Brainscape's Knowledge GenomeTM

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


See full index

BSMS308 > 1. Drugs for psych disorders > Flashcards

1. Drugs for psych disorders Flashcards

1
Q

Main classes of psych drugs

A 
Antidepressants
Anxiolytics
Mood stabilisers
Antipsychotics
Hypnotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

SSRI examples

A 
Fluoxetine
Paroxetine
Sertraline
Citalopram
Escitalopram
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

SSRI indications

A 
Depression
Anxiety disorders
Panic disorder
OCD
PTSD
other
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

SSRI similarities

A 
Indications
Mechanism of action
Delayed onset of action (10-14 days)
Efficacy
Relative safety in overdose
Advisability of prolonged course e.g. 6 months in major depression
Interactions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

SSRI differences

A

Half-life:
shortest is paroxetine (20 hours)
longest in fluoxetine (2-4 days, w active metabolite half life of 14 days)

Propensity to cause discontinuation syndrome if stopped abruptly

Side effect profiles: fluoxetine causes agitation most commonly

Individual differences: people are different

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

SSRI mechanism of action

A

Blocks 5-HT (serotonin) re-uptake transporter and so keeps 5-HT in the synaptic cleft to prolong its action

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

SSRI discontinuation syndrome

A

SSRI discontinuation syndrome happens when SSRIs are stopped, especially if they are stopped abruptly

Commonest with paroxetine

Symptoms: agitation and anxiety, dizziness, balance problems, nausea and diarrhoea, flu-like symptoms

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

How to treat SSRI discontinuation syndrome

A

Reassurance and monitoring
Reintroducing drug with a tapered withdrawal
Consider an alternative antidepressant or anxiolytic

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

Tricyclic antidepressants examples

A

Amitriptyline
Imipraine
Lofepramine
Dothiepin

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

TCA indications

A

similar to SSRIs (depression, anxiety, OCD, panic disorder, PTSD) although not used as widely outside of depression. Efficacy in major depression similar to SSRIs

Rarely used first-line nowadays due to adverse effects and overdose risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

TCA mechanism of action

A

Bind to noradrenaline (NA) and 5HT reuptake inhibitors which increases monoamine levels in synaptic cleft, increasing their action
Also pronounced anticholinergic/antimuscarinic effects

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

What is notable about different TCAs?

A

They have widely varying specific affinities between different compounds so have different properties. This can be clinically relevant as you can prescribe them depending on the effect you want e.g. if you want sedative effects prescribe amitriptyline or dothiepin

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

TCA adverse effects

A

Two types - anticholinergic and other

Anticholinergic - dry mouth, constipation, urinary retention, cognitive effects

Other: psychotropic effects e.g. agitation, nightmares; sexual dysfunction e.g. ED; akathisia (restlessness), muscle twitches, cardiac arrhythmias

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

TCA overdose

A

neurological and cardiovascular effects:

neuro: mydriasis, confusion, seizures, coma,
cardio: tachycardia and other arrhythmias, hypotension, cardiorespiratory arrest

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

Are TCAs or SSRIs more dangerous in overdose?

A

TCAs! almost 17 times as much

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

Venlafaxine

A

Serotonin and noradrenaline reuptake inhibitor (SNRI) antidepressant
Appears to have a more pronounced dose-response effect than other antidepressants.

Might be mildly useful for anxiety and depression

Side effects: headache, nausea, hypertension, discontinuation syndrome

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

Duloxetine

A

SNRI, without concerns re hypertension

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

Moclobemide

A

monoamine oxidase inhibitor (RIMA)- usually reserved for treatment resistant depression or atypical depression

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

Reboxetine

A

highly selective NA reuptake inhibitor

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

MAOIs

A

Inhibits monoamine oxidase which breaks down 5-HT, DA and NA, so preserves them

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

MAOIs interactions - non-drug

A

A lot of foods - most cheeses, red wine, yeast production liver, broad bean pods, fermented sausages, salami etc
Tyramine

Hypertensive effect -> hypertensive crisis
Moclobamide is much lower risk of causing hypertensive crisis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

MAOI drug interactions

A

DO NOT COMBINE WITH SSRI because will get serotonin syndrome

Adrenaline and noradrenaline

L-DOPA

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

Mirtazapine

A

NaSSA - noradrenergic and specific serotonergic antidepressant

Acts as an antagonist at alpha 2 receptors so cuts the brake cable on serotonin and noradrenaline release

24
Q

Mild depression

A

no pharmacology, psychological measures/reassurance

25
Q

Moderate depression

A

Select antidepressant - SSRI and consider side effects

If full response -> continuation therapy
If incomplete response -> referral to specialist

26
Q

Severe depression without psychotic features

A

1st line SSRI, 2nd line diff SSRI or mirtazepine, third line mertazapine, escitalopram, SNRI, TCA -> refractory depression -> augment:

  • SSRI and mirtazapine or venlafaxine and mirtazapine
  • others e.g. lithium, antipsychotic, CBT
  • venlafaxine at max doses
27
Q

Severe depression with psychotic features

A

add antipsychotic

28
Q

Continuation therapy

A

single episode - 6 months after resolution of symptoms

Recurrant depression - 2 years after resolution of symptoms

29
Q

Antipsychotic indications

A

psychotic illnesses
bipolar affective disorder
adjunctive therapy for depressive episodes
off-licensed uses:
behavioural disturbance in dementia and learning disability, conduct disorder, personality disorder, PTSD, anxiety disorders, many more

30
Q

Dopamine hypothesis

A

dopaminergic drugs especially amphetamine can produce symptoms very similar to schizophrenia symptoms
AND
drugs which block dopamine must have antipsychotic properties (D2 receptor blockade)

too much dopamine-> psychosis?

Major dopamine pathways in brain:
Nigostriatal system: Substantia nigra to basal ganglia, striatum

Tuberoinfundibular system

Ventral tegmental area to frontal cortex

31
Q

Serotonin hypothesis

A

some hallucinogenic drugs e.g. LSD structurally resemble serotonin
Some newer antipsychotic drugs especially clozapine acts at serotonin receptors

Too much serotonin -> psychosis?

32
Q

Glutamate hypothesis

A

Phencyclidine (PCP/angel dust) is a glutamate agonist which produces schizophrennia-like symptoms

There’s also evidence of abnormal glutamate activity in schizophrenia

too much glutamate -> schizophrenia?

33
Q

Neuropleptics or typical antipsychotics

A

Introduced in 1950s
Various different classes of drugs
Have roughly similar efficacy

SERIOUS NEUROLOGICAL SIDE EFFECTS:
Extrapyramidal symptoms - parkinsonism, akathisia, dystonia

Tardive dyskinesia - devellops in 5% of patients on long term antipsychotic meds per year

34
Q

Example typical antipsychotics

A

Butyrophenones e.g. halperidol

Phenothiazines e.g. chlorpromazine, trifluoperazine, fluphenazine

Thioxanthines e.g. flupenthixol

35
Q

How do different typical antipsychotics differ?

A

Side effect profiles
Degree of sedation
preparations available e.g. depot forms

36
Q

Atypical antipsychotics

A

Newer drugs, less likely to cause EPS

Different mechanisms of action, some not as specific for D2 receptors, and also act on 5HT system
Not necessarily more effective than typical antipsychotics

37
Q

Examples of atypical antipsychotics

A

risperidone
olanzapaine
quetiapine
aripiprazole
neurological side effects less common/severe than with typicals
problems w weight gain and metabolic syndrome especially with olanzapine

38
Q

What causes side effects?

A

receptor action
happen because:
the side effect of the direct action of a drug e.g. antipsychotics and dopamine
also
due to other receptors affected by the drug e.g. antipsychotics and histamine, muscarinic, alpha 1 & 2 receptors

39
Q

Dopamine receptor blockade side effects

A 
Extrapyramidal side effects
Parkinsonism
dystonias
tardive dyskinesia
hyperprolactinaemia
40
Q

Muscarinic/cholinergic receptor side effects

A 
Blurred vision - iris/ciliary bodies
Dry eyes - lacrimal gland
Dry mouth - salivary glands
Tachycardia - heart
Dyspepsia - stomach and oesophagus
Constipation - colon
Urinary retention - bladder
Dizziness, somnolence, impaired memory and cognition - CNS
41
Q

Alpha-adrenergic receptor side effects

A

Orthostatic hypotension
Vertigo
Palpitations
Sexual dysfunction

42
Q

Clozapine

A

reserved for treatment-resistant cases
most effective antipsychotic

Problems with haematological side effects necessitate blood test monitoring

Acts on range of neurotransmitter systems including D4 receptors and serotonin system

Low propensity to cause EPS

hypersalivation and hypotension may occur

43
Q

Rapid tranquillisation

A

for acute agitation/aggression where risk of harm to self or others

Oral first then IM

antipsychotics - haloperidol or olanzapine
benzodiazepines - lorazepam or midazolam
CHECK LOCAL PROTOCOLS

treat underlying cause

44
Q

Mood stabilisers

A 
lithium
valproarte
carbamezapine
lamotrigine
other anticonvulsants e.g. gabapentin
45
Q

Lithium

A

uncertain mode of action??

second messenger inhibition of inositol

Regulation of gene expression - protein kinase C

Side effects: toxicity, interactions, monitoring

loss of efficacy?

46
Q

Lithium side effects

A

short term: polydipsia and polyuria, nausea, fine tremor, loose stools
long term: hypothyroidism, renal impairment, weight gain, acne

47
Q

Lithium toxicity

A

narrow therapeutic index

Coarse tremor, nausea and vomiting, ataxia and cerebellar signs, confusion

Precipitants: salt depletion, dehydration e.g. in diarrhoea, drug interactions - thiazides, NSAIDs, deteriorating renal function

48
Q

Carbamezapine

A

antimanic but less effective than lithium
major problem with drug interactions
induces liver enzymes so reducing levels of other agents
other agents in turn alter CBZ metabolism

49
Q

Valproate

A

effect on inhibition of Ca and Na channels

Enhances inhibitory GABA

Reduces excitatory glutamate

Equal efficacy to Li in acute mania, ease of use, improved tolerablity, weight gain, teratogenic plus developmental disorders

May have role in emotional liability following brain injury especially orbitofrontal cortex

50
Q

benzodiazepines

A

commonly used:
diazepam, lorazepam, clonazepam, temazepam, clobazam (benzo derivative)

differ mainly in: potency, half-life, duration of action e.g. lorazepam is short acting, clonazepam is longer-acting

51
Q

Benzodiazepines use in psychiatry

A

hypnotics, anxiolytics, minor tranquilisers - role in acute tranquilisation, management of alcohol withdrawal
also anticonvulsant esp clobasam and muscle relaxant

52
Q

Benzodiazepine mechanism of action

A

bind to BZP site on GABA-A receptor

GABA is main inhibitory neurotransmitter in CNS

53
Q

Drugs acting on chloride channel

A

barbiturates - depressants
benzodazepine (agonists - depressants), antagnoists, inverse agonists

Steroid site - anaesthetic

Picrotexin site - convulsants

54
Q

Benzodiazepine dependency

A

tolerance
Withdrawal: abrupt withdrawal can precipitate acute delirium, rarely psychosis, convulsion
Other withdrawal symptoms: nausea, hyperacusis, dizziness and imbalance, tinnitus, depersonalisation

Avoid lengthy prescriptions

Tapered withdrawal using diazepam equivalents

55
Q

Managing alcohol withdrawal

A

reducing regimen of benzodiazepines
vitamin supplementation - oral/IM/IV

additional aids to maintain abstinence:
acamprosate- reduces cravings
naltrexone - reduces cravings/enjoyment via opiod receptors
Disulfiram (anatbuse) - induces severe reaction if alcohol consumed - risk of fulminating hepatitis so check LFTs frequently

56
Q

Buspirone

A

partial agonist at 5HT-1a receptors

generalised anxiety disorder

may have applications in other neuro/psych disorders e.g. can decrease side effect of medication in Parkinson’s disease, may have a role in behavioural desturbance in dementia

57
Q

Pregabalin

A

binds to and modulates voltage-gated calcium channels in CNS
originally developed for use in neuropathic pain but has a growing role in anxiety and panic disorder, also in partial seizures

BSMS308 (9 decks)

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