11) Psychopharmacology Flashcards
Describe neuroleptic malignant syndrome.
Adverse reaction to antipsychotic drug where there is muscle rigidity, fever, autonomic instability and cognitive changes such as delirium.
Which enzyme is raised in neuroleptic malignant syndrome?
Creatinine phosphokinase
Suggest some of the features of neuroleptic malignant syndrome.
- Muscle rigidity
- Hyperpyrexia
- Tachycardia
- Sweating
- Flucuating blood pressure
Describe serotonin syndrome.
Excess serotonin on the CNS and/or peripheral nervous system due to a drug reaction.
Suggest some possible ADRs of mirtazapine.
- Weight gain
Suggest some possible ADRs of lithium.
- Polydypsia and polyuria
- Nausea
- Diarrhoea
- Weight gain
Describe tardive dyskinesia and explain why it occurs.
Tardive dyskinesia is the choreo-athetoid movements of lips, tongue and mouth (and sometimes hands) caused by dopamine blockade such as performed by antipsychotics.
Suggest THREE neurological or psychiatric conditions in which sodium valproate may be used.
- Epilepsy
- Bipolar affective disorder
- Acute mania
How can antipsychotics raise plasma prolactin?
Blockade of the tubero-infundibular dopaminergic system reduces the inhibition on prolactin.
Suggest how a patient with lithium toxicity may present.
- Coarse tremor
- Reduced conciousness
- Convulsions
- Renal failure
Suggest how a patient with benzodiazepine toxicity may present.
- Drowsy
- Respiratory depression
Suggest some possible ADRs of SSRIs.
- GI (nausea, diarrhoea, dyspepsia, bloating)
- Weight loss
- Sexual dysfunction
- Headaches
- Fatigue
- Hyponatraemia
- Increased risk of bleeding (especially when given with NSAIDs)
- Discontinuation symptoms
After the first episode of depression, how long should patients continue on antidepressants after recovery?
6 months
Suggest TWO pharmacological interventions that may help a patient suffering from obsessive-compulsive disorder.
- SSRI’s
- TCAs (commonly Clomipramine)
What is the first line medication for most/all anxiety disorders?
SSRIs
Which benzodiazepine is commonly used in the treatment of alcohol withdrawal?
Chlordiazepoxide
Suggest some drugs which can cause serotonin syndrome.
- Antidepressants
- Opioids
- CNS stimulants
Suggest some of the features of serotonin syndrome.
- Hypotension and tachycardia
- Shivering
- Sweating
- Dilated pupils
- Myoclonus (intermittent jerking or twitching)
- Hypereflexia
- Hypervigilance, anxiety
Compare and contrast serotonin syndrome and neuroleptic malignant syndrome.
- Serotonin syndrome is caused by excessive serotonin, NMS is caused by a dopamine blockade
- Serotonin toxicity has a rapid onset after the administration of a serotonergic drug, NMS has a slow onset and typically evolves over several days after administration of a neuroleptic drug
- Serotonin syndrome responds to serotonin blockade via drugs like chlorpromazine/cyproheptadine, whereas NMS responds to dopamine agonists such as bromocriptine
Described how serotonin syndrome may be managed.
- Serotonin antagonists such as cyproheptadine/chlorpromazine
- Activated charcoal if there is serotonin still being digested
- BZDs for the myoclonus
- Supportive measures for hyperthermia
What is the first line treatment for Alzheimer’s disease?
Acetylcholinesterase inhibitors (ACHEIs)
Suggest TWO ways in which adverse drug reactions from acetylcholinesterase inhibitors (ACHEIs) can be made less likely.
- Take with food
- Titrate them up slowly
Give TWO examples of acetylcholinesterase inhibitors. (ACHEIs)
- Donepezil
- Rivastigmine
Suggest a mechanism for how acetylcholinesterase inhibitors (ACHEIs) may improve memory in patients with dementia.
As acetylcholine is reduced in dementia and plays a significant role in memory/attention/mood the prevention of its degradation leads to an improvement in this dimensions.
Suggest some ADRs of acetylcholinesterase inhibitors. (ACHEIs)
- Nausea and vomiting
- Fatigue and insomnia
- Worsen COPD
- Bradycardia
What is memantine? How does it work?
Memantine is the main drug in the group of NMDA antagonists. They work by preventing too much glutamate leaking out of cells and interfering with learning/memory.
Suggest some ADRs of NMDA antagonists.
Most of the ADRs of memantine and other NMDA antagonists are mild, however, some include:
- Nausea
- Restlessness
- Hypertension
- Dyspnoea
Which SSRI is most effective in the treating of eating disorders?
Fluoxetine
Suggest some possible ADRs of TCAs.
- H1 receptor block leads to sedation (tired, drowsy)
- Anticholinergic leads to blurred vision, urinary retention, xerostomia
- Sympatholytic leads to postural hypotension and reflex tachycardia
Which antipsychotic is considered first line for delirium?
Haloperidol
Suggest TWO uses for pregablin.
- Generalised anxiety disorder
- Neuropathic pain
Compare and contrast lorazepam and diazepam.
- Diazepam is slow onset, lorazepam is rapid in its onset
- Diazepam is long acting, lorazepam is short acting
Suggest some ADRs of the main AEDs. (valproate, lamotrigine, carbamezepine)
- GI disturbances (V&N)
- CNS problems like dizziness, drowsiness, ataxia
- Steven-Johnson syndrome
Which TWO SSRIs are generally accepted to be first line in the treatment of mild/moderate depression.
- Citalopram
- Fluoxetine
Suggest THREE possible discontinuation symptoms observed when stopping an SSRI abruptly.
- Increased mood change
- Restlessness/difficulty sleeping
- Unsteadiness
- GI symptoms
A patient asks to stop taking their SSRI. Over what period should you slowly wean them off their SSRI?
6 months
Describe the mechanism of action of TCAs.
- Inhibit reuptake of 5-HT in the synaptic cleft
- Inhibit reuptake of noradrenaline in the synaptic cleft
- Bind to:
+ mACh receptors
+ Histamine receptors
+ 5-HT2 receptors
Which class of drugs does Venlafaxine belong to? Name THREE ADRs of this class of drugs.
SNRIs:
- Headache
- Insomnia
- Sexual dysfunction
- Dry mouth
- Dizziness
- Hypotension (also occasionally hypertension)
Why should cheese lovers beware MAOis?
Cheese reaction! MAOis prevent breakdown of dietary tyramine, cheese and steak produce lots of it.
What class of drugs does Mirtzapine belong to?
NASSA
