23+24) Drugs in Psychiatric Disease Flashcards
What can predispose to psychiatric disorders?
Genetic vulnerability
Life events
Personality, coping skills
Environmental influences
What are the core symptoms of depression?
Low mood, anhedonia, decreased energy
Give examples of SSRIs:
Fluoxetine, citalopram, paroxetine, sertraline
What are some side effects of SSRIs?
Anorexia, nausea, diarrhoea, precipitation of mania, suicidal thoughts
What is an important side effect of citalopram?
Prolongs QT interval
Give examples of tricyclic antidepressants:
Amitryptyline, clomipramine
What are some side effects of tricyclic antidepressants?
Sedation, lower seizure threshold
Tachycardia, postural hypotension
Constipation, reduction in glandular secretion
Give examples of SNRIs:
Venlafaxine, duloxetine
What are some side effects of SNRIs?
Sleep disturbance, increased BP, dry mouth, hyponatremia (also SEs of SSRIs)
What are some symptoms of schizophrenia?
Hallucinations, delusions, thought disorder, behavioural changes, lack of insight
What is a hallucination?
Perception in the absence of an external stimulus
What is a delusion?
Fixed false belief out of keeping with someone’s culture or relgion
What are some risk factors/predispositions for schizophrenia?
Genetics
Environment
Cannibis
What is the function of the mesolimbic dopamine pathway?
Emotional response and behaviour
What is the function of the mesocortical dopamine pathway?
Arousal and mood
What is the function of the nigrostriatal dopamine pathway?
Production of movement
What are the effects of antipsychotics?
Block D2 receptors, reducing psychotic symptoms by effects on mesolimbic pathway
What are typical anti-psychotics?
Older, with increased D2 anatagonism so extra-pyramidal side effects and dyskinesia
What are atypical anti-psychotics?
Modern, cause less EPSE
What are the side effects of atypical anti-psychotics?
Weight gain, increase prolactin (risperidone), sedation
Neutropenia (clozapine)
What are the side effects of typical anti-psychotics?
Parkinsonism, acute dystonia, akathasia, tardive dyskinesia
Postural hypotension, weight gain, prolactinemia
Neuroleptic malignant syndrome
What is neuroleptic malignant syndrome?
Reaction to anti-psychotics
Severe rigidity, hyperthermia, tachycardia
What are the symptoms of anxiety?
Light-headedness, shortness of breath, flushes, palpitations, nausea
How can anxiety be treated?
CBT, antidepressants, anxiolytics, antipsychotics
Describe tolerance and dependence in benzodiazepines:
Tolerance - need to increase the dose for the same effect
Dependence - withdrawal effects on discontinuation
What are the side effects of benzodiazepines?
Drowsiness, Dizziness, psychomotor impairment, dry mouth, blurred vision
Describe potential toxicity caused by benzodiazepines:
Cleft lip and palate in pregnancy
If late in pregnancy - resp depression and feeding difficulties in baby
What can overdose on benzodiazepines cause?
Respiratory depression
How can benzodiazepine overdose be reversed?
IV flumazenil
What are the symptoms of bipolar disorder?
Overactive, poor concentration, poor sleep, poor judgement, increased interest in sex, psychosis
Give examples of mood stabilisers:
Lithium Sodium valproate Carbamazepine Lamotrigine Anti-psychotics
Describe lithium’s mechanism of action:
Increases serotonin
Attentuate effects of certain neurotransmitters on their receptors
How should lithium be monitored?
Renal and thyroid function every 6 months
Lithium blood levels weekly until stable conc. then 3 monthly (12 hours after dose)
What are the indications for starting a patient on lithium?
Prophylaxis of mania and depression
Reduces suicidality
What are the side effects of lithium?
Memory problems, thirst, tremor, weight gain, hypothyroidism, hair loss
What medications can be used in dementia?
ACh-esterase inhibitors
NMDA agonist
What are some side effects of ACh-esterase inhibitors?
N&V, fatigue, insomnia, bradycardia, worsening COPD, gastric ulcers
What are some side effects of memantine?
Hypertension, dyspnoea, headache, dizziness, drowsiness
