q

What is the MOA of benzodiazepines?

A

Potentiate the effect of GABA therefore reduce excitability of neurones
(positive allosteric modulators)

40
Q

How long should benzodiazepines ideally be used for?

A

No longer than 6 weeks

41
Q

Which bentos have the shorter and longer t 1/2

A 
Diazepam = longer 
Lorazepam = shorter
42
Q

How does pregabalin work?

A

Binds to Voltage gated Calcium channels in neurones

Reduces neuronal activity

43
Q

What is the treatment regime with zopiclone?

A

2 weeks max

Take for 5 out of 7 days

44
Q

Why is zopiclone used for only 5/7 days?

A

Get post synaptic GABA downregulation therefore potential for tolerance build up

45
Q

What is the therapeutic window for lithium?

A

0.6 - 1.0 mmol/L

46
Q

What monitoring requirements are needed for patients taking lithium?

A

Weekly lithium levels until stable then 3 monthly
U&Es annually
TFTs annually

47
Q

What are some of the side effects of lithium?

A
  • GI disturbance
  • Metallic taste
  • Dry mouth
  • Fine tremor
  • Polydipsia and polyuria
  • Weight gain
  • Long term: renal impairment and hypothyroidism
48
Q

What are the signs of lithium toxicity? (potentially fatal)

A
  • Confusion
  • Coarse tremor
  • N&V
  • Ataxia
  • Seizures
49
Q

How is lithium toxicity managed?

A
  • Stop lithium
  • Supportive measures , IV fluids
  • Dialysis is necessary
  • Benzodiazepines for seizure
50
Q

What other drugs can interact with lithium causing dangerous levels?

A
  • ACE inhibitors
  • NSAIDs
  • Loop diuretics
51
Q

Which drugs are most commonly used to treat ADHD/ ADD?

A

CNS stimulants

Methylphenidate most commonly prescribed

52
Q

What monitoring requirements are needed for patients on CNS stimulants?

A
  • Weight
  • Height
  • Pulse
  • BP

Year 4 (5 decks)

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