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Psych Drugs and Side Effects

Terms in this set (36)

What drug is prescribed first line for depression? What is its action?
SSRI - citalopram. Selective serotonin reuptake inhibitor.
What are the three most common SSRIs?
Citalopram, fluoxetine, sertraline
What are the main side effects of SSRIs?
1. GI upset and weight disturbance
2. Hypersensitivity
3. Hyponatramia/SIADH
4. Suicidal thoughts and behaviour
5. Lower seizure threshold and prolong QT interval - risk of epilepsy and arrythmias
6. Bleeding
What happens if you withdraw SSRIs too quickly?
Sudden withdrawal can cause tummy upset, flu like symptoms and sleeplessness
What is the action of tricyclic antidepressants and give an example?
Inhibits neuronal reuptake of serotonin and noradrenaline and block a wide array of receptors - muscarinic, histamine, adrenergic and dopamine D2. Amitryptyline.
What are the main side effects of tricyclics?
1. Antimuscarinic side effects - dry mouth, constipation, urinary retention and blurred vision
2. Sedation
3. Hypotension
4. Convulsions, hallucinations and mania
In what situation are tricyclics particularly dangerous:?
Overdose - can cause severe hypotension, convulsions, arrythmias, coma and respiratory failure
Other than depression what can tricyclics be prescribed for even though they are not licensed for this use?
neuropathic pain
Give three examples of first generation/typical antipsychotics.
Haloperidol, chlorpromazine, prochlorperazine
What is the MOA of typical antipsychotics and what is the main pathway affected?
Block synaptic D2 receptors to reduce DA activity. Mesolimbic pathway.
What are the three main dopaminergic pathways in the CNS and what do they do?
Mesolimbic - between midbrain and the limbic system and blockade in this pathway is probably most important in antipsychotic effect
Nigrostriatal pathway - connects substantia nigra with corpus striatum of basal ganglia
What are the main general side effect of typical antipsychotics?
Extrapyramidal effects
What are the early extrapyramidal side effects that are seen with antipsychotics?
NMS, akathisia, acute dystonic reactions
What happens in acute dystonic reactions?
involuntary parkinsonian movements or muscle spasms
What is akathisia?
State of restlessness
What happens in NMS and what is the cause?
Rigidity, confusion, autonomic dysregulation and pyrexia
Blockage of the nigrostriatal pathway
What is the late side effect of typical antipsychotics?
Tardive dyskinesia
What happens in tardive dyskinesia?
Pointless, involuntary and repetitive movements like lip smacking
Give four examples of atypical second generation antipsychotics.
Olanzapine, risperidone, cloazpine, quetiapine
What is the treatment of acute dystonia?
Procyclidine - anticholinergic agent
What is the treatment of neuroleptic malignant syndrome?
Dantrolene
What is a breast side effect of typical antipsychotics?
Hyperprolactinaemia leading to lactation and gynaecomastia
What is the action of second generation antipsychotics? Which pathway is the main one affected?
block post-synaptic dopamine receptors particularly in the mesolimbic pathway
What are the main side effects associated with atypical antipsychotics?
Weight gain
Hyperglycaemia
Metabolic syndrome
Which of the second generation antipsycotic most often causes breast symptoms?
Risperidone
Can you get extrapyramidal side effects with second generation antipsychotics?
YES - so always explain them
What is the key side effect of clozapine?
AGRANULOCYTOSIS - must warn patients.
What motinoring is done for clozapine?
FBC prior to starting then weekly FBCs for four weeks and then montly FBCs for duration of the treatment
What drugs are used to treat bipolar disorder?
1. Lithium
2. Valproate 3. Carbamazepine 4. Lamotrigine
What pathway is effected when extra-pyramidal side effects are shown?
Nigrostriatal
What other non psych drugs can cause agranulocytosis?
Carbimazole
What are the symptoms of lithium toxicity?
Vision decreased, D and V, hypokalaemia, ataxia, tremor, dysarthria, coma
What are normal plasma levels of lithium? Above what level do you get signs of overdose?
Normal - 0.6-1
Overdose >1.5 = symptoms
What is the monitoring required for lithium?
Check levels 12 hours after any dose
At start - weekly until constant for 4 weeks
Monthly for 6 months
3 Monthly is stable
What is the main side effect of lamotrogine in treatment of bipolar?
Maculopapular rash and SJS
Can lithium, valproate and carbamazepine be prescribed during pregnancy?
No they are all teratogenic
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