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Y4 Psychiatry > Therapeutics > Flashcards

Therapeutics Flashcards

(72 cards)

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1
Q

What is ECT ?

A

Electroconvulsive therapy is a treatment for severe depression where a small dose of electric current is used to induce seizures

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2
Q

What is the regimen of ECT ?

A

Administered twice weekly for up to 12 treatments

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3
Q

What type of pulse is given for optimal results in ECT ?

A

Brief pulse

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4
Q

What are the indications for ECT ?

A

Depression
Mania
Catatonia

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5
Q

What are some contra-indications for ECT ?

A

Raised intra-cranial pressure, cerebral aneurysm, recent cerebrovascular event
MI within 3 months
Unstable angina
DVT
Acute resp distress
Cochlear implant
Pregnancy
Uncontrolled epilepsy

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6
Q

What are some side effects of ECT ?

A

Confusion
Headache
Status epilepticus
Stroke
Bleeding from ulcers
Broken teeth
Memory loss

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7
Q

What are some side effects from the anaesthesia used in ECT ?

A

MI
Arrhythmia
Aspiration pneumonia
Nausea
Malignant hyperthermia

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8
Q

What are the physiological changes that occur from ECT ?

A

EEG changes
Cerebral blood flow increases
Blood brain barrier may be breached
Hormonal changes - TSH, ACTH, growth hormone and prolactin

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9
Q

What is needed for consent for ECT in someone lacks capacity ?

A

Second opinion approved doctor and complete T6
If emergency complete a C6

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10
Q

What monitoring is needed for ECT ?

A

Pre ECT physical health check
Consent
Medication
Monitoring side effects
Hamilton depression rating scale

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11
Q

What are some common adrenergic / noradrenergic receptor effects ?

A

Sweating
Tremor
Headaches
Nausea
Dizziness

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12
Q

What are some common Muscarinic receptor effects ?

A

Dry mouth , difficulty swallowing, thirst
Difficulty urinating
Urinary retention
Hot and flushed skin
Dry skin

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13
Q

How do most antidepressants work ?

A

Work on serotonin activity and the aim is to increase activity at post synaptic receptors

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14
Q

How long do most antidepressants take to work ?

A

2 - 3 weeks

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15
Q

How do SSRI’s work ?

A

Increase serotonin activity by reducing the presynaptic reuptake of serotonin after release. Therefore more serotonin sits in the synapse. This leads to a down regulation of post-synaptic receptors.

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16
Q

What are some common side effects of SSRI’s ?

A

Restlessness
Nausea
Headache
Weight changes
Sexual dysfunction

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17
Q

What are some examples of SSRI’s ?

A

Sertraline
Citalopram
Fluoxetine
Paroxetine

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18
Q

What are some risks for citalopram ?

A

Prolongs QTc

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19
Q

How do SNRI’s work ?

A

Act in the same way as SSRI’s nut bind to noradrenaline reuptake receptors as well

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20
Q

What are some side effects of SNRI’s ?

A

Sedation
Nausea
Sexual dysfunction

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21
Q

What are some SNRI’s ?

A

Duloxetine
Venlafaxine

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22
Q

When does venlafaxine need to started with caution ?

A

In heart disease - monitor BP at doses above 225mgs

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23
Q

What does mirtazapine act on ?

A

Acts as a 5HT-2 and 5HT-3 antagonist
Strong histamine 1 activity

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24
Q

What are the major side effects on mirtazapine ?

A

Sedation
Weight gain

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25
What are some types of tricyclic antidepressants ?
Lofepramine Nortiptyline Amitriptyline
26
What are some side effects of tricyclic antidepressants ?
Muscarinic and histaminic side effects
27
Why do tricyclic antidepressants need close observation ?
Causes QTc prolongation and arrhythmias
28
What are MAOI’s ?
Monoamine oxidase inhibitors work on serotonin (A) or dopamine ( B ).
29
What is discontinuation syndrome ?
Antidepressants aren’t addictive but they can be difficult to stop as they cause sweating, shaking, agitation, insomnia. Very unpleasant Shorter the half life the bigger the problem
30
What are some signs and symptoms of serotonin syndrome ?
Headaches Agitation Hypomania Shivering Sweating Hyperthermia Tachycardia Nausea Hyper-reflexia
31
How do most antipsychotics work ?
Reduce level of dopamine activity at D2 receptors Target dopaminergic pathways in the brain - mesocorticol and mesolimbic
32
What are some examples of typical antipsychotics ?
Haloperidol Flupenthixol Zuclopenthixol
33
What are some examples of atypical antipsychotics ?
Clozapine Olanzapine Risperidone
34
What are some side effects of antipsychotics ?
Sedation Weight gain QTc prolongation Typical - bradykinesia, muscle stiffness, tremor, tardive dyskinesia, dizziness, sexual dysfunction Atypical - weight gain, DM
35
What monitoring is required when starting antipsychotics ?
Baseline - FBC, lipids, HbA1c, weight ECG BP Weekly - weight 3 monthly - FBC, lipids, LFT, HbA1c, ECG BP
36
What is neuroleptic malignant syndrome ?
Rare, life-threatening reaction to antipsychotics
37
What are some features of neuroleptic malignant syndrome ?
Fever Confusion Muscle rigidity Sweating Rhabdomyolysis Renal failure Seizures
38
What is the treatment for neuroleptic malignant syndrome ?
Emergency referral to ED Stop antipsychotics Give benzodiazepines Fluid resus Cooling blankets O2 if necessary Dantrolene to relax muscles
39
What does clozapine work on ?
D2 and 5HT-2 antagonist
40
What are some side effects of clozapine ?
Constipation - fatal bowel obstruction Agranulocytosis Hypersalivation Urinary incontinence
41
What are some examples of anxiolytics ?
Beta blockers Benzodiazepines Pregabalin Antidepressants
42
How do beta blockers reduce anxiety ?
They act by reducing autonomic nervous system activation Bio-psycho-feedback
43
When are beta blockers contra-indicated ?
Asthma
44
How do benzodiazepines reduce anxiety ?
They bind to GABA receptors and potentate the effect of GABA and therefore reduce the excitability of neurones. They are positive allosteric modulators of GABA receptor
45
What are some risks of benzodiazepines ?
Tolerance Dependence Misuse Paradoxical disinhibition
46
How does pregabalin reduce anxiety ?
Binds to voltage gated calcium channels of neurones and reduces neuronal activity
47
What are some side effects of pregabalin ?
Sedation Weight gain
48
What are some examples of hypnotics ?
Benzodiazepines - temazepam Nonbenzodiazepines - zopiclone and zolpidem
49
What are some risks of prescribing hypnotics ?
Misuse Dependence Rebound insomnia
50
What are some examples of mood stabilisers ?
Lithium Anticonvulsants Second generation antipsychotics
51
How does lithium work ?
Mechanism of action is unknown Lowers noradrenaline release and increases serotonin synthesis
52
What are some side effects of lithium ?
GI disturbance Metallic taste Dry mouth Fine tremor Polydipsia and polyuria Weight gain
53
What are some long term effects of lithium ?
Hypothyroidism - usually reversible Renal impairment - usually irreversible
54
What can lithium toxicity cause ?
Can be fatal Confusion Coarse tremor Nausea and vomiting Ataxia and seizures
55
What treatment is given for lithium toxicity ?
Stop lithium IV fluids Dialysis Benzodiazepines for seizures
56
What are some medications that interact with lithium causing increasing levels ?
NSAIDs Loop diuretics ACEi
57
What second generation antipsychotic is used for bipolar ?
Quetiapine
58
What anticonvulsants can be used as mood stabilisers ?
Sodium valproate Carbamazepine Lamotrigine
59
What are some side effects of anticonvulsants as mood stabilisers ?
Sedation Weight gain Thrombocytopenia
60
What drugs are most commonly used in ADHD ?
CNS stimulants - Methylphenidate Dextroamphetamine
61
What is the mechanism of action of mirtazapine ?
Antidepressant that works by blocking alpha 2 adrenergic receptors which increases the release of neurotransmitters.
62
Why is mirtazapine used in the elderly ?
Two side effects - sedation and increased appetite - may help with insomnia and low weight
63
What is a risk of using MAOI’s ?
Have lots of side effects - causes increased levels of tyramine which can result in a hypotensive crisis
64
What are some side effects of olanzapine ?
Metabolic syndrome - weight gain, hypertension, DM, hyperlipidaemia Increased QRISK Parkinsonism Increased sedation
65
What are some risks of using risperidone ?
Increased prolactin release which causes - galactorrhoea - breast development - amenorrhea - low libido - decrease in sperm production - osteoporosis
66
What is beneficial about using risperidone ?
Less weight gain Less sedation
67
What are the benefits from using aripiprazole ?
No weight gain No sedation No effect on the heart Doesn’t affect prolactin Restlessness
68
What is the mechanism of action of aripiprazole ?
Partial agonist of dopamine
69
What are the major risks of using clozapine ?
Agranulocytosis - risk of neutropenia sepsis Cardiac Myositis Constipation Metabolic syndrome
70
What monitoring is needed when a patient is on clozapine ?
ECG Blood tests Required before medication is released to patient
71
What are some risks of using sodium valproate ?
Very teratogenic - can’t be given to women of child bearing age Hepatotoxic Weight gain
72
If sodium valproate has to be prescribed what must a woman of child bearing age be put on ?
Highly effective contraceptive - implant or copper coil

Y4 Psychiatry (7 decks)

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