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Psychiatry > Drugs action and side effects > Flashcards

Drugs action and side effects Flashcards

1
Q

Treatment of GAD?

A

CBT
SSRI/SNRI
Pregabalin; long term
Benzo (short term)

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2
Q

Treatment of panic disorder?

A

CBT
SSRI/SNRI/ TCA
Benzo (short term)

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3
Q

Treatment of specific phobias?

A

Behavioural therapy; exposure
Add CBT if necessary
SSRI/SNRI if required

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4
Q

Treatment of social phobia?

A

CBT
SSRI/SNRI
Benzo

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5
Q

Treatment of OCD?

A

CBT (including response prevention)

SSRI/ Clomipramine (TCA)

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6
Q

Action of benzodiazepines?

A

GABA-A receptor is an inhibitory ionotropic receptor
In the presence of GABA, the ion channel allows chloride ion influx
Membrane hyperpolarisation
Inhibitory postsynaptic potential
Benzodiazepines enhance the effect of GABA via allosteric modulation

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7
Q

What do agonists at the benzodiazepine site on the GABA-A receptor cause?

A

Relaxation and anticonvulsant effects

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8
Q

What do antagonists at the benzodiazepine site on the GABA-A receptor cause?

A

Anxiety

Proconvulsant

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9
Q

What other drugs act on the BZD site on the GABA-A receptor?

A

Alcohol

Barbituates

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10
Q

Adverse effects of BZD?

A 
Sedation and psychomotor impairment
Discontinuation/ withdrawal problems
Dependency and abuse
Alcohol interaction 
Can worsen co-morbid depression
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11
Q

What properties do psychiatric drugs need to have?

A

Lipophilic/ hydrophobic to pass through the BBB

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12
Q

Clinical uses of antidepressant drugs?

A 
Moderate to severe depression 
Dysthymia
GAS
Panic disorder/ OCD/ PTSD
Premenstrual dysphoric disorder
Bulimia nervosa
Neuropathic pain
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13
Q

What are examples of monoamine reuptake inhibitors?

A

TCAs
SSRI
NA reuptake inibitors
SNRI

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14
Q

Monoamine transmitters

A

NA
5-HT
Dopamine

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15
Q

Base amino acid of serotonin?

A

Typtophan

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16
Q

Base amino acid of NA?

A

Tyrosine

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17
Q

Examples of MAO inhibitors?

A

Phenelzine

Moclobemide

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18
Q

Mode of action of MAO inhibitord?

A

Irreversible (phenelzine) or reversible (moclobemide) inhibitors of MAO-A and B

19
Q

Side effects of MAO inhibitors?

A 
Cheese reaction/ hypertensive crisis: inhibition of MAO-A in gut preventing breakdown of dietary tyramine and multiple drugs that potentiate amine transmission (pseudoephedrine) 
Potentials barbiturates
Insomnia
Postural hypotension 
Peripheral oedema
20
Q

Examples of TCAs?

A

Impiramide
Dosulepin
Amitriptyline
Lofepramine

21
Q

Mode of action of TCAs

A

Blocks reuptake of monoamines (mainly NA and 5-HT) into the presynaptic terminas

22
Q

Common side effects of TCAs?

A

Anticholinergic; blurred vision, dry mouth, constipation, urinary retention
Sedation
Weight gain
CV; postural hypotension, tachycardia, arrhythmias
Cardiotoxic in overdose; do NOT give post MI or in IHD

23
Q

Examples of SSRIs?

A 
Fluoxetine
Citalopram
Escitalopram
Sertraline
Paroxetine
24
Q

Mode of action of SSRIs?

A

Selectivity inhibit reuptake of serotonin (5-HT) from the synaptic cleft

25
Q

Common side effects of SSRIs?

A 
Nausea
Headache
Sweating/ vivid dreams
Worsened anxiety 
Sexual dysfunction 
Hyponatraemia (elderly) 
Transient increase in self harm and suicidal ideation in under 25 
Discontinuation effects
26
Q

Examples of SNRIs?

A

Venlafaxine

Duloxetine

27
Q

Mode of action of SNRIs?

A

Block reuptake of monoamines NA and 5-HT into presynaptic terminals

28
Q

Side effects of SNRIS?

A

Similar to SSRIs

Lack major receptor-blocking actions so more limited range of side effects that TCAs

29
Q

What does mirtazapine act on?

A

Alpha 2
5-HT2
5-HT3

30
Q

When is mirtazapine useful?

A

For weight gain and sedation; if weight loss and insomnia are issues

31
Q

Example of dopamine uptake inhibitor

A

Buproprion

32
Q

Mode of action of lithium

A

Blocks phosphatidylinositol pathway or inhibit glycogen synthase kinase 3-beta

33
Q

When should blood levels of lithium be checked?

A

12 hours post dose then 1 week

34
Q

Side effects of lithium at therapeutic doses?

A 
Dry mouth/ strange taste
Polydipsia and polyuria
Tremor
Hypothyroidism
Long term reduced renal function 
Nephrogenic DI
Wt gain
35
Q

Toxic effects of lithium in overdose?

A 
Vomiting
Diarrhoea
Ataxia/ coarse tremor
Drowsiness
Convulsions
Coma
36
Q

What anticonvulsants are used as mood stabilisers?

A

Valproic acid (mainly mania)
Lamotrigine (mainly depression)
Carbamazepine

37
Q

Side effects of lamotrigine?

A

Stevens johnson syndrome

38
Q

Side effects of valproate and carbamazepine?

A

Drowsiness
Ataxia
CV effects
Induces liver enzymes

39
Q

Can valorpate be given in pregnancy?

A

NO; neural tube defects

40
Q

Which antipsychotics are used as mood stabilisers?

A

Quetiapine
Aripiprazole
Olanzapine
Lurasidone

41
Q

Mode of action of atypical antipsychotics?

A

D2 antagonism

5-HT antagonism

42
Q

Side effects of antipsychotics?

A

Sedation, weight gain, metabolic syndrome

Extra-pyramidal

43
Q

What extrapyramidal side effects are associated with antipsychotics?

A

Acute dystonic reaction; hours to days, muscle spasms. Tx with acetylcholine antagonists (procyclidine)
Akathisia (can’t stay still) - restless leg syndrome
Parkinsonism - ridigity, tremor, bradykinesia
Tardive dyskinesia - years to develop

44
Q

Risperidone mode of action

A

Dopamine D2, 5-HT2, alpha-1 and histamine-1 receptor antagonist

Psychiatry (35 decks)

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