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3. Mondays > 308 Drugs of psychiatric disorders > Flashcards

308 Drugs of psychiatric disorders Flashcards

1
Q

Name some SSRI’s

A

Fluoxetine
Paroxetine
Sertraline
Citalopram
Escitalopram

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2
Q

What are the indications for SSRI’s?

A

-Depression
-Anxiety disorders
-Panic disorders
-OCD
-PTSD

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3
Q

Which SSRI has the shortest half life?

A

Paroxetine (20 hours)

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4
Q

Which SSRI has the longest half life?

A

Fluoxetine (2-4 days)
But active metabolite has 14 day half life

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5
Q

How do SSRI’s work?

A

They prevent the reuptake of serotonin so it stays in the synaptic cleft longer and has more of a chance of acting

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6
Q

What are the main side effects of SSRI’s?

A

-Agitation and anxiety
-Dizziness, balance problems
-Nausea, diarrhoea
-Flu-like symptoms

Occur on abrupt cessation of the SSRI

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7
Q

How does Mirtazapine work?

A

It’s a noradrenergic and specific serotonergic antidepressant (NaSSA)

It works on alpha-2 receptors to cause continuous release of serotonin and noradrenaline without breaks

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8
Q

What are the side effects of Mirtazapine?

A

-Helps people to fall asleep
-Causes hunger and therefore weight gain

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9
Q

Name some tricyclic antidepressants

A

-Amitrptyline
-Imipramine
-Lofepramine
-Dothiepin

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10
Q

Why are tricyclic antidepressants not commonly used?

A
  • Worse side effects
  • Dangerous with overdose

Dothiepin: most cardio toxic

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11
Q

How do tricyclic antidepressants work?

A

They bind to reuptake inhibitors which increase the levels of neurotransmitters in the synaptic cleft

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12
Q

What are some side-effects of tricyclic antidepressants?

A

-‘They’re dry’: cause dry mouthy, constipation, urinary retention, cognitive effects (confusion)
-Psychotropic effects (agitation, nightmares)
-Sexual dysfunction
-Akathisia (restlessness)
-Muscle twitches
-Cardiac arrhythmias (QT interval)

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13
Q

How does Venlaflaxine work?

A

It’s a serotonin and noradrenaline reuptake inhibitor (SNRI)

Often combines with Mirtazapine in treatment resistant depression (Referred to as California rocket fuel)

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14
Q

What are some side effects of Venlafaxine?

A

-Headaches
-Nausea
-Hypertension
-Discontinuation syndrome

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15
Q

What alternative uses of Duloxetine are there?

A

An SNRI that doesn’t come with the risk of hypertension

Used for diabetic neuropathy and urinary stress incontinence at different doses and depression

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16
Q

How do MAOI’s work?

A

They prevent the action of monoamine oxidase which stops noradrenaline and serotonin being broken down

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17
Q

What are the food interactions of MAOI’s?

A

Most cheese
Red wine
Yeast production liver
Broad bean pods
Fermented sausages Eg. salami

These cause the tyramine reaction which is normally prevented by monoamine oxidase

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18
Q

What does an accumulation of tyramine cause?

A

A hypertensive crisis

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19
Q

Why are MAOI’s not commonly used?

A

-Lots of food interactions
-Increased risk of serotonin syndrome (so can’t be combined with SSRI’s. If medication is being switched, time is given for the medication to wash out of the system before the new medication is started)

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20
Q

Name some SNRI’s

A

Venlafaxine
Duloxetine

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21
Q

Name some tricyclic antidepressants

A

Amitriptyline
Dothiepin

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22
Q

How do tricyclic antidepressants work?

A

They block the serotonin and noradrenaline reuptake pump

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23
Q

Name some MAOI’s

A

Phenelzine
Monclebamide

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24
Q

Name some tetracyclic antidepressants

A

Mirtazapine

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25
Q

Which neurotransmitter do antipsychotic medications work?

A

Dopamine

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26
Q

Which receptors does dopamine work on?

A

Metabotropic G-protein coupled receptors

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27
Q

What is the precursor to dopamine?

A

Tyrosine

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28
Q

What does dopamine do?

A

Executive functions
Motor control
Motivations
Reward
Lactations
Nausea

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29
Q

Name some dopamine pathways in the brain

A

Mesocortical
- from VTA to prefrontal cortex

Mesolimbic
- from VTA to nucleus accumbens

Tuberoinfundibular
- from hypothalamus to pituitary gland

Nigrostriatal
- from substantia nigra to caudate nucleus and putamen

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30
Q

What is the VTA?

A

The ventral tegmental striatum

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31
Q

What is the mesocortical pathway for?

A

Motivation
Emotion
Executive functions

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32
Q

What is the Mesolimbic pathway for?

A

Pleasure and reward

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33
Q

What is the Tuberoinfundibular pathway for?

A

Regulates prolactin secretion to the pituitary gland

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34
Q

What is the Nigrostriatal pathway for?

A

Voluntary movement through basal ganglia motor loops. It can influence cognition, reward, and addiction

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35
Q

Decreased function in which brain pathway causes negative symptoms of schizophrenia?

A

The mesocortical pathway

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36
Q

Increased function in which brain pathway causes positive symptoms of schizophrenia?

A

The mesolimbic pathway

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37
Q

Why are antipsychotics most effective at treating positive symptoms?

A

Because they block the effect of dopamine

Positive symptoms are caused by too much dopamine

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38
Q

How do antipsychotics cause hyperprolactinaemia?

A

Dopamine has an inhibitory effect on prolactin release and antipsychotics block dopamine

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39
Q

What are extrapyramidal side effects?

A

Symptoms like:
inability to sit still
involuntary muscle contraction
tremors
stiff muscles
involuntary facial movements
Parkinsonism
Dystonias
Tardive dyskinesia
Hyperprolactinaemia

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40
Q

How do antipsychotics cause extrapyramidal side effects?

A

Dopamine is needed in the nigrostriatal pathway. Decreased dopamine causes the symptoms

41
Q

What are the symptoms of raised prolactin?

A

Lactation
Amenorrhoea
Sexual dysfunction
Osteoporesis

42
Q

What is the serotonin hypothesis of depression?

A

It’s a theory as to the cause of depression

Some hallucinogenic drugs like LSD have structural resemblance to serotonin, some newer antipsychotics act on serotonin receptors eg, clozapine

43
Q

What is the glutamate hypothesis?

A

Theory that there is abnormal glutamate activity in schizophrenia

Phenocyclidine (PCP) is a glutamate agonist that produces schizophrenia-like symptoms

44
Q

What are neuroleptic drugs?

A

Another name for typical antipsychotics

45
Q

What is the difference between typical and atypical antipsychotics?

A

Typical antipsychotic drugs act on the dopaminergic system, blocking the dopamine type 2 (D2) receptors

Atypical antipsychotics have lower affinity and occupancy for the dopaminergic receptors, and a high degree of occupancy of the serotoninergic receptors 5-HT2A

46
Q

What are the main symptoms of typical antipsychotics?

A

Parkinsonism
Akathisia
Dystonia
Tardive dyskinesia

47
Q

Give examples of typical antipsychotics

A

Butyrophenones:
Haloperidol

Phenothiazines:
Chlorpromazine
Trifluoperazine
Fluphenazine

Thioxanthines:
Flupenthixol

48
Q

Name some atypical antipsychotics

A

Risperidone
Olanzapine
Quetiapine
Aripiprazole

49
Q

Which are newer, atypical or typical antipsychotics?

A

Atypical antipsychotics

50
Q

What is tardive dyskinesia?

A

A condition where your face, body or both make sudden, irregular movements which you cannot control

Typical symptoms include facial grimacing, sticking out the tongue, sucking or fish-like movements of the mouth

51
Q

What are some muscarinic (cholinergic) receptor side effects of antipsychotics?

A

Blurred vision
Dry eyes
Dry mouth
Tachycardia
Dyspepsia
Constipations
Dizziness
Impaired memory and congition

52
Q

What are muscarinic receptors?

A

They’re activated by acetylcholine

Associated mainly with parasympathetic functions

53
Q

What are some alpha adrenergic receptor side effects of antipsychotics?

A

Orthostatic hypotension
Vertigo
Palpitations
Sexual dysfunction

54
Q

How do antipsychotics cause vertigo?

A

Because they can lower blood pressure

55
Q

What is the difference between alpha and beta adrenergic receptors?

A

Alpha adrenoceptors mediate smooth muscle contraction and vasoconstriction

Beta (β) receptors mediate vasodilation, smooth muscle relaxation, bronchodilation, and excitatory cardiac function

56
Q

What is vertigo?

A

Dizziness

57
Q

What is the most effective antipsychotic?

A

Clozapine

It’s used for treatment resistant cases because it has a lot of side effects

58
Q

What are some side effects of clozapine?

A

Hypersalivation
Hypotension
Haematological problems
Constipations
Blurred vision
Fast, pounding, or irregular heartbeat
Drowsiness
Trembling hands and legs

59
Q

Which antipsychotics can be given for rapid tranquillisation?

A

Haloperidol
Olanzapine
Lorazepam
Midazolam

60
Q

Name some mood stabiliser medications

A

Lithium
Sodium valproate
Lamotrigine (Carbamazepine)

Rarely used: gabapentin

61
Q

What are the advantages of using lithium?

A

It reduces suicidality
Reduced signals that contribute to mania

62
Q

Which medication inhibits inositol?

A

Lithium

63
Q

What is Inositol?

A

Also called myo-inositol, D-chiro-inositol, or hexaphosphate (IP6)

It plays a critical function in the body’s cellular growth. Though it used to be referred to as Vitamin B8, inositol is not actually a vitamin. It’s a type of sugar that helps your body process insulin

64
Q

How does Lithium act in the body?

A

At a neuronal level, lithium reduces excitatory (dopamine and glutamate) but increases inhibitory (GABA) neurotransmission

65
Q

What are the side effects of Inositol deficiency?

A

Hair loss (alopecia)
Skin problems such as eczema (extremely dry, itchy skin)
Mental health symptoms such as troubles with sleep, mood, anxiety.
Constipation.
Hyperlipidemia (too many fats such as cholesterol or triglycerides in the blood).
Muscle weakness

66
Q

What are the short term side effects of lithium?

A

Polydipsia and polyuria
Nausea
Fine hair
Loose stools

67
Q

How does lithium cause alopecia?

A

Because it causes a hypoactive thyroid

68
Q

What are the long term side effects of lithium?

A

Renal impairment
Hypothyroidism
Weight gain
Acne

69
Q

How does lithium cause acne?

A

When lithium is taken, many neutrophils move from the bloodstream to the skin, where they can cause inflammation and increase the likelihood of pimples

70
Q

How does lithium cause hypothyroidism?

A

It inhibits iodine uptake

71
Q

How does lithium cause polyuria and polydypsia?

A

The most common renal side effect of lithium is of concentrating urine despite normal or elevated concentrations of the antidiuretic hormone vasopressin

The concentrating defect leads to decreased urine osmolality and increased urine volume (polyuria)

72
Q

What is the therapeutic index of lithium?

A

0.4 - 1.0 mmol/L

73
Q

What are the symptoms of lithium toxicity?

A

Coarse tremor
Nausea
Vomiting
Ataxia
Cerebellar signs
Confusion

74
Q

What is a coarse tremor?

A

It has more of a displacement than a fine tremor (More shaking)

75
Q

What can cause lithium toxicity?

A

Dehydration
Drug interactions Eg, NSAID’s
Deteriorating renal function

76
Q

What effects does lithium have on protein kinase C and gene regulation?

A

Lithium decreases the phosphorylation of CREB

It decreases protein kinase C translocation

77
Q

What effects does valproate have in the body?

A

Inhibition of Ca2+ and Na+ channels
Enhances inhibitory GABA
reduces excitatory glutamate

78
Q

How does Valproate produce a calming effect?

A

It enhances GAMA so blocks transmission across neurones and this has a calming effect

79
Q

What are the uses of valproate?

A

Mood stabiliser
migraine prophylaxis

80
Q

What are the side effects of valproate?

A

VALPROATE
Vomiting
Alopecia
Liver dysfunction
Pancreatitis
Retention of fat
Oedema
Appetite increase
Tremor
Enzyme inducer

Teratogenic and causes developmental disorders (contraindicated in women of child baring age)

81
Q

What are the side effects of Carbamazepine?

A

CABSANT

CYP450 inducer
Ataxia, diplopia
Bone marrow suppressor (thrombocytopaenia, neutropoenia)
Steven Johnson and other rashes
Aplastic anaemia
Na - Hyponatraemia (SIADH)
Teratogenic

82
Q

What is a Steven Johnson rash?

A

Starts off as flu-like symptoms

It’s made up of circular patches that are darker in the middle and lighter around the outside

83
Q

What are anxiolytic drugs?

A

Medications that prevent anxiety

84
Q

Name some commonly-used bendodiazapines

A

Diazepam
Lorazepam
Clonazepam
Temazepam
Clobazam

85
Q

Name a short-acting benzodiazepine

A

Lorazepam

86
Q

Name a long-acting benzodiazepine

A

Clonazepam

87
Q

What are the uses of benzodiazepines in psychiatry?

A

Hypnotics
Anxiolytics
Minor tranquillisers
Management of alcohol withdrawal
Anticonvulsant (clobazam) and muscle relaxant

88
Q

How do benzodiazepines produce their effect in the body?

A

They bind to BZP site of GABA-A receptors (the main inhibitory neurotransmitter in the CNS)

89
Q

What are the disadvantages of using benzodiazepines?

A

They create tolerance
- But there are people where long-term treatment is still indicated

Abrupt withdrawal can precipitate acute delirium, rarely psychosis, convulsions

Withdrawal causes nausea, hyperacusis, dizziness and imbalance, tinnitus, depersonalisation

90
Q

What are hypnotic drugs?

A

Medications used to induce, extend, or improve the quality of sleep, and to reduce wakefulness during sleep

91
Q

What is tinnitus?

A

Experience of ringing or other noises in the ear

92
Q

What is depersonalisation?

A

Where you have the feeling of being outside yourself and observing your actions, feelings or thoughts from a distance

93
Q

How is alcohol withdrawal managed?

A

Vitamin supplementation

Medications:
Acamprostate - reduces cravings
Naltrexone - reduces cravings/enjoyment via opioid receptors
Disulfiram (antabuse) - induces severe reaction if alcohol is consumed. It blocks the breakdown of alcohol
Benzodiazepines

94
Q

What is Chlodiazepoxide used for?

A

It’s an anxiolytic
Can be used instead of diazepam

95
Q

Which medications are given instead of diazepam or Chlordiazepoxide in hepatic compromise?

A

Oxazepam or lorazepam

96
Q

What is the difference between diazepam and chlordiazepoxide?

A

Chlordiazepoxide has a lower abuse potential

Chlordiazepoxide is used short-term for severe anxiety, muscle spasm and alcohol withdrawal

97
Q

What does pregabalin do in the body?

A

It binds to and modulates voltage-gated calcium channels in the CNS

Originally developed for neuropathic pain but now has a role in anxiety, panic disorders, and partial seizures

There are concerns with misuse because it gives a euphoria

98
Q

What is Buspirone used for?

A

It’s a partial agonist ay 5HT_1a receptors

Licenced for generalised anxiety disorder but there are doubts over efficacy

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