PSYCHIATRY DRUGS Flashcards
(121 cards)
1
Q
what drug is first line in depression
A
SSRI
2
Q
how long does it take for antidepressants to take affect
A
2-6 weeks
3
Q
what is non-response is regards to antidepressants
A
no/inadequate response after 6 weeks at max dose/highest tolerated dose
4
Q
what is the treatment for depression after one episode
A
continue treatment for 6 to 12 months after full resolution of symptoms
5
Q
what is the treatment for depression after two episodes
A
continue treatment for 12 to 24 months after full resolution of symptoms
6
Q
what is the treatment for depression after three episodes
A
continue treatment indefinitely
7
Q
name 3 drug classes used to stabilise mood in bipolar disorder
A
lithium
anticonvulsants
antipsychotics
8
Q
when are lithium and antipsychotics used in bipolar disorder
A
good in elevated and depressed states
9
Q
when is lamotrigine used in bipolar disorder
A
bipolar depression
10
Q
when is valproate used in bipolar disorder
A
bipolar mania/hypomania
11
Q
how to SSRIs work
A
selectively inhibit reuptake of serotonin from synaptic cleft
12
Q
name 3 SSRIs
A
fluoxetine
sertraline
citalopram
13
Q
what is an initial side effect of SSRIs
A
can initially make anxiety/depression symptoms worse
14
Q
what are SSRIs side effects
A
nausea headache anxiety sweating insomnia -> take in morning vivid dreams sexual dysfunciton hyponatraemia (older patients) increase in self harm/suicidal thoughts <25 years
15
Q
what receptor causes nausea side effects
A
5HT3
16
Q
what receptor causes headache side effects
A
5HT1
17
Q
SSRIs and NSAIDs taken together increase risk of what
A
GI bleed
18
Q
what SSRI is safest with cardiac problems
A
sertraline
19
Q
what SSRI is safest in epilepsy
why
A
citalopram
associated with long QT syndrome
20
Q
why is SSRI tapered over weeks
A
to avoid discontinuation symptoms
reduces risk of myoclonus
21
Q
name 5 tricyclics
A
amitriptyline imipramine dosulepin clomipramine lofepramine
22
Q
how to tricyclics work
A
block reuptake of NA and 5HT into presynaptic terminals
23
Q
why are tricyclics not used 1st line in depression
A
cardiac side effects
dangerous if overdosed
24
Q
what are the side effects of tricyclics
A
sedation -> take in evening
weight gain
anticholingeric -> blurred vision (can’t accommodate), dry mouth, constipation, urinary retention
cardiac -> postural hypotension, tachycardia, fatal arrhythmias
25
in what people should tricyclics be avoided
people with cardiac problems
people with suicidal intent
older people
26
which tricyclic has lower cardiac risk
lofepramine
27
when else are tricyclics used
neuropathic pain
OCD
anxiety
migraines
28
how does mirtazapine work
act on pre-synaptic andrenorecptors and post-synaptic 5HT receptors
29
when is mirtazapine used 1st line
in patients with insomnia or poor appetite
| when SSRI hasn't worked
30
what is a benefit to mirtazapine
reduces anxiety
31
what are side effects of mirtazapine
```
sedation -> take at night
hunger -> weight gain
constipation
dizziness
falls
dry mouth
unusual/vivid dreams
```
32
what are rare side effects of mirtazapine
blood dycrasias
| seizures
33
is mirtazapine safe for people with cardiac problems
yes
34
what should you avoid taking mirtazapine with
alcohol
| causes GI upset
35
what other drug can mirtazapine taken along with
| what is the result
SSRI
| blocks nausea and vomiting caused by SSRIs
36
name 3 SNRIs
venlafaxine
duloxetine
reboxetine
37
how do SNRIs work
block reuptake of noradrenaline and 5HT into presynaptic terminals
38
why are SNRIs not 1st line in depression
high risk of side effects
39
when are SNRIs used
SSRIs and/or mirtazapine hasn't worked
40
which SNRI is very good in combination with mirtazapine
venlafaxine
41
which SNRI helps patients with reduced energy levels/fatigue
reboxetine
42
what else is duloxetine used for
neuropathic pain
| bladder instability
43
what are the side effects of SNRIs
same as for SSRIs
hypertension
arrhythmias
44
when should SNRIs be taken
in the morning to avoid insomnia
45
name an irreversible monoamine oxidase inhibitor
phenelzine
46
name a reversible monoamine oxidase inhibitor
moclobemide
47
which MAO inhibitor is more effective
phenelzine
| moclobemide less side effects but less effective
48
how do MAO inhibitors work
inhibit monoamine oxidase
causing decreased breakdown of monoamine neurotransmitters
leading to increased levels in synaptic cleft
increasing excitation
49
when are MAO inhibitors used
only used in resistant depression
50
are MAO inhibitors effective
very effect
51
why aren't MAO inhibitors used more often
dietary and medication restrictions
52
what are the side effects of monoamine oxidase inhibitors
```
postural hypotension
peripheral oedema
insomnia
tiredness
nausea
constipation
```
53
what are rare side effects caused by monoamine oxidase inhibitors
hypertensive crisis
hepatic impairment
seizures
54
what causes a hypertensive crisis when taking MAO inhibitors
MAO-A breaks down norepinephrine in gut and liver
if MAO-A is inhibited, breakdown of tyramine prevented
tyramine potent releaser of norepinephrine
causes increased BP -> hypertensive crisis
55
what are the symptoms of a hypertensive crisis
headache
shortness of breath
nosebleed
anxiety
56
what can a hypertensive crisis lead too
arrhythmias
subarachnoid haemorrhage -> stroke
seizure -> death
57
what foods are high in tyramine
```
cheese
gravy
alcohol
dried meats
pate
```
58
what is the treatment for hypertensive crisis
phentolamine infusion
59
what drugs does MAO inhibitors interact with
| what does MAO inhibitors do to them
```
SSRI
SNRI
tricyclics
mirtazapine
some opioids
decreases their metabolism
```
60
name a SARI
trazodone
61
how do SARIs work
serotonin 2 antagonist/reuptake inhibitor
62
when are SARIs used in depression
when sedation is needed
| taken at night
63
what are the side effects of SARIs
```
GI upset
dizziness
headache
blurred vision
hypotension
syncope
oedema
```
64
what is the most effective drug for bipolar disorder
lithium carbonate
65
how does lithium carbonate work
BPAD causes altered levels of inositol in brain
| lithium depletes intracellular inositol by blocking its synthesis
66
why is lithium closely monitored
narrow therapeutic index
67
what is the target range for lithium
0.4 - 1.0 mmol/l
68
what tests are done prior to initiation of lithium
U+E
TFTs
ECG
69
what tests are done initially once started on lithium
12 hour post dose blood level
| U+E every 5 days until lithium levels stable and within therapeutic range
70
what tests are done every 3 months on lithium
lithium levels
| U_E
71
what tests are done every 6 months on lithium
TFTs
72
what is done to treat hypothyroidism caused by lithium
treat with levothyroxine instead of stopping lithium
73
when should lithium levels and U+E be carried out on someone on lithium
dehydrated
generally unwell
signs of toxicity
74
what are the side effects of lithium
```
GI upset
dry mouth
tremor, weakness, shakiness
weight gan
sedation -> take at night
polydypsia, polyuria
ankle swelling
renal impairment
cardiac arrhythamias
hypothyroidism, hypoparathyroidism
```
75
what drug interaction causes particularly bad renal impairment when taking lithium
NSAIDs
76
what are drugs that interact with lithium
NSAIDs
ACEIs
angiotensin II receptor antagonists
diuretics
77
which type of diuretic interacts badly with lithium
thiazide worse than loop
78
what are the symptoms of the toxic effect of lithium
GI upset
blurred vision
worse tremor
drowsiness
79
what are the symptoms of severe lithium toxicity
confusion
loss of consciousness
seizures
coma
80
what causes lithium toxicity
increased dose
dehydration
drug interactions
reduced salt intake
81
what is the treatment for lithium toxicity
stop lithium
IV fluids
monitor renal function
dialysis if severe
82
how does sodium valproate work
blocks voltage sensitive sodium channels
| increases levels of GABA
83
for which bipolar symptom is sodium valproate most effective
mania/hypomania
84
what should be checked before starting sodium valproate
platelet count
| LFTs
85
what are the side effects of sodium valproate
```
sedation, drowsiness
GI upset
tremor, ataxia
weight gain
cardiovascular effects
```
86
what are rare side effects of sodium valproate
hepatoxicity (induces enzymes)
pancreatitis
increase in suicidal behaviour
87
who should sodium valproate be avoided in
| why
women of child bearing age
| highly teratogenic -> neural tube defects
88
how does lamotrigine work
blocks voltage sensitieve sodium channels
89
for which bipolar symptom is lamotrigine most effective
bipolar depression
90
what are the side effects for lamotrigine
GI upset
insomnia, tiredness
dizziness, ataxia
rash
91
what are a rare side effects of lamotrigine
steven johnson syndrome
| blood dyscrasis
92
how is the risk of SJS with lamotrigine reduced
slowly titrate over 6 weeks
93
what are the side effects of carbamazepine
drowsiness
ataxia
cardiovascular effects
induces liver enzymes
94
with what other co-morbidity should carbamazepine be avoided
myoclonic epilepsy
95
name 4 atypical antipsychotics
olanzapine
risperidone
quetiapine
aripiprazole
96
what symptoms of bipolar do atypicals treat
both manic and depressed moods
97
how do atypical antipsychotics work
dopamine and 5HT neurotransmitters
98
what are the side effects of atypical antipsychotics
sedation
weight gain
metabolic syndrome
99
what side effects does aripiprazole cause
extrapyramidal side effects
| inner agitation
100
what symptoms are aripiprazole good for
negative symptoms
101
when should tests be carried out when on atypical antipsychotics
prior to initiation
at 1 month
then yearly checks
102
name 5 typical antipsychotics
```
haloperidol
chlorpromazine
zuclopentixol
flupentixol
sulpiride
```
103
how do typical antipsychotics work
dopamine 2 receptor blockage
104
what symptoms of bipolar do typical antipsychotics treat
manic and depressed mood states
105
what are the side effects of typical antipsychotics
```
extrapyramidal
QTc prolongation
sedation
dizziness
hyperprolactinaemia
neuroleptic malignant syndrome
```
106
what are the symptoms of neuroleptic malignant syndrome caused by typical antipsychotics
```
high fever
confusion
rigid muscles
variable blood pressure
sweating
fast heart rate
```
107
what are 4 extrapyramidal side effects caused by atypical antipsychotics
acute dystonia
parkinsonisms
akathisia
tardive dyskinesia
108
what is acute dystonia
painful muscle spasms
109
where does acute dystonia effect
neck
back
extraocular muscles
110
how is acute dystonia treated
acetylcholine antagonist -> duloxetine
111
what are the symptoms of parkinsonsims
tremor
bradykinesia
rigidity
postural instability
112
how are parkinsonisms treated
anticholingeric drugs
113
what is akathisia
internal restlessness
114
how is akathisia treated
reducing dose of dopamine antagonist
| doesn't respond to anticholinergics
115
what is tardive dyskinesia
| give examples
repetitive involuntary purposeless movements
| sticking tongue out, grimacing
116
if a patient is unresponsive or intolerant to 2 or more antipsychotics, what is 3rd line treatment for schizophrenia
how effective is it
clozapine
| hugely effective
117
why is clozapine 3rd line
| give examples
side effects
| agranulocytosis, myocarditis
118
what monitoring has to be done for clozapine
| how often
```
full blood count
weekly for first 6 months
fortnightly for next 6 months
every 4 weeks thereafter
for one month after cessation
```
119
what symptoms are worrying in a patient on clozapine
sore throat, fever
| risk of agranulocytosis -> do full blood count
120
what affect does smoking have on clozapine
metabolised more slowly
| if patient stops, look at dose, start to metabolise it more quickly and may need a smaller dose
121
what tests should be done if myocarditis is suspected in someone on clozapine
monitor ECG, BP and pulse
