Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MRCPsych Part A - Rach > Clinical Psychopharmacology > Flashcards

Clinical Psychopharmacology Flashcards

1
Q

SNRIs

A

Venlafaxine

Duloxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

SARI

Serotonin Antagonist and Re-uptake Inhibitor

A

Trazadone

  • Blocks SERT (serotonin reuptake pump) at
    5HT1A
  • Antagonised 5HT2A and 5HT2C

Trazadone blocks SERT and receptors responsible for side effects such as insomnia, anxiety and sexual dysfunction (5HT2A/C)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

NaSSa

Noradrenaline Serotonin Specific antidepressant

A

Mirtazapine

  • 5HT2 and 5HT3 antagonist
  • H1 antagonist
  • alpha 1 and 2 antagonist
  • moderate muscarinic antagonist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pharmacokinetics

ADME

A

What the body does to a drug:

Absorption

Distribution

Metabolism

Excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pharmacodynamics

A

What the drug does to the body

MOA
Drug interaction
Reception binding
Biological effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pharmacokinetics in pregnancy

A

Most pronounced changes in 3rd trimester

Plasma ⬆️, albumin ⬇️ = volume of distribution increases for lipohillic drugs

Concentration of albumin-bound drug decreases

Renal blood flow and gfr increases = enhanced elimination

Delayed gastric emptying, reduced small intesting mobility

Prog and oest induce some CYP enzymes and inhibit others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Volume of distribution =

A

Amount of drug in body ÷ concentration in plasma (volume)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Clozapine mechanism

A 
Antagonist D4>D1>D2>D3
Alpha 1 and Alpha 2 adrenergic antagonist
5HT2a/c antagonist 
H, M1-3 antagonist 
M4 AGONIST

Low D2 receptor affinity; weak and displacable
60-70% D2 occupancy (like Quetiapine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Type I drug reaction

A

IgE binds to mast cell and releases histamine and inflammatory markers.

Anaphylaxis, urticaria, bronchospasm

Minutes to hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Type 2 drug reaction

A

Thrombocytopenia and Neutropenia

IgG or IgM antibody binds to cell which haa been altered by a drug hapten

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Type 3 reaction

A

Complement system is activated.

1-3 weeks post exposure

Rash, fever urticaria, vasculitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Type 4 reaction

A

MHC presents drugs to t cells.

Allergic contact dermatitis and rash. 2-7 days post exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Immunological adverse drug reaction

A

1 = anaphylaxis
2= blood abnormalities
3=fever, rash, urticaria, vasculitis
4=allergic rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Immunological adverse drug reaction

A

1 = anaphylaxis
2= blood abnormalities
3=fever, rash, urticaria, vasculitis
4=allergic rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Autoreceptor

A

A presynaptic receptor on the same neuron which inhibits the release of more neurotransmitter by negative feedback

E.g. mirtazapine promotes release of NA and 5HT3 by preventing the negative feedback at the presynaptic autoreceptors which would inhibit release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Elderly pharmacology

A

PK

Absorption;

  • reduced gastric acid secretion, surface area and motility
  • reduced Absorption if b12/iron/calcium.
  • Levodopa increased

Distribution:

-reduced water content to body fat.
- increased concentration in water and reduced in fat (increased VoD)
Increased t1/2 in lipid soluble

Metabolism:

Reduced hepatic Metabolism due to decrease blood flow and enzyme activity

Excretion:

Drugs which are really excreted e.g. lithium and surprise will accumulate

16
Q

Elderly pharmacology

A

Pharmacodynamics

Therapeutic response is delayed

Receptor sensitivity tends to increase so they tend to require lower doses

17
Q

Secondary amine

2nd generation

A

Desipramine
Nortriptyline
Protriptyline
Amoxapine

18
Q

Tertiary amine

First-generation

A 
Amitryptyline 
Imipramine
Lofepramone
Clomipramone
Dosulepin
Dodecanese
Trimipramine
Butrptyline
19
Q

Cytochrome p450

  • Drug metabolism
A
  • Endoplasmic reticulum in liver/small intestine

Enzyme induction:
Carbamazepine; Phenytoin; Alcohol; Barbituates; Smoking; St John’s Work

Enzyme inhibition: Chlorpromazine, ssri, grapefruit juice (cyp2d6 and cyp3a)

20
Q

CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness)

A

Double-blind pragmatic RCT
2005
Atypical (OLZ, QUE, RIS, ziprasidone vs perphenazine)
Real World measure of discontinuation

74% patients had discontinued treatment at 18 months. Median 4.6 months.

OLZ lowest discontinuation (64%), but highest SE burden. Most discontinued ziprasisone (79%).

Phase 2
People who stopped due to ineffectiveness of therapy were re-randomised to clozapine.

Clz has lowest discontinuation rate of all atypicals.

People who stopped due to intolerance were re-randomised to OLZ, Qu, ris, ziprasidone. (OLZ AND RISP equally effective better than Que and Zipra)

21
Q

CUtLASS

Cost-Utility and Latest Antipsychotic Drugs in Schizophrenia

A

Unblinded RCT

Typical Vs Atypical

QoL at 12 months primary outcome, symptom measure secondary

Atypical: amisulpride, olanzapine, quetiapine, risperidone

Those on typical seemed to do slightly better in QoL and symptom burden vs typical.

Participants no clear preferences for either class.

Phase 2 = clozapine vs atypical in 136 pts who had not responded to 2 or more previous drugs. Significant advantage with clozapine in symptom improvement at 1 year and patients preferred.

22
Q

STAR*D Trial

A

Sequenced Treatment Alternatives to Relieve Depression

Pragmatic, effectiveness study

Symptom remission main outcome.

Received citalopram for 14 weeks (remission 28%); then entered into study of sequential treatment

Switch

  • Bupropion
  • Venlafaxine
  • Sertraline

Or augment bupropion, buspirone

Next

Then mirtazapine, nortriptyline

Or Augment

Add Lithium Or T3

4th step mirtazapine and venlafaxine or tranylcypromine

23
Q

GHB intoxication

A

Euphoria, reduced inhibition, anxiety, loss of motor control, emotional warmth, increase libido

Reduced GCS, resp depression

Psych: amnesia, disorientation

OD - headache, n+v, hallucinations, seizure, coma

24
Q

GHB withdrawal

– Medical Emergency

A 
Tachycardic, hypertensive 
Anxiety/ restlessness 
Delirium/ confusion 
Nausea, vomiting, tremor
Hallucinations 
Sweating

Withdrawal lasts around 9 days

Dependency can come on after using 3-4mls for 2-3 months

Can use diazepam and baclofen to detox

GHB t1/2 <1hr, abrupt onset

25
Q

Illicit drug mechanism

Iontoropic receptors

A

Alcohol
Benzodiazepines
Nicotine
Ketamine

26
Q

Illicit drugs: G-Coupled receptors

A

Opioid, GHB, Cannabinoids

27
Q

Drugs that target monoamine transporter

A

Amphetamine, ecstasy, cocaine

Mdma (ecstasy) and cocaine increase the dopamine levels at the synaptic cleft.

MRCPsych Part A - Rach (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions