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MRCPsych Part A > 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
What is the chemical structure of Quetiapine?
Dibenzothiazepine
26
What is the chemical structure of Olanzapine?
Dibenzodiazepine
27
What is the chemical structure of Arpiprazole?
Arylpiperidylindole (quinolone)
28
Which antipsychotics are Benzisothiazole?
Ziprasidone
29
Which antidepressants are tertiary amines?
``` Imipramine Amitriptyline Clomipramine Dosulepin Trimipramine (Venlafaxine) ```
30
Importance of antidepressants which are secondary amines?
More potent Less sedating more noradrenergic Less anthihistaminic or anticholinergic then tertiar
31
Which antidepressants are secondary amines?
``` Desipramine Amoxapine Notriptyline Protriptyline Duloxetine ```
32
Which antidepressants are hydrazine derivatives?
Phelzine
33
Which antidepressants are Aminoketone?
Bupropion
34
Chemical structure of zopiclone?
Cyclopyrrolone
35
Chemical structure of Trazadone?
Triazolopyridine
36
Is Sertraline an SSRI?
Yes
37
Name four SNRIs
Venlafaxine Milnacipran Duloxetine Sibutramine
38
Classification of Duloxetine?
SNRI
39
E.g. of NARI
Reboxetine
40
E.g. of NDDI
Agomelatine
41
Two examples of NaSSA
Mirtazapine | Mianserin
42
Example of DARI
Bupropion
43
Example of RIMA
Moclobemide
44
Examples (2) of SARI
Nefazodone | Trazodone
45
What does RIMA stand for?
Reversible inhibitor of Monoamine A oxidase
46
What does DARI stand for?
Dopamine reuptake inhibitor
47
What does NaSSA stand for?
Noradrenergic and specific serotonergic antagonist
48
What does NDDI stand for?
Noradrenaline Dopamine Dis-inhibitor
49
Classification of Mirtazapine?
NaSSA
50
How does Xanomeline act?
Via M1/M4 agonism.
51
Initial features of Xanomeline with Alzheimers?
Improving cognitive function in Alzheimers and dose-dependent reductions in psychotic symptoms in Alzheimers.
52
Initial features of Xanomeline with Schizophrenia?
Efficacy in both positive and negative symptoms | Improvement in verbal learning and short term memory
53
Side effect of Xanomeline?
Gastrointestinal
54
How does Ketamine work?
NMDA receptor antagonist
55
Psychiatric use of Ketamine?
Rapid antidepressant effects in treatment-resistant depression
56
What is hygrophilicity?
When drugs exposed to moisture and light gain moisture, thereby reducing the availability of their active ingredient.
57
What is deliquescence?
Hygrophilicity to the degree that the drug will change to liquid if exposed to moist air.
58
E.g. of drug which has deliquescence
Sodium Valproate
59
What is an active placebo?
One that has some activity inherently, but not against the specific condition
60
Who coined the term placebo?
Beecher (1955)
61
What is it called when a placebo causes side effects?
Nocebo
62
What is placebo sag?
Decrease in placebo effect with repeated or chronic administration of placebo drugs
63
What is the efficacy paradox?
Where the placebo effect is disproportionately large for non-blinded therapies
64
Which diseases do placebos work best for?
Pain Disorders of autonomic sensation Disorders of factors under neurohumoral control e.g. nausea, BP, bronchial asthma
65
Which psych disorders show good response to placebo?
Depression Anxiety Phobias
66
Rate response to depression with placebo?
25-60%
67
Rate response to mania via placebo?
25%
68
Rate response to schizophrenia via placebo?
25-50%
69
Three factors needed for placebo action?
Nature of disease treated Nature of dynamic relationship between pt and doctor Patients expectations and experience with treatment in the past
70
What is the placebo run-in approach?
Where placebo reactors are eliminated prior to trial, which have been found to not lower placebo response rate.
71
Hypothesis of placebo analgesia?
Decreased beta-adrenergic activity of the heart
72
Which colour of tablets does anxiety respond best to?
Green
73
Which colour of tablets does depression respond best to?
Yellow
74
What is the natural remission theory?
Disorders for which placebo works are inherently episodic. Hence, even w/o treatment they would have eventually improved.
75
What is the measurement regression hypothesis?
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
What is the conditioning theory?
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
Difference between placebo and antidepressant in depression
Placebo: acts quickly, less likely to persist. Antidepressant: acts later, more likely to persist.
78
What part of the brain is activated during placebo analgesia?
ACC - anatomical component of dopaminergic as well as opioid system
79
Phases of drug approval
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
Regulatory agency for medications in UK
MHRA
81
What happens in preclinical animal studies?
Molecule is shown to have specific actions, on at least two different species. Mutagenicity, carcinogenicity and organ system toxicity are studied.
82
What happens in phase 1 of drug trials?
Is drug safe for humans? | Given to humans; safety, tolerability and pharmacokinetics are studied.
83
What type of studies occur during phase 1?
Open or uncontrolled
84
What happens in phase 2 of drug trials?
Effectiveness studied in patients with disease compared to placebo.
85
Main methods in phase 2?
RCTs/controlled trials
86
What happens in phase 3 of drug trials?
Drug undergoes double-blind RCT to check how well it works and common SE.
87
What happens in phase 4 of drug trials?
Drug undergoes approval by regulatory bodies. Less common SE picked up when large scale prescribing occurs. Post-marketing surveillance
88
Define compliance
To the extent to which a persons behaviour coincides with medical advice
89
Define adherence
Both clinician and patient are responsible for adherence.
90
Define concordance
Based on the notion that the therapeutic alliance between pt and dr is a negotiation process with equal respect to both parties.
91
Self-report adherence measurement tools?
Tablet Routine Questionnaire Pill counts Prescription monitoring Saliva/plasma/urine tests
92
How to do a pill count?
Adherence (%) = (number of pills taken + number of pills prescribed) x 100
93
Non-adherence rate for antipsychotics?
40-60%
94
Non-adherence rate for mood stabilizers?
18-56%
95
Non-adherence rate for antidepressants?
30-97%
96
Factors that increase adherence
``` Family support Liquid/sublingual form High enthusiasm from clinician Good dr-pt relationship Continued access to clinician ```
97
Factors that reduce adherence
``` 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
Most common cause of non-adherence?
Lack of insight
99
Four main belief categories of the health belief model of adherence?
Benefits Costs Susceptibility Secondary benefits of medication and adherence
100
Examples of psycho-education aimed at improving adherence
Cognitive-based Behaviour-modification Motivational interviewing Compliance therapy
101
What does cognitive-based intervention do?
Targets patients attitudes and beliefs towards medication to influence their construction of the meaning of medication and illness
102
What does behaviour-modification intervention do?
Assume behaviour is learnt and can be modified. Patients are given instructions and strategies (reminds, reinforcements)
103
What does motivational interviewing do for medication adherence?
Allows patient to express personal reasons for and against adherence
104
What does compliance therapy do?
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 (22 decks)

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