Psychopharmacy Flashcards by Margaret Grant

Indications for Antidepressants? (7)

Unipolar and Bipolar Depression

Organic Mood Disorders

Schzioaffective Disorder

Anxiety Disorder

PTSD

Phobia

Premenstrual Dysphoric Disorder

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What is the delay after therapeutic dose of antidepressants has been reached?

2-4 Weeks

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How long should you give antidepressants to work?

2 Months at least

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Tricyclics Side Effects (5)

Antihistaminic

Anticholinergic

Antiadrenergic

Lethal in Overdose

Can cause QT Lengthening

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Name 4 Tertiary TCA’s?

Impiramine

Amitryptyline

Doxepin

Clomipramine

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Name 2 Secondary TCA’s?

Desipramine and Notriptyline

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What do Secondary TCA’s do?

Primarily block noradrenaline

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Side Effects of Secondary TCA’s?

Antihistaminic

Anticholinergic

Antiadrenergic

Lethal in Overdose

Can cause QT Lengthening

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Action of Monoamine Oxidase Inhibitors?

Bind to monoamine oxidase thereby preventing inactivation of amines such as Norepinephrine, Dopamine and Serotonin = Increased Synaptic Levels

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Monoamine Oxidase Inhibitors are very effective for?

Resistant Depression

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Monoamine Oxidase Inhibitors Side Effects? (5)

Orthostatic Hypotension
Weight Gain
Sedation
Sexual Dysfunction
Sleep Disturbance

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Hypertensive Crisis can develop with what psychiatric medication?

MAOI’s taken with Tyramine Rich Foods or Sympathomimetics

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MAOI’s taken with what can cause Hypertensive Crisis?

Tyramine Rich Foods or Sympathomimetics

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Serotonin Syndrome can develop if take MAOI with?

Meds that contain Serotonin or have Sympathomimetic Actions

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Serotonin Syndrome Symptoms? (6)

Abdo Pain
Diarrhoea
Sweats
Tachycardia
Myoclonus
Irritability Delirium

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Serotonin Syndrome can lead to? (3)

Hyppyrexia
Cardiovascular Shock
Death

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How to avoid Serotonin Syndrome? (2)

Wait 2 weeks before switching from SSRI to MAOI

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How long to wait from switching from Fluoxetine to MAOI?

5 Weeks

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What do selective serotonin reuptake inhibitors (SSRIs) do?

Block presynaptic serotonin reuptake

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What do SSRI’s treat?

Treat Anxiety and Depressive Symptoms

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Side Effects of SSRI’s? (6)

GI Upset
Sexual Dysfunction
Anxiety
Insomnia
Fatigue
Dizzy

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Activation Syndrome is caused by?

Increased Serotonin

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Symptoms of Activation Syndrome (4)

Nausea
Increased Anxiety
Panic
Agitation

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Length of Activation syndrome

2-10 Days

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Symptoms of Discontinuation Syndrome? (4)

Agitation Nausea Disequilibrium Dysphoria

If a patient gets discontinuation syndrome what should you consider switching to?

Fluoxetine

Sertraline Pros? (4)

Very Weak P450 Interactions Short Half Life Lower Build up of Metabolites Less Sedating when Compared to Paroxietine

Sertraline Cons? (2)

Max Absorption requires full stomach | Increases number of GI adverse drug reactions

Fluoxetine is also known as?

Prozac

Fluoxetine Pros? (3)

Long Half Life Good for Patients with Medication Noncompliance Issues May provide Increased Energy

How to taper someone off SSRI when trying to prevent SSRI Discontinuation Syndrome?

Give 20mg Fluoxetine

Cons of Fluoxetine

Active Metabolite may build up Significant P450 Interactions Initial activation = Anxiety and Insomnia Can Induce Mania

Fluoxetine is not a good choice in what type of Gi patient?

Hepatic illness

SNRI Action?

Inhibit both serotonin and noraadrenergic reuptake but without the bad side effects

SNRI uses? (3)

Depression Anxiety Neuropathic

Venlafaxine is a type of what drug?

SNRI

Duloxetine is a type of what drug?

SNRI

Venlafaxine Pros?

Minimal Interactions Almost no P450 Activity Short Half Life Fast Renal Clearance

Venlafaxine is good for what population?

Geriatrics

Cons of Venlafaxine? (5)

Can cause 10-15mmHg dose Dependent increase in a diastolic BP May Cause significant nausea Can cause Discontinuation Syndrome QT Prolongation Sexual Side Effects

Venlafaxine can cause what increase in bp?

10-15mmHg dose dependent diastolic bp

Venlafaxine can cause what syndrome?

Discontinuation

Duloxetine cons? (3)

CYP2DS and CYPA1A Inhibitor Cannot break capsule as active ingredient not stable within stomach Higher drop out rate

What types of SSRI are least sedating?

Citalopram Fluxoetine Sertraline

What psychiatric tablets are sedative/weight gain

Paroxetine Mirtazepine

Novel Antidepressants Pros? (2)

5HT2 and 5HT3 Receptor Antagonist Can be used as Hypnotic at Lower Dose

Novel Antidepressants Cons (2)

Increased Serum Cholesterol by 20% and Triglycerides in 6% Very Sedating at Lower Doses

Novel Antidepressants: At what dose can become activating and needing change of admin time?

30mg +

Novel Antidepressants at doses below 45mg are associated with?

Weight Gain

Indications for Mood Stabilisers (3)

Bipolar Cyclothymia Schizoaffective

Three Classes of Mood Stabilisers?

Lithium Anticonvulsants Antipsychotics

Which medication is the only medication to reduce suicide rate?

Lithium

Rate of Completed Suicide in BAD is?

15%

Lithium is effective in long term prophylaxis of?

Mania and Depressive Episodes in 70% of BAD

Factors that predict positive response to lithium? (3)

Prior Long Term Response or Family Member with Good Response Pure Mania Mania followed by Depression

Before starting Lithium bloods to do (3)

Baseline U+E TSH Pregnancy Test

Pregnancy and Lithium are associated with what anomaly?

Ebstein's

Ebstein's is associated with what risk in first trimester with lithium use?

20x greater risk

Steady State is achieved after how many days with lithium use?

5 Days

Check steady state how many hours after last dose?

How to check steady state, TSH and creatinine long term into lithium use?

Steady State 3 Months | TSH and Creatinine 6 months

Goal blood level with lithium?

0.6 and 1.2

Side Effects of Lithium use? (7)

``` GI Distress Thyroid Abnormalities Nonsignificant Leukocytosis Polyuria/Polydyspia Interstitial Renal Fibrosis Hair Loss Reduces Seizure Threshold ```

More common side effects of lithium?

GI Distress

Polyuria/Polydypsia as a side effect to lithium can be caused secondary to what?

ADH Antagonism

Lithium use can cause?

Interstitial Renal Fibrosis

Mild Lithium Toxicity levels are?

1.5-2

Moderate Lithium Toxicity levels are?

2.0 to 2.5

What happens to patients limbs in moderate lithium toxicity?

Clonic Limb Movements

Severe Lithium Toxicity Levels are?

>2.5

Oliguria and Renal Failure can present in what level of Lithium Toxicity?

Severe

Valproic Acid is what type of psychiatric drug?

Anticonvulsant

Name a type of valproic acid?

Depakote

Valproic acid Depakote is useful in?

Mania Prophylaxis

Factors predicting positive response in Valproic Acid (Depakote)? (3)

Rapid Cycling Patients (Females) Substance Issues Patients with Comorbid Anxiety Disorders

Valproic Acid (Depakote) is better tolerated than what?

Lithium

Tests to do before starting Valproic Acid (Depakote)?

Baseline Liver Function Tests Pregnancy Test FBC

Avoid Valproic Acid in what patients?

Child bearing age

Valproic Acid can cause?

Neural Tube Defects

Steady State for Valproic Acid can be achieved after?

4-5 Days

Check Valproic Acid Steady state how long after last dose?

12 Hours

How to monitor steady state of Valproic Acid?

Repeat CBC and LFT

Goal of Valproic Acid Steady State?

Target Level 50-125

Side Effects of Valproic Acid? (8)

``` Thrombocytopenia Platelet Dysfunction GI Upset Weight Gain Sedation Tremor Increased Risk of Neural Tube Defects Hair Loss ```

Carbamazepine is also called?

Tegretol

First line agent for acute mania and mania prophylaxis?

Carbamazepine (Tegretol)

Tests to do before starting Carbamazepine (Tegretol) (3)

Baseline Liver Function Tests FBC ECG

How to check steady state for Carbamazepine (Tegretol)

Check after 5 Days

When to check steady state after last dose of Carbamazepine (Tegretol)

12 hours

What tests should be repeated after last dose of Carbamazepine (Tegretol)

CBC and LFT

Goal for Steady State level for Carbamazepine (Tegretol)?

4-12 mcg/ml

When to check level and adjust dosing with Carbamazepine (Tegretol)?

A month

Why to check Carbamazepine (Tegretol) levels and adjust dosing after a month?

It induces own metabolism

Tests to do before starting Carbamazepine (Tegretol)? (3)

Baseline Liver Function, FBC, ECG

Steady State for Carbamazepine (Tegretol) is achieved when?

12 hours after last dose

Which tests to repeat for Carbamazepine (Tegretol) after last dose?

Repeat CBC and LFTs

Target Level for Carbamazepine (Tegretol)?

4-12mcg/ml

Most Common side effect for Carbamazepine (Tegretol)?

Rash

Side Effects for Carbamazepine (Tegretol) (7)

``` Rash GI Sedation/Dizzy/Ataxia Av Conduction Delays Aplastic Anaemia and Agranulocytosis Hyponatraemia ```

What blood disorders can be caused by Carbamazepine (Tegretol)

Aplastic Anaemia and Agranulocytosis

What cardiovascular complication can be caused by Carbamazepine (Tegretol)

AV Conduction Delays

What psychiatric tablet can cause Hyponatraemia?

Carbamazepine (Tegretol)

Lamotrigine is also known as?

Lamictal

Lamotrigine (Lamictal) is indicated for?

Neuropathic/Chronic Pain

What test before starting Lamotrigine (Lamictal)?

Baseline Liver Function test

What dose to start Lamotrigine (Lamictal) at?

25mg Daily for 2 Weeks

Faster titration of Lamotrigine (Lamictal) has higher incidence of what side effect?

Serious Rash

If a patient stops Lamotrigine (Lamictal) for 5+ days then re-start at what dose?

25mg Daily

Side Effects of Lamotrigine (Lamictal)? (6)

``` GI Symptoms Sedation/Dizzy Ataxia/Confusion Toxic Epidermal Necrolysis and Steven Johnson syndrome Blood Dyscrasis ```

What serious dermatological side effects can Lamotrigine (Lamictal) cause?

Toxic Epidermal Necrolysis and Steven Johnson syndrome

What serious blood side effects can Lamotrigine (Lamictal) cause?

Blood Dyscrasias

Which drugs can increase Lamotrigine (Lamictal) levels?

VPA | Sertraline

Which drug can double concentration of Lamotrigine (Lamictal)

VPA

Which four pathways are affected by Dopamine in brain?

Nigrostriatal Mesolimbic Mesocortical Tuberoinfundibular

Mesocortical Dopamine Pathway projects from and to?

Ventral Tegmentum (Brain Stem) to Cerebral Cortex

Mesocortical Dopamine Pathway is where what happens?

Neg Symptoms and Cognitive Disorders (Lack of executive function) arise

Lack of executive function arises in what dopamine pathway?

Mesocortical

What problem is present in Mesocortical Dopamine pathway for patients?

Too Little Dopamine

Mesolimbic Dopamine Pathway projects from and to?

Dopaminergic cell bodies in ventral tegmentum to limbic system

Mesolimbic Dopamine Pathway is where what happens?

Positive Symptoms come from hallucinations, delusions and thought disorders

What problem is present in Mesolimbic Dopamine Pathway

Too much dopamine

Nigrostriatal Dopamine pathway projects from?

Dopaminergic cell bodies in substantia nigra to basal ganglia.

Which dopamine pathway is involved in movement regulation?

Nigrostriatal Dopamine pathway

Dopamine suppresses what?

Acetylcholine activity

Dopamine hyperactivity can cause what?

Parkinsonian movements eg Rigidity, Bradykinesia, Tremors, Akathisia and Dystonia

Tuberoinfundibular Dopamine pathway projects from

Hypothalamus to Anterior Pituitary

Dopamine release inhibits/regulates what release?

Prolactin

Blocking dopamine in Tuberoinfundibular dopamine pathway will predispose patient to?

Hyperprolactinaemia (Gynaecomastia, Galactorrhoea, Decreased Libido and Menstrual dysfunction)

What do typical antipsychotics do?

D2 Dopamine Receptor Antagonists

Typical antipsychotics can cause? (3)

Dyslipidaemia Abnormal LFT Elevated BP

Monitoring tests needed for putting a patient on Atypical Antipsychotics? (3)

Fasting Lipids Fasting Blood Sugar LFT and CBC

Risperidone (Risperdal) functions at doses greater than?

6mg

Which antipsychotic drug is most likely atypical to induce hyperprolactinaemia?

Risperidone (Risperdal)

Side Effects of Risperidone (Risperdal) (3)

Hyperprolactinaemia Weight Gain and Sedation Akathisia

What is Akathisia?

Feels uncomfortable in skin like can't sit still

Akathisia is associated with what high risk thing in psychiatry?

Suicide

Olanzapine (Zyprexa) is what type of drug?

Antipsychotic

Olanzapine (Zyprexa) side effects? (6)

``` Weight Gain Hypertriglyceridemia Hypercholesterolemia Hyperglycemia Hyperprolactinamia Abnormal LFT's ```

How much weight can be gained from Olanzapine (Zyprexa)?

30-50lbs

Quetiapine (Seroquel) is available in what form?

Regular tablet only

Quetiapine (Seroquel) side effects? (6)

``` Abnormal LFT Weight Gain Hypertriglyceridemia Hypercholesterolemia Hyperglycemia Orthostatic Hypotension ```

Quetiapine (Seroquel) is most likely to cause what type of side effect?

Orthostatic Hypotension

What does Aripiprazole (Abilify) do?

D2 Partial Agonist

Clozapine (clozaril) is used for?

Treatment resistant patients

Clozapine (clozaril) side effects (6)

``` Agranulocytosis Seizures Hypertriglyceridemia Hypercholesterolemia Hyperglycemia Non Ketoic Hypersmolar Coma and Death ```

Non Ketoic Hypersmolar Coma and Death is a side effect for what antipsychotic

Clozapine (clozaril)

What blood side effect can Clozapine (clozaril) cause?

Agranulocytosis

Most common psychotic symptom?

Lack of insight

People with psychotic illnesses relapse most commonly due to?

Non Compliance

What is Tardive Dyskinesia?

Involuntary Muscle Movements

Tardive Dyskinesia is an adverse effect of what?

Antipsychotic

Neuroleptic Malignant Syndrome is an adverse effect of what psychiatric drug?

Neuroleptic Malignant Syndrome

Neuroleptic Malignant Syndrome symptoms? (4)

Severe Muscle Rigidity Fever Altered Mental Status Autonomous Instability

Neuroleptic Malignant Syndrome Tests will show? (3)

Elevated WBC, CPK and LFT

Extrapyramidal Side effects (3) for Antispsychotics?

Acute Dystonia Parkinsons Akathisia

Anxiolytics are used to treat? (6)

``` Panic Disorder GAD Substance Related Disorder Withdrawal Insomnia Parasomnia ```

Anxiolytics can be used in combination with what in Anxiety Disorders?

SSRI or SNRI

Buspirone (Buspar) pros?

Good Augmentation strategy

Buspirone (Buspar) action?

5HT1A Agonist

How long does Buspirone (Buspar) take to work?

2 Weeks before patients notice results

Buspirone (Buspar) and Bzodiazapine are what?

Anxiolytics

Benzodiazapines are used to treat? (3)

Insomnia Parasomnias Anxiety Disorders

Side Effects of Benzodiazapines? (6)

``` Somnolence Cognitive Deficits Amnesia Disinhibition Tolerance Dependence ```

Psychopharmacy Flashcards

(163 cards)