12.1: Drugs Used In Psychiatric Disease

Question 1

What are the core symptoms of depression?

Answer 1

Low mood
Low energy
Lack of pleasure

Need 2 of 3 core symptoms

Question 2

What are 4 examples of SSRIs?

Answer 2

Fluoxetine
Sertraline
Citalopram
Paroxetine

Question 3

What are some side effects of SSRIs?

Answer 3

GI upset
Nausea
Anorexia
Diarrhoea
Citalopram prolongs QTc

Use fluoxetine if under 18
Sertraline most cardiac safe

Question 4

Which type of antidepressants are reasonably safe in overdose?

Answer 4

SSRIs

Question 5

What are some examples of TCAs?

Answer 5

Amitriptyline
Lofepramine
Clomipramine
Imipramine

Question 6

How do TCAs work?

Answer 6

Inhibit NA re-uptake, hence sympathetic effect

Also block muscarinic ACh receptors, hence anticholinergic effect

Question 7

What are some side effects of TCAs?

Answer 7

Sedation
Lower seizure threshold
Constipation
Reduced glandular secretions
Tachycardia
Postural hypotension
Eye accommodation block

Question 8

What would the consequence be of a patient overdosing on amitriptylline versus an SSRI?

Answer 8

Amitriptyline is a TCA, very dangerous in overdose and can lead to sudden cardiac death
Whereas SSRIs are reasonably safe in overdose

(So better for lots of patients)

Question 9

What are some examples of SNRIs?

Answer 9

Duloxetine

Venlafaxine

Question 10

What are some examples of typical antipsychotics?

Answer 10

Haloperidol

Chlorpromazine

Question 11

What are 3 examples of atypical antipsychotics?

Answer 11

Olanzapine
Risperidone
Quetiapine
Sulpiride

Question 12

What pathways in the brain are affected by D2 antagonist antipsychotics which are responsible for the side effects?

Answer 12

Nigrostriatal

Tubero infundiblar

Question 13

What is the 3rd line antipsychotic agent?

Answer 13

Clozapine

Question 14

What is akathisia?

Answer 14

Movement disorder characterised by feeling of restlessness and inability to stay still
Type of EPSE

Question 15

How do benzodiazepines exert their action?

Answer 15

Act as agonists at BDZ receptors
Leads to enhancement of GABA
(Chief inhibitory neurotransmitter in the brain)

Question 16

Why are benzodiazepines generally avoided long term and in pregnancy?

Answer 16

Px will build up tolerance so need increasing dose
Px can build a dependence and have withdrawals symptoms if discontinued
In pregnancy can cause cleft lip and palate, and respiratory distress in foetus

Question 17

What are some side effects of benzodiazepines?

Answer 17

Dizziness
Drowsiness
Blurred vision
Psychomotor impairment
Headache
GI upset 
Dry mouth
Low BP

Question 18

Why are antidepressants avoided in bipolar disorder?

Answer 18

As they can induce mania

Question 19

What are some examples of mood stabilisers?

Answer 19

Lithium
Sodium valproate
Carbamazepine
Lamotrigine

Question 20

What checks needs to be done before commencing lithium and every 6 months, and why?

Answer 20

Renal function, as it is renally excreted

Thyroid function as it can cause hypothyroidism

Question 21

What is memantine used in?

Answer 21

Alzheimer’s dementia

Question 22

How does memantine work?

Answer 22

NMDA antagonist

Question 23

What class of drugs is first line in dementia?

Answer 23

AChE inhibitors

Eg rivastigmine, galantamine, donepezil

Question 24

What are some side effects of AChE inhibitors used in dementia?

Answer 24

Nausea
Vomiting
Worsen COPD
Diarrhoea
Headache
Anorexia 
Bradycardia
Insomnia
Peptic ulcers