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Psychiatry > Psycho Pharmacology > Flashcards

Psycho Pharmacology Flashcards

(128 cards)

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1
Q

What are the indications for anti-depressants

A 
Unipolar and bipolar depression
Organic mood disorder
Anxiety disorders - OCD / panic / social
Schizoaffective disorder
PTSD
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2
Q

What are the guidelines surrounding anti-depressants

A

All have similar efficacy so think what worked before / SE

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3
Q

How long do anti-depressants take to work

A

3-6 weeks

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4
Q

How long on anti-depressant before switching

A

2 months

3-4 weeks of highest dose

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5
Q

What should you do if coming of anti-depressant

A

Reduce dose over 4 weeks

Cross taper if switching to TCA

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6
Q

What anti-depressant is different and what do you. do

A

Fluoxetine as long half life

Leave a gap if discontinued

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7
Q

What do you do for mild depression

A

Psychoeducation
Lifestyle
Period of active monitoring if don’t want intervention
Low intensity psychological

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8
Q

When do you reassess if active monitoring

A

2weeks

1 if high risk or young <30

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9
Q

What do you do if mod-severe depression or sub threshold >2 years or don’t respond

A

High intensity CBT / interpersonal
Start SSRI
Refer

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10
Q

What do you do if this doesn’t work

A

SNRI = 2nd line

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11
Q

How long do you keep stable patient on meds

A

6 months - 1 year

Longer if previous episode

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12
Q

How do you follow up patients

A

If started on med then 2 weeks or 1 week if young
Once stable
2-4 weeks
3 monthly

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13
Q

What are problems with anti-depressant

A

Serotonin syndrome
Discontinuation
Drug Interactions
Cholinergic rebound

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14
Q

What do you do for treatment resistant

A

Augment
Add lithium / mood stabiliser / anti-psychotic
ECT

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15
Q

What is the mechanism of TCA

A

Block reuptake of NA and serotonin

Also block histamine / androgen / Ach

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16
Q

What are TCA used for

A

Neuropathic pain
Headache
Due to high SE

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17
Q

What are the SE of TCA

A 
Lethal overdose - safeguard
QT lengthen 
Lower seizure
Anti-histamine
Anti-cholinergic
Anti-androgenic
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18
Q

What are antihistamine symptoms

A

Sedation

Weight gain

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19
Q

What are anti-cholinergic symptoms

A 
Dry eyes and mouth
Constipation
Urinary retention
Hypotension
Falls
Confusion
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20
Q

What are anti-androgen symptoms

A

Hypotension
Sedation
Sexual

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21
Q

What is tertiary TCA

A

Amitriptyline

Block serotonin

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22
Q

What are secondary TCA

A

Imipramine
Block Na
Less severe SE

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23
Q

When are secondary used

A

Resistant OCD / phobic

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24
Q

How do Monoaine oxidase inhibitors work

A

Stop MO enzyme working so stop amine breakdown
Increase Na, dopamine, serotonin
RARELY USED

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25
WHen are MOAI used
Atypical Resistant High SE
26
What ae the risks of MAOI
``` Same as TCA Anti-cholinergic Postural hypotension Insomina Hypertensive crisis ```
27
Why do MAOI cause hypertensive crisis and what should you avoid
Tyramine not broken down | Cheese
28
What causes serotonin syndrome
Medication that increases serotonin - MAOI - SSRI / SNRI - Ectasy - Amphetamines
29
What are symptoms of serotonin syndrome
``` Abdominal pain Diarrhoea Sweating Altered mental Tachycardia Hypertension Tremor Dilated pupils Fever Hyperreflexia Myoclonus Rigid Raised CK and renal failure can occur ```
30
What must you rule out
Infection Metabolic Substance abuse Withdrawal
31
How do you treat serotonin syndrome
``` Prevent 2 week Gap when switching from SSRI to MAOI 5 if fluoxetine IV fluid Benzo IV anti-histamine if severe ```
32
What is 1st line in depression
SSRI
33
What are SSRI also 1st line in
``` OCD Bulimia PTSD Panic Anxiety - different doses (sertraline) ```
34
How do SSRI work
Block serotonin uptake
35
What are the SE of SSRI
``` GI - N+V / diarrhoea = most common GI bleed Headache Insomnia Sexual - ED Fatigue Dizzy Hyponatraemia Serotonin syndrome Activation syndrome Mild parkinson / akathisia ```
36
What do you prescribe with SSRI
PPI if already on NSAID | Zopiclone if insomnia
37
What are symptoms of activation syndrome
Anxiety Restless Nausea
38
Why does it affect GI
Stimulate 5HT3 in gut wall
39
What can you develop if stop SSRI suddenly
Discontinuation syndrome
40
What are the symptoms of discontinuation syndrome
``` N+V, abdo pain, diarrhoea Mood Agitation Sleep Sweating Dysphoria Paraesthesia ```
41
What is CI if on SSRI
NSAID - or give with PPI due to GI bleed risk Warfarin Triptans MAOI
42
What do SSRI cause in pregnancy
Congenital HD in 1st trimester | Persistent pulmonary hypertension in 3rd
43
Examples of SSRI
FLuxetine Citalopram Sertraline Paraoxetine
44
What is 1st line anti-depressant
Fluoxetine (Prozac) | Can induce mania
45
What does citalopram do and what should be done
Prolong QT CI if long QT / cardiac / other drugs Do ECG + U+E
46
When is sertraline useful
Post MI / cardiac / chronic | Anxiety
47
What are SNRI
Serotonin and Na reuptake inhibitor
48
Examples of SNRI
Venllafaxine | Dluoextine
49
What are SE of SNRI and when are they used
``` BP - measure regular as can cause hypertension CI in high BP / arrhythmia GI symptoms Nausea Dry mouth Insomina Constipation Sexual ```
50
Mirtazapine
NA and specific Serotonergic Antidepressant (NaSSA) | Block A2 or 5HT2
51
When is mirtazapine useful and what are SE
Sedation, weight gain, appeitiet | Useful in insomnia or poor appetite
52
Bupriprion
Block dopamine and Na Little SE Increased seizure and anorexia so CI
53
When are mood stabilisers indicated
``` Bipolar Cyclothymia Acute treatment of mania Augmentation with resistant depression Schizoaffective ```
54
What is used for long term prophylaxis in bipolar
Lithium (renal excretion)
55
What are SE of lithium
``` GI - Decreased appetite, N+V, diarrhoea Tremor Weight gain Oedema ADH antagonism - polyuria/ polydipsia Worsening of psoriasis and acne Nephrotoxity Increased PTH and Ca Intercranial hypertension Hypothyroid post 18 months Leucocytosis TERATOGENIC ```
56
What should you do for GI Sx What may increase lithium toxicity
Encourage fluid Anything that affects renal as renal excreted Dehydration Renal failure Thiazide / ACEI / NSAID / metronidazole
57
What are signs of toxicity
``` Blurred vision D+V Delirium Syncope Slurred speech Tremor Seizure Hyper-reflexia Renal-failure Coma ```
58
How do you monitor lithium
``` TFT + U+E prior and every 6 months Lithium levels every 3 months - 12 hours after last dose - 7 days after change Can interact with NSAID, CCB and Ax ``` If toxicity - IV saline if mild - Haemodialysis sometimes needed if neuro Sx / seizure or renal failure or significant toxicity
59
What do you do when stable
3 monthly
60
What should you do before starting
Preg as risk of Ebstein Baseline U+E + thyroid 6 monthly
61
What does Ebstein cause
Tricuspid incompetence
62
What is sodium valproate used for
Mania prophylaxis
63
When is sodium valproate useful
Rapid cycling Substance use Comorbid
64
What are SE
``` Thrombocytopenia Sedation Tremor N+V Weight gain Liver ```
65
When is it CI
Child bearing age as teratogenic | Neural tube defect
66
What do you do before starting
FBC + LFT - don't worry until 3x LFT periodically Pregnancy test
67
What is 1st line for acute mania / pregnancy
Carbamazepine
68
What are SE of carbamazepine
``` AV conduction Rash N+V+D Sedation Ataxia ```
69
What do you do before starting
ECG
70
Lamotrigine
TENS / SJS N+V Blood dyscarisia
71
What do you do if rash
Discontinue
72
When are anti-psychotics indicated
``` Schizophrenia Schizoaffective Psychosis Treatment resistant anxiety Bipolar if very unwell ```
73
What pathways are affected by dopamine
Mesocortical Mesolimbic Nigrostriatal Tuberoinfundibular
74
What is important in anti-psychotics
Mesolimbic
75
What does too much dopamine cause in mesolimbic
+Ve Sx of psychosis
76
What do anti-psychotics do
Dopamine antagonist so reduce +ve sx
77
What does too little dopamine cause in mesocorticol
-ve symptoms of psychosis
78
What do anti-psychotics do
Can't help as reduce dopamine
79
What is nigrostriatal pathway
SN-basal ganglia
80
What does anti-psychotics do to this pathway
Decrease Ach | Cause Parkinson / tardive dyskinésie
81
What is tuberoinfindubular pathway
Hypothalamus-AP
82
What does dopamine do in this pathway
Inhibits prolactin
83
What do anti-psychotics do
Hyperprolactin | Do not treat with dopamine agonist as you would if prolactinoma as could cause relapse
84
What are SE of anti-psychotics
``` Gynaecomastia Galactorrhoea Decreased libido Amenorrhoea Breast cancer Osteoporosis Visual field disturbance Headache ```
85
What are typical anti-psychotics
Haloperidol - QT | Chlorpromazine
86
What are SE of typical
``` Extrapyramidal Sedation Lengthen QT Weight gain Cardiotoxic Anti-cholinergic ```
87
What are 1st line in schizophrenia
Atypical anti-pyschotic as less extra-pyramidal SE
88
What are common SE of atypical
``` Weight gain Type II DM Sedation High cholesterol Hyperprolactin Anti-cholinergic Decreased seizure Cardiac Increased risk of VTE and stroke in the elderly Prolonged QT NMS ```
89
Examples of atypical
``` Work against +Ve and -ve symptoms Prescribed in secondary care only Olanzapine Quetapine Aripiprazole Risperidone ```
90
What has very good SE profile esp prolactin
Aripriprazole
91
What cause postural hypo
Quetapine
92
What is treatment resistant schizophrenia
2 anti-psychotics tried for 2 months
93
What is used in treatment resistant schizophrenia
Clozapine | Effective in +Ve and -ve symptoms which is useful
94
How do you monitor clozapine
Weekly FBC, ECG, troponin - Want to see what WCC / neutrophils are - May need to stop Esp if infection - If below certain level need to stop and discuss with on call psych team - If at certain level can just monitor FBC regularly
95
What increases and decreases dose requiring adjustment
Stop smoke = decreases levels in blood p450 inducer - carbamazepine = decrease level Alcohol binge = increases
96
What do you do if forget for 48 hours
Retitrate up
97
SE of clozapine
``` Agranulocytosis - lower WCC Neutropenia Decreaed seizure threshold Myocarditis Arrythmia LFT Metabolic Increased saliva Hypothermia Sedation GI - obstruction ```
98
What do you not get with clozapine
Tardive dyskinesia
99
What is neuroleptic malignant syndrome
Rare SE of anti-psychotic a few days after starting or storage of dopaminergic drugs suddenly Medical emergency
100
What are symptoms of NMS
``` Slower onset than serotonin Rigid Hyperthermia Altered mental Sweating Tachycardia Tachypnoea Hypertension Autonomic Fluctuating BP Increased WCC / LFT / CK Hyperkalaemia due to muscle damage AKI ```
101
How do you treat NMS
Stop anti-psychotic IV fluids to prevent renal failure Dantrolene - muscle relaxant Dopamine agonist can be used - bromocriptine
102
What are extra-pyramidal SE and what causes - Anti-psychotics - Metoclopramide
Tardive dyskinesia Acute dystonia Akathisia Parkinsonism
103
When doe Tardive dyskinesia occur
Late SE | May be irreversible
104
What is it
Choreathetoid movement | Chewing / pointing
105
How do you treat
Tetrbenazine
106
When is acute dystonia
Torticolis - unilateral pain and deviation on palpation of neck / decreased ROM Oculogyric = upward deviation of eyes / clenched jaw
107
How do you treat dystonia
IV anti-muscarinic / anti-cholinergic - Benzotropine - Procyclidine
108
What is Akathisia
Restless
109
How do you treat
BB
110
When does it occur
Long Hx
111
How do you treat Parkinson
Dopamine facilatators | Anti-cholinergic
112
What do anti-psychotics have increased risk of in elderly
VTE and stroke
113
What are cardiac SE
QT prolong esp haloperidol Myocarditis Fatal tachy
114
What is metabolic syndrome
``` 3+ of High BP High cholesterol High TG High BG Obestity ```
115
What do you do baseline
``` FBC, U+E, LFT BMI BG Prolactine BP ECG ```
116
What do you asses annually
CVS risk FBC, U+E, LFT Lipid
117
How often do you monitor BG and prolactin
6 month | Then annual
118
How often do you monitor lipid
3 monthly then annul
119
When are anxiolytic indicated
``` Panic GAD Substance abuse Insomina Psychosis Withdrawal ```
120
Examples of anxiolytic meds
Benzodiazepine Barbiturates Anti-histamine Opiod
121
What do Benzo's do
``` Increase GABA (inhibitory) Increase frequency CL ```
122
What are benzo used for
``` Anxiolytic Hypnotic Sedation Muscle relaxant Anti-convulsant ```
123
What has shot half life
Lorazepam | Use for acute
124
What has long half life
Diazepam | Use for anxiety
125
What do benzo cause
Tolerance and dependence so only short term
126
What are SE
``` Sedation Cogntiive Antegrade amnesia (new memories) Poor coordination Falls Disinhibited ```
127
What can you get if stop
``` Withdrawal - up to 3 week Similar to alcohol Insomina Irritable Anxiety Tremor Loss of appetite Tinnitus Hyperventilation Seizure ```
128
How do you prevent withdrawal
Switch to same dose of diazepam | Reduce in 1/8 over 4 weeks

Psychiatry (11 decks)

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