Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psychiatry > Psychotropic medications > Flashcards

Psychotropic medications Flashcards

1
Q

Examples of SSRIs

A

Citalopram, Escitalopram, Sertraline, Fluoxetine, Fluvoxamine, Paroxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Contraindications/precautions to SSRIs

A

High bleeding risk, high risk for angle-closure glaucoma, bipolar disorder, concurrent treatment with other antidepressants (especially MAOIs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Safety of SSRIs in pregnancy and breastfeeding

A

Category C in pregnancy - DON’T USE (use in 3rd trimester may also cause withdrawal in newborn)

Considered safe in breastfeeding, especially sertraline due to low levels in breast milk - potential drowsiness and irritability in newborn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Side effects of SSRIs

A

SSRI:
Serotonin syndrome
Stimulate CNS (tremor, headache, agitation)
Reproductive dysfunction (reduced libido, impotence)
Insomnia
+ GIT (nausea, diarrhoea)

Significant: hepatitis, increased QT interval, SIADH, abnormal platelet aggregation, acute angle-closure (esp paroxetine), EPS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Zoloft generic name

A

Sertraline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Lexapro generic name

A

Escitalopram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Prozac generic name

A

Fluoxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Indications for SSRIs

A

Major depression
Anxiety disorders (Panic disorder, OCD)
Bulimia nervosa
Premenstrual dysphoric disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Indications for SNRIs

A

Major depression

duloxetine also indicated in general anxiety disorder and second line in painful diabetic peripheral neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Contraindications/precautions of SNRIs

A 
CrCl less than 30 (reduced dose)
Hepatic impairment
Bipolar
Epilepsy/increased risk of seizures
High bleeding risk
High risk of angle-closure
High risk of overdose (esp avoid venlafaxine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Safety of SNRIs in pregnancy and breastfeeding

A

Category B2 - limited studies, use in 3rdT can cause withdrawal in newborns

Low concentrations in breast milk, monitor baby for sedation and FTT, consider using alternative to duloxetine until more data

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Side effects of SNRIs

A

Common: Nausea, constipation, dry mouth, sexual dysfunction, sweating, dizziness, headache, reduced appetite, rash

Significant: seizures, myositis, Takotsubo, SIADH, orthostatic hypotension, urinary retention (duloxetine), Steven-Johnson, increased bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Monitoring patient on SNRI

A

Check baseline BP and regularly after commencement for rise
Baseline Na then monitoring soon after commencement especially at risk patients(e.g. elderly)
Monitor frequently and carefully early in treatment for suicidal thoughts and behaviours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Monitoring patient on SSRI

A

Baseline sodium and soon after starting treatment if risk of hypoNa e.g. elderly
Monitor frequently early in treatment for suicidal thoughts and behaviours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Indications for mirtazapine

A

Major depression, especially useful where insomnia or anorexia are prominent features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Mechanism of action of mirtazapine

A

Blocks post-synaptic serotonin receptors and presynaptic alpha-adrenergic receptors

Also a potent H1 antagonist (causes sedation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Contraindications/precautions to use of mirtazapine

A

Treatment with, or within 14 days of stopping, a MAOI
Epilepsy/increased risk of seizures
Phenylketonuria
Bipolar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Drug class of mirtazapine

A

Serotonin noradrenaline disinhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Side effects of mirtazapine

A

Common: increased appetite, weight gain, sedation, weakness, peripheral oedema

Significant:
Mania, seizures, agranulocytosis, granulocytopaenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Dosing of mirtazapine

A

Initial dose 15mg nocte - increase to 30-45mg nocte as indicated
Max. dose 60mg nocte
Withdraw over at least 1-2 weeks to minimise withdrawal symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Indications for monoamine oxidase inhibitors

A 
Major depression (third line)
Some anxiety disorders, including phobic disorders and panic disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Examples of SNRIs

A

Venlafaxine, desvenlafaxine, duloxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Generic name of Efexor

A

Venlafaxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Generic name of Pristiq

A

Desvenlafaxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Generic name of Cymbalta

A

Duloxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Examples of MAOIs

A

Phenelzine
Tranylcypromine
Moclobemide - selective for type A (second line)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Mechanism of action of MAOIs

A

IRREVERSIBLE inhibition of monoamine oxidase A and/or B - increased synaptic concentrations of adrenaline, noradrenaline, dopamine and serotonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Contraindications/precautions to using MAOIs

A

Catecholamine-secreting tumours (e.g. phaeochromocytoma)
Cerebrovascular or cardiovascular disease
Angina/CAD (may reduce pain associated with MI)
Epilepsy/high risk of seizures
Bipolar
Diabetes (may reduce BGL)
Significant liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Safety of MAOIs in pregnancy and breastfeeding

A

Category B2/3 - avoid in pregnancy until more data

Moclobemide appears safe in breastfeeding, limited data for other MAOIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Side effects of MAOIs

A

Common: Orthostatic hypotension, sleep disturbance, headache, drowsiness, weakness, myoclonus, agitation, tremors/twitching, sexual dysfunction (less likely with moclobemide), nausea, diarrhoea/constipation

Significant: hypertensive crisis (usually precipitated by tyramine or med interactions), SIADH, hepatic damage, blurred vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Usage guidelines for MAOIs

A

Best taken with food.
Best to take last dose before 3pm (reduce sleep disturbance)
Avoid tyramine containing foods, including for 2 weeks after ending treatment: (matured or out of date cheese, aged meat products e.g. salami, protein extracts, yeast extracts e.g. vegemite, soy bean extracts e.g. tofu, miso)

32
Q

Monitoring during use of MAOIs

A

Monitor frequently early in treatment for suicidal thoughts and behaviours
Monitor BP

33
Q

Withdrawal symptoms of MAOIs

A

Nausea, vomiting, panic, hallucinations

Post-phenelzine: seizures, psychosis

Post-tranylcypromine: delirium

34
Q

Indications for TCAs

A

Major depression
OCD, Panic disorder, cataplexy
Pain relief adjunct, migraine prophylaxis (amitriptyline)
Nocturnal enuresis, urinary incontinence

35
Q

Examples of TCAs

A

Amitriptyline, nortriptyline, dothiepin, imipramine, clomipramine

36
Q

Generic name for Endep

A

Amitriptyline

37
Q

Mechanism of action of TCAs

A

Inhibit reuptake of NorAd and serotonin into presynaptic terminals
Also block cholinergic, histaminergic, alphar-adrenergic and serotonergic receptors - unrelated to therapeutic effects

38
Q

Contraindications/precautions to TCA therapy

A

Prostatic hypertrophy (may precipitate retention), risk of acute angle-closure, hyperthyroidism, epilepsy/risk of seizures, heart block or post-MI, coronary artery disease, orthostatic hypotension, Long QT, bipolar, suicidal ideation or high risk of overdose, hepatic impairment

39
Q

Safety of TCAs in pregnancy and breastfeeding

A

Category C i.e. do not use in pregnancy

Can be used while breastfeeding (avoid doxepin - neonatal respiratory depression)

40
Q

Side effects of TCAs

A

Common: sedation, dry mouth, blurred vision, mydriasis, weight gain, constipation, orthostatic hypotension, urinary retention, sexual dysfunction, dizziness, sweating, insomnia, anxiety, confusion

Significant: arrhythmias, raised IOP, SIADH, seizures, hepatitis, paralytic ileus

41
Q

Usage of TCAs

A

Take at night to reduce daytime drowsiness
Dosing same for all TCAs in major depression:
Initially 25-75mg, increase by 25-50mg every 2-3 days to 75-150mg daily

May split to BD dosing
Max dose 300mg/day

42
Q

Indications for melatonin agonists

A

Major depression

43
Q

Example of melatonin agonists

A

Agomelatine (valdoxan)

44
Q

Generic name for Valdoxan

A

Agomelatine

45
Q

Mechanism of action of agomelatine

A

Unclear : melatonin receptor agonist, serotonin receptor antagonist

46
Q

Contraindications/precautions to agomelatine therapy

A

Bipolar disorder
Hepatic impairment
Elderly over 75y

47
Q

Safety of agomelatine in pregnancy

A

Category B1 - very little data i.e. discourage use

No data re: breastfeeding, therefore avoid in breastfeeding mothers

48
Q

Side effects of agomelatine

A

Increased aminotransferases, dizziness, abdo pain

Significant: hepatitis, blurred vision

49
Q

Monitoring of patients on agomelatine

A

Baseline LFTs, then at 3, 6, 12, 24 weeks after starting/dose increase.
Cease if increase to over 3 times upper limit of normal

50
Q

Indications of lithium

A

Prevention of manic or depressive episodes in bipolar disorder
Treatment of acute mania
Schizoaffective disorder
Chronic schizophrenia (rarely used)
Augmentation for treatment-resistant depression

51
Q

Types of lithium available

A

Normal release “Lithicarb”

Slow release “Quilonum SR”

52
Q

Mechanism of action of lithium

A

Inhibition of dopamine release, enhancement of serotonin release, reduced formation of intracellular second messengers

53
Q

Contraindications/precautions to lithium treatment

A 
Hyponatremia (inc. Li conc)
Hypothyroidism
Psoriasis
Treatment with drugs that may contribute to serotonin toxicity
Reduced CrCl (renally reduced dose)
Pregnancy
54
Q

Safety of lithium in pregnancy/breastfeeding

A

Category D - TERATOGENIC

Avoid in breastfeeding

55
Q

Side effects of lithium

A 
LITHIUM:
Lethargy/Leucocytosis
Intention tremor
Teratogenicity (Ebstein's anomaly)
Hypothyroidism
Insipidus (DI, nephrotoxicity, RTA, Nephrotic syndrome)
Urine Excess (polyuria without DI)
Metallic taste

+ GI symptoms (nausea, diarrhoea, epigastric discomfort)

56
Q

Therapeutic range of lithium

A

Acute mania: 0.5-1.2mmol/L

Prophylacis: 0.4-1mmol/L

57
Q

Lithium toxicity concentration and presentation

A

Serum Li higher than 1.5 (1.2 in elderly)
GI symptoms (nausea, vomiting, cramping, diarrhoea)
Neuromuscular signs (tremor, dystonia, hyperreflexia, ataxia)
T wave flattening

58
Q

Lithium monitoring

A

Measure serum Li 5-7 days after commencing treatment, and after every dose change until stabilised, then every 3 months

Monitor more frequently during illness, manic/depressive periods, pregnancy

Take level at least 8-12 hours after last dose

59
Q

Mood stabilising medications

A

Lithium
Sodium Valproate
Carbamazepine
Lamotrigine

60
Q

Indications for sodium valproate

A

Epilepsy
Bipolar disorder
Migraine prophylaxis (when other treatments have failed)

61
Q

Brand names for sodium valproate

A

Epilim, valpro

62
Q

Contraindications to sodium valproate therapy

A

Pancreatic dysfunction
Porhypria
Urea cycle disorders
POLG gene mitochondrial disorders

63
Q

Sodium valproate in pregnancy and breastfeeding

A

Category D pregnancy (spina bifida/other neural tube defects), monitor closely with 5mg folic acid supplementation

Should be safe in breastfeeding

64
Q

Side effects of sodium valproate

A 
VALPROATE
Vomiting
Alopecia (usually temporary)
Liver toxicity
Pancreatitis, pancytopenia
Retention of fat (weight gain)
Oedema (peripheral)
Appetite increase
Tremor
Enzyme inducer (liver)
65
Q

Normal doses of valproate for bipolar

A

Initial dose 300mg BD, maintenance 1-2g daily

66
Q

Brand name for carbamazepine

A

Tegretol

67
Q

Contraindications for use of carbamazepine

A

AV conduction abnormalities
History of bone marrow depression
Porphyria

68
Q

Precautions in valproate therapy

A

Diabetes - use sugar-free oral liquid or tablets (epilim syrup contains a lot of sucrose)
Avoid if possible in hepatic impairment and pregnancy

69
Q

Major drug interactions with carbamazepine

A

Thyroxine: may need to increase thyroxine dose due to increased metabolism
COCP: reduced COCP concentration, therefore use alternative contraceptive method
Clozapine: increased risk of serious haematological adverse effects
Warfarin: monitor INR and increase warfarin as needed (may need to be doubled)

70
Q

Safety of carbamazepine in pregnancy and breastfeeding

A

Category D: spina bifida, minor craniofacial defects, developmental disability - give with 5mg folic acid supplementation if cannot avoid. CAN ALSO CAUSE VIT K DEF IN NEWBORN - prophylactic vit K to mother prior to delivery

Safe in breastfeeding: monitor for drowsiness and poor suckling

71
Q

Side effects of carbamazepine

A 
CARBAMAZEPINE
Congestive heart failure
Ataxia
Renal damage
Blurred vision
Agranulocytosis
Migraine
Aplastic anaemia
Z (nothing)
Erythematous skin (most reactions are transient)
Platelet reduction
Increased risk of SLE
Nausea
Emesis

Also associated with severe skin reactions (DRESS, exfoliative dermatitis, Steven-Johnson Syndrome and toxic epidermal necrolysis)

72
Q

Precautions in treatment with lamotrigine

A

Myoclonic seizures
Allergy/rash with other anticonvulsants
Child-Pugh B or C hepatic impairment
Children (higher risk of severe skin reactions)

73
Q

Major drug interactions with lamotrigine

A

COCP: COCPs increase lamotrigine’s metabolism - reducing concentration therefore consider taking COCP without a pill-free period (reduce possible rise in lamotrigine during this time) or use an alternative contraception

Valproate: increases lamotrigine concentration

74
Q

Safety of lamotrigine in pregnancy and breastfeeding

A

Category D: less data than other anticonvulsants, potentially associated with oral clefts
BUT lamotrigine clearance increases during pregnancy, therefore monitor plasma concentrations closely to make sure therapeutic (especially important if indication = epilepsy)

Lamotrigine is passed into breast milk, contact specialist

75
Q

Side effects of lamotrigine

A 
Laziness (somnolence)
Ataxia
Muscle spasms (hyperkinesia)
Ophthalmic (diplopia, blurred vision)
Thrombocytopaenia, neutropenia (rare)
Rash (most commonly maculopapular, rarely Steven Johnson Syndrome)
Irritating headache
Giddiness (dizziness)
Interactions with other medications (valproate, COCP)
No hair (alopecia)
Emesis, nausea
76
Q

Monitoring of lamotrigine

A

Not necessary except in pregnancy - monitor plasma levels to ensure remains therapeutic

Psychiatry (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions