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Y3 DRUGS PROFILES > MENTAL HEALTH DRUGS > Flashcards

MENTAL HEALTH DRUGS Flashcards

1
Q

give an example of a benzodiazepine

A

Diazepam, lorazepam, oxazepam

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2
Q

what is the structure and pathophysiology of benzodiazepines?

A

It contains benzoring
Acts on the GABAa receptor increasing the inhibitory neurotransmitter effects by opening the chloride channel( gaba receptor) and increase chloride movement into the cells
Which causes inhibitor of the cells to depolarize

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3
Q

What conditions are BZDP used for?

A
  • Short term for severe, disabling or distressing Anxiety
  • Short term for severe, disabling or distressing Insomnia
  • First line for seizure and status epilepticus
  • 1st line for alcohol withdrawal
  • premedication for procedures + agitation
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4
Q

when would you give buccal midazolam

A

seizure emergency

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5
Q

why shouldn’t BZDP’s be given in myasthenia graves, sleep apnoea, bronchitis or COPD?

A

can cause respiratory depression

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6
Q

why shouldn’t BZDP’s be given to a patient with liver failure?

A

Increase chance of hepatic encephalopathy

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7
Q

why shouldn’t BZDP’s be given in patients with renal failure?

A

Increased cerebral sensitivity to the drug

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8
Q

what is the antidote for BZDP overdose?

A

flumazenil

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9
Q

give 3 complications of taking BZDP’s in pregnancy

A

cleft palate
floppy infant syndrome
neonatal withdrawal syndrome

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10
Q

what effect can BZDP’s have on the circulation?

A

Hypotension and hypovolaemia

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11
Q

how are BZDP’s metabolised?

A

cytochrome P450

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12
Q

what 2 things can potentiate action of BZDP’s?

A

alcohol

opiates

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13
Q

give an example of an acetylcholinesterase inhibitor

A

donepezil, rivastigmine and galantamine

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14
Q

how do ACh-E inhibitors work?

A

Inhibits the acetylcholinesterase enzyme from breaking down acetylcholine,–> increasing the level and duration of action of the neurotransmitter acetylcholine on the synapse .

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15
Q

when are ACh-E inhibitors used?

A

mild to moderate treatment of alzheimer’s and Parkinsons ( non cognitive symptoms)

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16
Q

give 2 cardiac contraindications for ACh-E inhibitors

A

heart disease

arrhythmias

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17
Q

give 2 respiratory contraindications for ACh-E inhibitors

A

asthma

COPD

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18
Q

give 2 GI contraindications for ACh-E inhibitors

A

peptic ulcer disease
NSAIDs
(they increase risk of peptic ulcer disease)

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19
Q

how do ACh-E inhibitors interact with bentropine/atropine/trihexyphenidyl?

A

anticholinergic drugs- reverse action

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20
Q

give an example of a TCA

A

amitriptyline, doxepin, lofepramine and imipramine

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21
Q

TCA’s inhibit reuptake of what? How long do they take to work?

A

serotonin and noradrenaline and therefore more neurotransmission activity
Take 2-4 weeks to work

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22
Q

when are TCA’s used?

A

depression= second line treatment

Unlicensed for neuralgia, panic disorder and migraine

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23
Q

What is the interaction of TCA and MAO’s?

A

Both increase the levels of noradrenaline and serotonin which can cause precipitation of hypertension, hyperthermia and serotonin syndrome

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24
Q

Due to the antimuscarinic effects of TCA who should it be cautiously used for?

A

cautious in patients with prostatic hypertrophy, chronic constipation, increased intra-ocular pressure, urinary retention, or those with a susceptibility to angle-closure glaucoma.

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25
Q

give a cardiovascular side effect of TCAs

A

ECG changes
Arhythmia= Increase QR and QRS
Increase risk of MI and stroke

26
Q

What are the antimuscarinic side effects of TCA?

A

Constipation
dry mouth
urinary retention and blurred vision

27
Q

what is the metabolism of TCAs?

A

cytochrome P450

28
Q

why shouldn’t TCAs be given with anticholinergics?

A

increase risk of paralytic ilius

29
Q

give an example of an SSRI

A

citalopram, setryline, flouxetine and fluvoxamine

30
Q

how do SSRIs work?

A

inhibit neuronal uptake of serotonin (5-ht)

31
Q

give 2 examples of when SSRIs are used

A

Moderate to severe depression
Mild depression if physiological treatment not worked
OCD
Panic disorder

32
Q

use of SSRIs with MAOIs increases the risk of what syndrome?

A

serotonin syndrome

33
Q

why should SSRIs be used with caution with other CNS drugs

A

can interfere with CNS due to central action

34
Q

how do SSRIs interfere with NSAIDs, aspirin and warfarin?

A

interfere w homeostasis and can cause upper GI bleed.

Need gastroprotection

35
Q

For what condition is benzodiazepine

a) short acting
b) long acting

A

a) insomnia

b) anxiety

36
Q

Which one of these is not a route for benzodiazepine

a) IV
b) IM
c) rectal
d) buccal
e) oral

A

oral

37
Q

What is BZDP used for?

A

Anxiety
Insomnia
Seizures and muscle spasm
Alcohol withrawel

38
Q

Except for circulation side effects what other side effects does BZDP have?

A

Dependancy and withdrawel symptoms
Loss of airway reflex leading to airway closure and death
Dose dependent drowsiness, sedation and coma

39
Q

How is ACETYLCHOLINESTERASE INHIBITORS administrated?

A

Oral–> daily

40
Q

What MSK symptom do you get in using ACh-E inhibitors

A

Muscle cramps

41
Q

How is ACh-E inhibitors metabolised?

A

Cytochrome p450

42
Q

What drugs reduce the effects of ACH-E inhibitor?

A

Dexemathasone, rifampicin, ACh-E inhibitors, carbamazepine

43
Q

What type of rash do you get with hypersensitivity to TCA?

A

Urticaric rash

44
Q

What is serotonin syndrome?

A

Triad of:
Autonomic hyperactivity
Neuromuscular excitation
Altered mental state

45
Q

What affect does SSRi’s have on patients with epilepsy?

A

Increase the chance of a seizure and they reduce the threshold for seizures

46
Q

Why is it important not to give SSRI’s to a patient especially elderly if they are hyponatraemia?

A

Increase the risk of confusion and reduced consciousness

47
Q

How does SSRI’s increase the risk of bleeding?

A

They increase the risk of peptic ulcer diseases

48
Q

Why should the use of SSRI’s with young adults be used cautiously?

A

Low efficiency and increase the incidents of self harm and suicide thoughts

49
Q

What are common adverse effects of SSRI’s?

A

GI distrubance, weight and appetite change and hypersensitivity reaction

50
Q

What ECG changes may you see in someone taking SSRI’s?

A

Increase QT interval

51
Q

What drug should SSRI’s not be combined with due to excessive increase of QT interval?

A

Antipsychotics.

52
Q

What are the side effects of sudden withdrawal of SSRI’s or TCA?

A

GI upset, neurological and influenza like symptoms and sleep disturbance

53
Q

Which drug is preferred SSRI’s or TCA and why?

A

SSRI’s due to less adverse effects and less danger of overdose

54
Q

which of these is not an effect of diazepines?

a) sedative
b) hypnotic
c) spasmodic
d) muscle relaxant
e) anticolvulsant

A

c) spasmodic

55
Q

why shouldn’t BZDP’s be given in major depression?

A

can precipitate suicidal thoughts

56
Q

What should happen to the dose when giving BZDP to elderly patient?

A

Reduced dose

57
Q

How is Acetycholinesterase inhibitor metabolised?

A

By p450

58
Q

Should TCA be used after immediate recovery period of MI?

A

No

59
Q

What are the acute withdrawel symptoms of TCA?

A

gastrointestinal upset, neurological and influenza-like symptoms and sleep disturbance.

60
Q

What side effects can TCA have on the brain?

A

Hallucinations
Convulsions
mania

61
Q

What is the side effects of TCA overdose?

A 
Severe hypotension
Arrhythmias
Convulsions
Respiratory  failure
Coma

Y3 DRUGS PROFILES (9 decks)

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