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308 Clinical pharmacology > Drugs for psychiatric disorders > Flashcards

Drugs for psychiatric disorders Flashcards

1
Q

What are the main types of antidepressant?

A 
SSRI
Tricyclic antidepressants
SNRI
Monoamine oxidase inhibitors
NaSSA
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2
Q

What are SSRIs indicated for?

A 
Depression
Anxiety disorders
Panic disorders
Obsessive-compulsive disorder
PTSD
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3
Q

Give examples of SSRIs

A 
Fluoxetine
Paroxetine
Sertraline
Citalopram
Escitalopram
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4
Q

How do SSRIs work?

A

Blocks uptake of serotonin into presynaptic neuron

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5
Q

What are the symptoms of discontinuation syndrome with SSRIs?

A 
Agitation
Anxiety
Dizziness, balance problems
Nausea, diarrhoea
Flu-like symptoms
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6
Q

Give examples of tricyclic antidepressants

A

Amitriptyline
Imipramine
Lofepramine
Dothiepin

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7
Q

How do tricyclic antidepressants work?

A

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

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8
Q

What are the side effects of tricyclic antidepressants?

A 
Dry mouth, constipation, urinary retention, cognitive effects
Psychotropic effects 
Sexual dysfunction
Akathisia 
Muscle twitches
Cardiac arrhythmias
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9
Q

What are the symptoms of a tricyclic antidepressant overdose?

A 
Confusion
Tachycardia
Arrhythmia
Hypotension
Mydriasis
Seizures
Coma
Cardiorespiratory arrest
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10
Q

Give examples of SNRIs

A

Venlafaxine

Duloxetine

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11
Q

What are the side effects of venlafaxine?

A

Headache
Nausea
Hypertension
Discontinuation syndrome

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12
Q

Why may duloxetine be more suitable than venlafaxine?

A

It doesn’t cause hypertension

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13
Q

What foods do monoamine oxidase inhibitors react with?

A 
Cheese
Red wine
Yeast production
Broad bean pods
Fermented sausages
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14
Q

What drugs do MAOI interact with?

A

SSRIs
Adrenaline and noradrenaline
L-Dopa

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15
Q

Give examples of monoamine oxidase inhibitors

A

Moclobemide
Phenelzine
Selegiline

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16
Q

What is reboxetine?

A

Highly selective noradrenaline reuptake inhibitor

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17
Q

Give an example of a NaSSA

A

Mirtazapine

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18
Q

How do NaSSAs work?

A

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

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19
Q

What are antipsychotics indicated for?

A

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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20
Q

What is the evidence of glutamate hypothesis?

A

PCP is a glutamate agonist which causes schizophrenia like symptoms

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21
Q

What is the evidence of the serotonin hypothesis?

A

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

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22
Q

What is the evidence for the dopamine hypothesis?

A

Dopaminergic drugs produce symptoms similar to schizophrenia

Dopamine-blocking drugs have antipsychotic properties

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23
Q

What EPS can typical antipsychotics cause?

A

Parkinsonism
Akathisia
Dystonia

24
Q

What are some types of typical antipsychotics?

A 
Butyrophenones
Phenothiazines
Thioxanthones
Diphenylbutylpiperidines
Substituted benzamides
25
Q

Give an example of a butyrophenones

A

Haloperidol

26
Q

Give an example of a phenothiazine

A

Chlorpromazine
Trifluoperazine
Fluphenazine

27
Q

What are the side effects of phenothiazines?

A

Blood dyscrasias
Retinal pigmentation
Photosensitivity
Cholestatic jaundice

28
Q

Give an example of a thioxanthone

A

Flupenthixol

29
Q

Give an example of a diphenylbutylpiperidine

A

Pimozide

30
Q

Give an example of a substituted benzamide

A

Sulpiride

31
Q

Give examples of atypical antipsychotics?

A 
Risperidone
Olanzapine
Quetiapine 
Aripiprazole
Clozapine
32
Q

What are the side effects of atypical antipsychotics?

A

Weight gain
Metabolic syndrome with new-onset diabetes
Dyslipidaemia

33
Q

What is the most effective antipsychotic?

A

Clozapine

34
Q

When is clozapine indicated?

A

For cases that have failed to respond to 2 antipsychotics

35
Q

What are the side effects of clozapine?

A 
Fatal agranulocytosis 
Seizures
Haematological
Hypersalivation
Hypo/hypertension
Constipation
Weight gain
Nausea
36
Q

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

A 
CNS: dizziness, impaired cognition
Iris: blurred vision
Dry eyes
Dry mouth
Tachycardia
Dyspepsia
Constipation
Overactive bladder
37
Q

What drugs block alpha adrenergic receptors?

A

Doxazosin
Clonidine
Methyldopa

38
Q

What are the side effects of blocking alpha adrenergic receptors?

A

Orthostatic hypotension
Palpitations
Sexual dysfunction

39
Q

What drugs are given for tranquillisation?

A

Antipsychotics - haloperidol or olanzapine

Benzodiazepines - lorazepam or midazolam

40
Q

Give examples of mood stabilisers

A 
Lithium
Valproate
Carbamazepine
Lamotrigine
Anticonvulsants - gabapentin
Benzodiazepines
Buspirone
Pregabalin
41
Q

What is the mechanism of lithium?

A

Second messenger inhibition of inositol

Regulation of gene expression of protein kinase C

42
Q

What are the short term side effects of lithium?

A 
Polydipsia
Polyuria
Nausea
Fine tremor
Loose stools
43
Q

What are the long-term side effects of lithium?

A

Hypothyroidism
Renal impairment
Weight gain
Acne

44
Q

Why is lithium toxic?

A

Narrow therapeutic range

45
Q

What are the signs of lithium toxicity?

A 
Coarse tremor
Nausea and vomiting
Ataxia
Cerebellar signs
Confusion
46
Q

What can lithium toxicity be precipitated by?

A

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

47
Q

What is the mechanism of valproate?

A

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

48
Q

What are the side effects of valproate?

A

Weight gain

Teratogenic

49
Q

Give examples of benzodiazepines

A 
Diazepam
Lorazepam
Clonazepam
Temazepam
Clobazam
50
Q

What are benzodiazepines indicated for?

A 
Hypnotics
Anxiolytics
Minor tranquilisation
Management of alcohol withdrawal
Anticonvulsant and muscle relaxant
51
Q

What is the mechanism of benzodiazepines?

A

Bind to BZP site on GABA-A receptor

52
Q

What drugs should be given for alcohol withdrawal management?

A 
Benzodiazepines
Vitamin supplementation
Acamprostate 
Naltrexone
Disulfiram
53
Q

What does disulfiram do?

A

Induces a severe reaction if alcohol is consumed

54
Q

What is buspirone used for?

A

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

55
Q

What is the mechanism of buspirone?

A

Partional agonist at 5HT_1a receptors

56
Q

What is pregabalin indicated for?

A

Neuropathic pain
Anxiety and panic disorder
Partial seizures

308 Clinical pharmacology (10 decks)

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