Drugs for psychiatric disorders Flashcards by Olivia Tolson

What are the main types of antidepressant?

SSRI
Tricyclic antidepressants
SNRI
Monoamine oxidase inhibitors
NaSSA

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What are SSRIs indicated for?

Depression
Anxiety disorders
Panic disorders
Obsessive-compulsive disorder
PTSD

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Give examples of SSRIs

Fluoxetine
Paroxetine
Sertraline
Citalopram
Escitalopram

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How do SSRIs work?

Blocks uptake of serotonin into presynaptic neuron

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What are the symptoms of discontinuation syndrome with SSRIs?

Agitation
Anxiety
Dizziness, balance problems
Nausea, diarrhoea
Flu-like symptoms

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Give examples of tricyclic antidepressants

Amitriptyline
Imipramine
Lofepramine
Dothiepin

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How do tricyclic antidepressants work?

Bind to NA and 5HT reuptake inhibitors leading to increased monoamine levels in synaptic cleft

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What are the side effects of tricyclic antidepressants?

Dry mouth, constipation, urinary retention, cognitive effects
Psychotropic effects 
Sexual dysfunction
Akathisia 
Muscle twitches
Cardiac arrhythmias

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What are the symptoms of a tricyclic antidepressant overdose?

Confusion
Tachycardia
Arrhythmia
Hypotension
Mydriasis
Seizures
Coma
Cardiorespiratory arrest

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Give examples of SNRIs

Venlafaxine

Duloxetine

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What are the side effects of venlafaxine?

Headache
Nausea
Hypertension
Discontinuation syndrome

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Why may duloxetine be more suitable than venlafaxine?

It doesn’t cause hypertension

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What foods do monoamine oxidase inhibitors react with?

Cheese
Red wine
Yeast production
Broad bean pods
Fermented sausages

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What drugs do MAOI interact with?

SSRIs
Adrenaline and noradrenaline
L-Dopa

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Give examples of monoamine oxidase inhibitors

Moclobemide
Phenelzine
Selegiline

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What is reboxetine?

Highly selective noradrenaline reuptake inhibitor

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Give an example of a NaSSA

Mirtazapine

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How do NaSSAs work?

Antagonistic action at alpha 2 receptors which increases release of serotonin and noradrenaline on presynaptic neuron

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What are antipsychotics indicated for?

Licensed uses:

psychotic illness
bipolar affective disorder
adjunctive therapy for depressive episodes

Off licence uses:

behavioural disturbances in dementia and LD
conduct disorder
personality disorder
PTSD
anxiety disorder

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What is the evidence of glutamate hypothesis?

PCP is a glutamate agonist which causes schizophrenia like symptoms

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What is the evidence of the serotonin hypothesis?

Some hallucinogenic drugs have structural similarities with serotonin e.g. LSD

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What is the evidence for the dopamine hypothesis?

Dopaminergic drugs produce symptoms similar to schizophrenia

Dopamine-blocking drugs have antipsychotic properties

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What EPS can typical antipsychotics cause?

Parkinsonism
Akathisia
Dystonia

What are some types of typical antipsychotics?

Butyrophenones
Phenothiazines
Thioxanthones
Diphenylbutylpiperidines
Substituted benzamides

Give an example of a butyrophenones

Haloperidol

Give an example of a phenothiazine

Chlorpromazine Trifluoperazine Fluphenazine

What are the side effects of phenothiazines?

Blood dyscrasias Retinal pigmentation Photosensitivity Cholestatic jaundice

Give an example of a thioxanthone

Flupenthixol

Give an example of a diphenylbutylpiperidine

Pimozide

Give an example of a substituted benzamide

Sulpiride

Give examples of atypical antipsychotics?

``` Risperidone Olanzapine Quetiapine Aripiprazole Clozapine ```

What are the side effects of atypical antipsychotics?

Weight gain Metabolic syndrome with new-onset diabetes Dyslipidaemia

What is the most effective antipsychotic?

Clozapine

When is clozapine indicated?

For cases that have failed to respond to 2 antipsychotics

What are the side effects of clozapine?

``` Fatal agranulocytosis Seizures Haematological Hypersalivation Hypo/hypertension Constipation Weight gain Nausea ```

What are the side effects of drugs acting at muscarinic receptors?

``` CNS: dizziness, impaired cognition Iris: blurred vision Dry eyes Dry mouth Tachycardia Dyspepsia Constipation Overactive bladder ```

What drugs block alpha adrenergic receptors?

Doxazosin Clonidine Methyldopa

What are the side effects of blocking alpha adrenergic receptors?

Orthostatic hypotension Palpitations Sexual dysfunction

What drugs are given for tranquillisation?

Antipsychotics - haloperidol or olanzapine | Benzodiazepines - lorazepam or midazolam

Give examples of mood stabilisers

``` Lithium Valproate Carbamazepine Lamotrigine Anticonvulsants - gabapentin Benzodiazepines Buspirone Pregabalin ```

What is the mechanism of lithium?

Second messenger inhibition of inositol | Regulation of gene expression of protein kinase C

What are the short term side effects of lithium?

``` Polydipsia Polyuria Nausea Fine tremor Loose stools ```

What are the long-term side effects of lithium?

Hypothyroidism Renal impairment Weight gain Acne

Why is lithium toxic?

Narrow therapeutic range

What are the signs of lithium toxicity?

``` Coarse tremor Nausea and vomiting Ataxia Cerebellar signs Confusion ```

What can lithium toxicity be precipitated by?

Salt depletion and dehydration e.g. in diarrhoea Drug interactions - thiazides and NSAIDs Deteriorating renal function

What is the mechanism of valproate?

Inhibition of calcium and sodium channels Enhances inhibitory GABA Reduces excitatory glutamate

What are the side effects of valproate?

Weight gain | Teratogenic

Give examples of benzodiazepines

``` Diazepam Lorazepam Clonazepam Temazepam Clobazam ```

What are benzodiazepines indicated for?

``` Hypnotics Anxiolytics Minor tranquilisation Management of alcohol withdrawal Anticonvulsant and muscle relaxant ```

What is the mechanism of benzodiazepines?

Bind to BZP site on GABA-A receptor

What drugs should be given for alcohol withdrawal management?

``` Benzodiazepines Vitamin supplementation Acamprostate Naltrexone Disulfiram ```

What does disulfiram do?

Induces a severe reaction if alcohol is consumed

What is buspirone used for?

Generalised anxiety disorder May decrease SE from Parkinson's drugs Role in behavioural disturbance in dementia

What is the mechanism of buspirone?

Partional agonist at 5HT_1a receptors

What is pregabalin indicated for?

Neuropathic pain Anxiety and panic disorder Partial seizures