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MRCPsych Part A - Al-Rashid Hospital > Basic Pharmacology > Flashcards

Basic Pharmacology Flashcards

1
Q

Who coined the term psychopharmacology?

A

Mach and Mora (1915)

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2
Q

How did the term psychopharmacology come about?

A

Studying opioid alkaloids on rat behaviour in a circular maze.

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3
Q

First antipsychotic found?

A

Plant Rauwolfia serpentine (1931) - Sen and Bose

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4
Q

When was Lithium found?

A

1949 (Cade)

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5
Q

When was the term neuroleptic coined?

A

1955 (Delay)

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6
Q

When was the first antidepressant discovered?

A

1952 - Iproniazid

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7
Q

When was the first benzo discovered?

A

Chlordiazepozide - 1954 (Sternbach)

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8
Q

When was Amitriptyline introcued?

A

1961

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9
Q

When was haloperidol found?

A

1958 - Janssen

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10
Q

When was risperidone found?

A

1989 - Janssen

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11
Q

Who made the first SSRI?

A

Carlssen

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12
Q

When was Fluxoetine trialled?

A

1970s

Remarketed in 1987

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13
Q

When was clozapine found?

A

1988 (Kane et al)

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14
Q

Which antipsychotics are aliphatic phenothiazines?

A

Chlorpromazine
Promazine
Triflupromazine

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15
Q

Which antipsychotics are piperidine derivatives?

A

Thioridazine

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16
Q

Which antipsychotics are piperazine derivatives?

A

Trifluoperazine
Fluphenazine
Perphenazine
Thioridazine

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17
Q

Which antipsychotics are Butyrophenones?

A

Haloperidol

Droperidol

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18
Q

Which antipsychotics are Thioxanthenes?

A

Thiothixene
Flupenthixol
Zuclopethixol

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19
Q

Which antipsychotics are Dihydroindoles?

A

Molindone

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20
Q

Which antipsychotics are Diphenylbutylpeperidine?

A

Primozide

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21
Q

Which antipsychotics are Dibenzodapine?

A

Loxapine

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22
Q

Chemical structure of Risperidone?

A

Benzisoxazole

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23
Q

Which antipsychotics are substituted benzamides?

A

Amisulpride

Sulpride

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24
Q

What is the chemical structure of clozapine?

A

Dibenzodiazepine

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25
Q

What is the chemical structure of Quetiapine?

A

Dibenzothiazepine

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26
Q

What is the chemical structure of Olanzapine?

A

Dibenzodiazepine

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27
Q

What is the chemical structure of Arpiprazole?

A

Arylpiperidylindole (quinolone)

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28
Q

Which antipsychotics are Benzisothiazole?

A

Ziprasidone

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29
Q

Which antidepressants are tertiary amines?

A 
Imipramine
Amitriptyline
Clomipramine
Dosulepin
Trimipramine (Venlafaxine)
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30
Q

Importance of antidepressants which are secondary amines?

A

More potent
Less sedating
more noradrenergic
Less anthihistaminic or anticholinergic then tertiar

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31
Q

Which antidepressants are secondary amines?

A 
Desipramine
Amoxapine
Notriptyline
Protriptyline
Duloxetine
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32
Q

Which antidepressants are hydrazine derivatives?

A

Phelzine

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33
Q

Which antidepressants are Aminoketone?

A

Bupropion

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34
Q

Chemical structure of zopiclone?

A

Cyclopyrrolone

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35
Q

Chemical structure of Trazadone?

A

Triazolopyridine

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36
Q

Is Sertraline an SSRI?

A

Yes

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37
Q

Name four SNRIs

A

Venlafaxine
Milnacipran
Duloxetine
Sibutramine

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38
Q

Classification of Duloxetine?

A

SNRI

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39
Q

E.g. of NARI

A

Reboxetine

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40
Q

E.g. of NDDI

A

Agomelatine

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41
Q

Two examples of NaSSA

A

Mirtazapine

Mianserin

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42
Q

Example of DARI

A

Bupropion

43
Q

Example of RIMA

A

Moclobemide

44
Q

Examples (2) of SARI

A

Nefazodone

Trazodone

45
Q

What does RIMA stand for?

A

Reversible inhibitor of Monoamine A oxidase

46
Q

What does DARI stand for?

A

Dopamine reuptake inhibitor

47
Q

What does NaSSA stand for?

A

Noradrenergic and specific serotonergic antagonist

48
Q

What does NDDI stand for?

A

Noradrenaline Dopamine Dis-inhibitor

49
Q

Classification of Mirtazapine?

A

NaSSA

50
Q

How does Xanomeline act?

A

Via M1/M4 agonism.

51
Q

Initial features of Xanomeline with Alzheimers?

A

Improving cognitive function in Alzheimers and dose-dependent reductions in psychotic symptoms in Alzheimers.

52
Q

Initial features of Xanomeline with Schizophrenia?

A

Efficacy in both positive and negative symptoms

Improvement in verbal learning and short term memory

53
Q

Side effect of Xanomeline?

A

Gastrointestinal

54
Q

How does Ketamine work?

A

NMDA receptor antagonist

55
Q

Psychiatric use of Ketamine?

A

Rapid antidepressant effects in treatment-resistant depression

56
Q

What is hygrophilicity?

A

When drugs exposed to moisture and light gain moisture, thereby reducing the availability of their active ingredient.

57
Q

What is deliquescence?

A

Hygrophilicity to the degree that the drug will change to liquid if exposed to moist air.

58
Q

E.g. of drug which has deliquescence

A

Sodium Valproate

59
Q

What is an active placebo?

A

One that has some activity inherently, but not against the specific condition

60
Q

Who coined the term placebo?

A

Beecher (1955)

61
Q

What is it called when a placebo causes side effects?

A

Nocebo

62
Q

What is placebo sag?

A

Decrease in placebo effect with repeated or chronic administration of placebo drugs

63
Q

What is the efficacy paradox?

A

Where the placebo effect is disproportionately large for non-blinded therapies

64
Q

Which diseases do placebos work best for?

A

Pain
Disorders of autonomic sensation
Disorders of factors under neurohumoral control e.g. nausea, BP, bronchial asthma

65
Q

Which psych disorders show good response to placebo?

A

Depression
Anxiety
Phobias

66
Q

Rate response to depression with placebo?

A

25-60%

67
Q

Rate response to mania via placebo?

A

25%

68
Q

Rate response to schizophrenia via placebo?

A

25-50%

69
Q

Three factors needed for placebo action?

A

Nature of disease treated
Nature of dynamic relationship between pt and doctor
Patients expectations and experience with treatment in the past

70
Q

What is the placebo run-in approach?

A

Where placebo reactors are eliminated prior to trial, which have been found to not lower placebo response rate.

71
Q

Hypothesis of placebo analgesia?

A

Decreased beta-adrenergic activity of the heart

72
Q

Which colour of tablets does anxiety respond best to?

A

Green

73
Q

Which colour of tablets does depression respond best to?

A

Yellow

74
Q

What is the natural remission theory?

A

Disorders for which placebo works are inherently episodic. Hence, even w/o treatment they would have eventually improved.

75
Q

What is the measurement regression hypothesis?

A

When a continuous variable is measured repeatedly, with each subsequent measurement the mean will move from extreme values and come closer to the population mean.

76
Q

What is the conditioning theory?

A

Placebo is a behavioural intervention. Patients who have learnt that receiving medications improves symptoms, will show a conditioned response of improvement with a placebo.

77
Q

Difference between placebo and antidepressant in depression

A

Placebo: acts quickly, less likely to persist.
Antidepressant: acts later, more likely to persist.

78
Q

What part of the brain is activated during placebo analgesia?

A

ACC - anatomical component of dopaminergic as well as opioid system

79
Q

Phases of drug approval

A

Preclinical Animal Studies
Human trials - volunteers phase 1 (safety)
Human trials - patients phase 2 (effectiveness)
Human trials - patients phase 3 (comparative efficacy and tolerance)
Human trials - post-marketing surveillance phase 4

80
Q

Regulatory agency for medications in UK

A

MHRA

81
Q

What happens in preclinical animal studies?

A

Molecule is shown to have specific actions, on at least two different species.
Mutagenicity, carcinogenicity and organ system toxicity are studied.

82
Q

What happens in phase 1 of drug trials?

A

Is drug safe for humans?

Given to humans; safety, tolerability and pharmacokinetics are studied.

83
Q

What type of studies occur during phase 1?

A

Open or uncontrolled

84
Q

What happens in phase 2 of drug trials?

A

Effectiveness studied in patients with disease compared to placebo.

85
Q

Main methods in phase 2?

A

RCTs/controlled trials

86
Q

What happens in phase 3 of drug trials?

A

Drug undergoes double-blind RCT to check how well it works and common SE.

87
Q

What happens in phase 4 of drug trials?

A

Drug undergoes approval by regulatory bodies. Less common SE picked up when large scale prescribing occurs.
Post-marketing surveillance

88
Q

Define compliance

A

To the extent to which a persons behaviour coincides with medical advice

89
Q

Define adherence

A

Both clinician and patient are responsible for adherence.

90
Q

Define concordance

A

Based on the notion that the therapeutic alliance between pt and dr is a negotiation process with equal respect to both parties.

91
Q

Self-report adherence measurement tools?

A

Tablet Routine Questionnaire
Pill counts
Prescription monitoring
Saliva/plasma/urine tests

92
Q

How to do a pill count?

A

Adherence (%) = (number of pills taken + number of pills prescribed) x 100

93
Q

Non-adherence rate for antipsychotics?

A

40-60%

94
Q

Non-adherence rate for mood stabilizers?

A

18-56%

95
Q

Non-adherence rate for antidepressants?

A

30-97%

96
Q

Factors that increase adherence

A 
Family support
Liquid/sublingual form
High enthusiasm from clinician
Good dr-pt relationship
Continued access to clinician
97
Q

Factors that reduce adherence

A 
Asymmptomatic
Cognitive deficits
EtOH/substance misure
Devaluation of medication by dr
Fear of SE
High frequency of daily doses
Homelessness
Chronic disease
PO formulation
Previous hx of non-adherence
Polypharmacy
Prophylactic/maintenance treatment
Hostility/suspiciousness
98
Q

Most common cause of non-adherence?

A

Lack of insight

99
Q

Four main belief categories of the health belief model of adherence?

A

Benefits
Costs
Susceptibility
Secondary benefits of medication and adherence

100
Q

Examples of psycho-education aimed at improving adherence

A

Cognitive-based
Behaviour-modification
Motivational interviewing
Compliance therapy

101
Q

What does cognitive-based intervention do?

A

Targets patients attitudes and beliefs towards medication to influence their construction of the meaning of medication and illness

102
Q

What does behaviour-modification intervention do?

A

Assume behaviour is learnt and can be modified. Patients are given instructions and strategies (reminds, reinforcements)

103
Q

What does motivational interviewing do for medication adherence?

A

Allows patient to express personal reasons for and against adherence

104
Q

What does compliance therapy do?

A

Based on motivational therapy and cognitive approaches.
Patients ambivalence towards medication is explored, following by discussion around consequences if medication were to stop.
Analogies with chronic physical illness are made, and pros and cons of medication considered.

MRCPsych Part A - Al-Rashid Hospital (22 decks)

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