Revision - Psych Drugs

Question 1

When would typical antipsychotics be indicated over atypical in the management of schizophrenia?

Answer 1

Particularly when the METABOLIC side effects of second generation (atypical) antipsychotics are likely to be problematic

Question 2

Give 3 contraindications for 1st line antipsychotics

Answer 2

1) Elderly

2) Dementia

3) Parkinson’s

Question 3

What are elderly patients on typical antipsychotics at a particularly increased risk of?

Answer 3

Stroke & VTE

Question 4

What is an alternative to typical antipsychotics for Parkinson’s patients?

Answer 4

Small dose of lorazepam might be alternative in distress

Question 5

Management of akathisia?

Answer 5

Propranolol

Question 6

What is NMS?

Answer 6

A life-threatening idiosyncratic reaction to (often 1st line) antipsychotic drugs (rare).

Can happen after change in dose, treatment commencing or suddenly stopping

Question 7

What happens in NMS?

Answer 7

Ridigity –> muscle breakdown –> rhabomyolysis –> kidney failure

Question 8

Give some symptoms seen in NMS

Answer 8

Fever
Altered mental status
Autonomic dysfunction
Neuromuscular excitability –> hypertonia, hyperreflexia
Confusion
Autonomic dysregulation –> tachycardia, hyperthermia, unstable BP

Question 9

Management for NMS?

Answer 9

1) Stop antipsychotic
2) IV fluids
3) Sodium bicarbonate
4) Codeine
5) Dantrolene (muscle relaxant)
6) Bromocriptine (dopamine agonist)

Question 10

Management of tardive dyskinesia?

Answer 10

Tetrabenazine

Question 11

Which 1st line antipsychotics particularly causes QT interval prolongation?

Answer 11

Haloperidol

Question 12

In an emergency, what 1st line antipsychotic is typically given?

Answer 12

Haloperidol can be given via rapid acting IM injection

Question 13

What investigations are required 3 MONTHS after starting 1st line antipsychotics?

Answer 13

Weight
Lipids

Then annually.

Question 14

What investigations are required 6 MONTHS after starting 1st line antipsychotics?

Answer 14

Fasting blood glucose.

Then annually.

Question 15

Which 2nd line (atypical) antipsychotic is associated with weight gain and hypercholesterolaemia?

Answer 15

Olanzapine

Question 16

Which 2nd line (atypical) antipsychotic is LEAST likely to help with SLEEP?

Answer 16

Risperidone

Question 17

Which 2nd line (atypical) antipsychotic has the MOST TOLERABLE side effect profile, particularly for prolactin elevation?

Answer 17

Aripiprazole

Question 18

Which class of antipsychotics should be used in schizophrenia where NEGATIVE symptoms are prominent?

Answer 18

Atypical

Question 19

What are 2 major contraindications of clozapine?

Answer 19

1) severe heart disease

2) history of neutropenia

Question 20

Give some drug interactions for 2nd line antipsychotics

Answer 20

1) dopamine blocking antiemetics e.g. metoclopramide

2) drugs which prolong the QT interval

3) sedating drugs

Question 21

Why can carbamazepine (anti-epileptic) not be prescribed with clozapine?

Answer 21

Both affect bone marrow function

Question 22

Symptoms of agranulocytosis?

Answer 22

o Myocarditis
o Weight gain
o Excessive salivation – sleep sitting up/towels
o Seizures

Question 23

How does lithium affect calcium levels?

Answer 23

Often mild hypercalcaemia seen (due to hyperparathyroidism)

Question 24

What is dysarthria?

Answer 24

Difficulty speaking because the muscles you use for speech are weak.

Question 25

Why is lithium contraindicated in Cardiac disease or Addison’s disease?

Answer 25

Causes sodium depletion

Question 26

Which SSRI is licensed in bulimia nervosa?

Answer 26

Fluoxetine

Question 27

Which SSRI causes QT prolongation?

Answer 27

Citalopram

Question 28

Why should SSRIs NOT be given with monoamine oxidase inhibitors?

Answer 28

both increase synaptic serotonin levels so together may precipitate serotonin syndrome

Question 29

Give 4 classes of drugs that SSRIs should not be prescribed with/prescribed with caution with?

Answer 29

1) MAOIs, triptans & tramadol --> risk of serotonin syndrome 2) Aspirin or NSAIDs --> risk of GI adverse effects 3) Anticoagulants --> risk of bleeding 4) Drugs that prolong QT interval e.g. antipsychotics

Question 30

How long should SSRI treatment be continued for after the patient feels better?

Answer 30

6m

Question 31

How should patients stop SSRIs?

Answer 31

Gradual dose reduction over 4 weeks

Question 32

What class of drug are amitriptyline, clomipramine & imipramine?

Answer 32

TCAs

Question 33

Which TCA is licensed for OCD?

Answer 33

Clomipramine

Question 34

Cardiac effect of TCAs antidepressants blocking a1 receptor?

Answer 34

Inhibit smooth muscle contraction –> hypotension

Question 35

What is the side effect caused by tricyclic antidepressants blockage of H1 receptors?

Answer 35

Sedation & weight gain

Question 36

What is the side effect caused by tricyclic antidepressants blockage of a1 receptors?

Answer 36

Hypotension

Question 37

What are the side effects caused by tricyclic antidepressants blockage of dopamine receptors? Why?

Answer 37

o Breast changes –> due to raised prolactin levels o Sexual dysfunction –> due to raised prolactin levels o EPSEs (tremors, dyskinesia) –> thought to create a dopaminergic-cholinergic imbalance that leads to development of extrapyramidal symptoms

Question 38

Anticholinergics and IOP?

Answer 38

Can increase IOP --> avoid in raised IOP e.g. glaucoma

Question 39

Why should TCAs be used with CAUTION in people with prostatic hypertrophy and/or raised intraocular pressure?

Answer 39

May be worsened by antimuscarinic effects

Question 40

Give 3 examples of monoamine oxidase inhibitors (MAOIs)

Answer 40

1) Phenelzine 2) Isocarboxazid 3) Moclobemide

Question 41

MOA of MAOIs?

Answer 41

Inhibit the enzyme monoamine oxidase –> prevent the breakdown of amine neurotransmitters: - 5-HT (serotonin) - Dopamine - Noradrenaline

Question 42

How can MOAIs interact with food?

Answer 42

'Tyramine’ reaction If you take an MAOI and you eat high-tyramine foods, tyramine can quickly reach dangerous levels. This can cause hypertensive crisis.

Question 43

What class of drug is Mirtazapine?

Answer 43

NaSSa

Question 44

Name 2 SNRIs

Answer 44

1) Venlafaxine 2) Duloxetine

Question 45

How does venlafaxine affect the QT interval?

Answer 45

Prolongs it --> fainting, seizures

Question 46

Why is the efficacy of antiepileptic drugs reduced by antipsychotics?

Answer 46

As antipsychotics lower the seizure threshold

Question 47

What is the interaction between carbamazepine and antipsychotics?

Answer 47

Carbamazepine DECREASES plasma concentrations of antipsychotics (is an enzyme inducer)

Question 48

What condition are benzos contraindicated in?

Answer 48

Mysathenia gravis

Question 49

Contraindications of AChEIs?

Answer 49

1) Use with caution in asthma and COPD (due to increased secretions), and those at risk of developing peptic ulcers 2) Avoid in patients with heart block or sick sinus syndrome, or bradycardia

Question 50

What MMSE score indicates severe dementia?

Answer 50

<10

Question 51

Why should AChEIs be used with caution alongside NSAIDs and corticosteroids?

Answer 51

Concomitant therapy with NSAIDs and corticosteroids may increase risk of peptic ulceration

Question 52

How long should z drugs be prescribed for?

Answer 52

Max 4 weeks

Question 53

What class of drug is used in the management of NMS?

Answer 53

Dopamine agonist - bromocriptine

Question 54

Why are SSRIs contraindicated in epilepsy?

Answer 54

Cause hyponatraemia (can lead to seizures)