22 - Systemic Drugs II - CNS

Question 1

what CNS drugs are used for mental health

Answer 1

1. antidepressants (anti-cholonergic effects, pupilary dilation, impact on accomodation and blurred vision)
2. anxiolytics and hypnotics (sedatives)
3. antipsychotics
4. antiepileptics

Question 2

who should anti depressants be considered for

Answer 2

• past history of moderate/severe depression
• subthreshold depressive symptoms present for long time
• suqbthreshold depressive symptoms or mild depression that persist after other interventions

Question 3

first line choice of drug for prescribing in depression

Answer 3

• SSRI
  as effective as TCAs and much safer in overdose

Question 4

depression is associated with low levels of?

Answer 4

monoamine neutrotransmitters in brain

Question 5

name some of the neutotransmitters

Answer 5

• serotonin 5HT
• noradrenalin
• dopamine

Question 6

what should the drugs do to the levels of these monoamines

Answer 6

maintain the levels

low = depression

Question 7

selective serotonin re uptake inhibitors (SSRI)

Answer 7

They restore the levels of 5HT in the synaptic cleft by binding at the 5HT reuptake transporter -preventing the reuptake and subsequent degradation of 5HT

Question 8

simply how does the drug SSRI work

Answer 8

by blocking the receptor and increasing the levels of 5HT

Question 9

examples of SSRI

Answer 9

• citalopram
• escitalopram
• fluoxetine
• paroxetine

Question 10

tricylic anti- depressants TCAs

Answer 10

• TCA bind to 5HT and noradrenalin re-uptake transporters: prevents re-uptake of these monoamines from the synaptic cleft
• leads to accumulation of 5HT and noradrenalin in synaptic cleft, conc returns to normal range

Question 11

what is the half life of a TCA

Answer 11

long, allows single daily dose regime, given at night when sedative effect might be helpful

Question 12

examples of TCA

Answer 12

• amitriptyline
• clomipramine
• imipramine

Question 13

serotonin and noradrenaline reuptake inhibitors

Answer 13

Next generation of anti depressant drugs
Similar to tricyclics

Question 14

-serotonin-norepinephrine reuptake inhibitors? work by

Answer 14

block re-uptake

increasing concentration of these neurotransmitters at synaptic cleft

Question 15

examples of serotonin and noradrenaline reuptake inhibitors

Answer 15

• venlafaxine
• duloxetine

Question 16

Monoamine oxidase inhibitors (MAOI’s)

Answer 16

• treatment resistant depression - use limited due to dietry restrictions

Question 17

examples of MAOI

Answer 17

Phenelzine (Nardil), Isocarboxazid. Moclobemide (Manerix)

Question 18

monoamine oxidase A - What is it and what does it do

Answer 18

an enzyme involved in metabolism of the monoamines 5-HT and noradrenalin

• converts monoamines into their corresponding carboxylic acid

-MAOI inhibit monoamine degradation and result in greater stores being available for release

Question 19

what are hypnotics used for

Answer 19

short-term managment of insomnia
- tolerance occurs in 1-3 nights

Question 20

what are anxiolotyics for

Answer 20

short term relief of anxiety that is severtr

Question 21

what to use for chronic anxiety (>4 weeks)

Answer 21

antidepressant

Question 22

what are some hypnotics (sleeping tabs)

Answer 22

benzodiapenes
-short half life
nitrazepam, flurazepam

non-benzodiazepene hypnotics
- zomplicone

Question 23

what are some anxiolytics

Answer 23

benzodiapenes with a long half life
- diazepam
- lorazepam
- oxazepam

muscle relaxers
more effective as longer half life

Question 24

how do benzodiazepines work

Answer 24

- enhnace the action of GABA at GABA-A receptors when they bind - makes GABA more effective at calming down nerve activity

Question 25

antipsychotics are also known as

Answer 25

neuroleptics or major tranquillisers

Question 26

what are antipsychotics used for

Answer 26

- schizophrenia - mania - psychotic depression useful for short term sedation in aggression/agitation

Question 27

what effects do antipsychotics have in schizophrenia

Answer 27

prophylactic - prevents something from happening

Question 28

what type of antipsychotics are there

Answer 28

typical and atypical

Question 29

where do typical (conventional) antipsychotics act

Answer 29

- dopamine receptors

Question 30

what are the side effects of typical antipsychotics

Answer 30

- sedation - extrapyramidial effects - anticholinergic effects

Question 31

examples of typical antipsychotics

Answer 31

-Phenothiazines e.g. chlorpromazine -Thioxanthenes e.g.flupentixol -Butyrophenones e.g. haloperidol

Question 32

where do atypical antipsychotics act on

Answer 32

- other receptors as well as dopamine - less likely to cause movement disorders as a side effect as more modern

Question 33

examples of atypical antipsychotics

Answer 33

-Amisulpride -Clozapine -Olanzapine -Quetiapine -Risperidone

Question 34

how is psychosis induced

Answer 34

increased levels of dopamine activity

Question 35

how do most antipsychotic drugs work

Answer 35

- block post synaptic dopamine receptos (D2)

Question 36

what are bipolar drugs used for

Answer 36

to control acute attacks and also to prevent their recurrence

Question 37

which drugs are used for bipolar disorder

Answer 37

Acute attack -Benzodiazepines -Antipsychotics Prophylaxis -Lithium (Priadel)

Question 38

what is the objective treatment of antiepilectics

Answer 38

prevent recurrence of epileptiform events (seizures)

Question 39

what occurs in a epileptiform event

Answer 39

a sudden, excessive depolarisation of cerebral neurones which may remain localised (focal epilepsy) or spread (generalised epilepsy)

Question 40

what do anti-epileptic agents prevent

Answer 40

depolarisation of neurones -inhibition of excitatory neurotransmitters -direct membrane stabilisation -stimulation of inhibitory neurotransmittersq

Question 41

what are common anti-epileptics

Answer 41

-Carbamazepine -Lamotrigine -Sodium Valproate ) Antiepileptics with significant ocular adverse reactions -Vigabatrin -Topiramate