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Clinical pharmacology and therapeutics > Drugs for psychiatric disorders > Flashcards

Drugs for psychiatric disorders Flashcards

1
Q

List the main classes of drugs for psychiatric disorders

A 
Antidepressants
Antipsychotics
Mood stabilisers
Anxiolytics
Hypnotics
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2
Q

Name some selective serotonin reuptake inhibitors

A 
Fluoxetine 
Paroxetine
Sertraline
Citalopram
Escitalopram
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3
Q

What are the indications for selective serotonin reuptake inhibitors being prescribed?

A 
Depression
Anxiety disorders
Panic disorder
Obsessive compulsive disorder
PTSD
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4
Q

What do Selective serotonin reuptake inhibitors have in common?

A 
Indications
Mechanism of action 
Delayed onset of action (10-14 days)
Efficacy
Relative safety in overdose
Advisability of prolonged course 
Interactions
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5
Q

How do different selective serotonin reuptake inhibitors differ?

A

Half life

Side effects

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6
Q

Which SSRI has the shortest half life?

A

Paroxetine (20hrs)

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7
Q

Which SSRI has the longest half life?

A

Fluoxetine (2-4 days)

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8
Q

What is fluoxetines most common side effect?

A

Agitation

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9
Q

How do SSRIs work?

A

Block the reuptake of serotonin so more serotonin is available in the synaptic cleft

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10
Q

What is SSRI discontinuation syndrome?

A

Occurs on cessation of SSRIs especially when abrupt

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11
Q

List some symptoms of SSRI discontinuation syndrome

A

Agitation and anxiety
Dizziness and balance problems
Nausea and diarrhoea
Flu like symptoms

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12
Q

Which SSRI most commonly results in SSRI discontinuation syndrome?

A

Paroxetine

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13
Q

How do you treat SSRI discontinuation syndrome?

A

Reassurance and monitoring
Reintroduction of the drug with tapered withdrawal
Consider alternative antidepressant or anxiolytic

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14
Q

List the main tricyclic antidepressants

A

Amitriptyline
Imipramine
Lofepramine
Dothiepin

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15
Q

Why are tricyclic antidepressants rarely used as first line treatments?

A

Risk of overdose and adverse effects

Similar efficacy to SSRIs

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16
Q

Give the mechanism of action for tricyclic antidepressants

A

Bind to NA and 5HT reuptake inhibitors, increasing monoamine levels in synaptic cleft

  • Also have pronounced anticholinergic (antimuscarinic) effects
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17
Q

List the anticholinergic effects of tricyclic antidepressants

A

Dry mouth
Constipation
Urinary retention
Cognitive effects

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18
Q

List some non-anticholinergic side effects of tricyclic antidepressants

A 
Psychotropic effects - agitation and nightmares
Sexual dysfunction
Akathisia 
Muscle twitches
Cardiac arrhythmias
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19
Q

Describe the effects of tricyclic antidepressant overdose

A 
Confusion
Tachycardia
Arrhythmias
Hypotension
Mydriasis 
Seizures
Coma
Cardiorespiratory arrest
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20
Q

Name some SNRIs (serotonin and noradrenaline reuptake inhibitors)

A

Venlafaxine

Duloxetine

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21
Q

What are the side effects of Venlafaxine?

A

Headache
nausea
hypertension
Discontinuation syndrome

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22
Q

Why is duloxetine a better SNRI than venlafaxine?

A

No concern regarding hypertension

23
Q

What is moclobemide?

A

A monoamine oxidase inhibitor usually reserved for treatment resistant depression or atypical depression

24
Q

What is reboxetine?

A

Highly selective noradrenaline reuptake inhibitor

25
Describe the action of monoamine oxidase inhibitors
Prevents the action of monoamine oxidase | Prevents serotonin, dopamine and noradrenaline being broken down
26
Which foods can monoamine oxidase inhibitors interact with?
Most cheeses, red wine, yeast, broad bean pods, liver, fermented sausages
27
What can interactions of some foods and monoamine oxidase inhibitors cause?
Hypertensive crisis
28
What drugs can monoamine oxidase inhibitors interact with?
SSRIs - serotonin syndrome Adrenaline and noradrenaline Ldopa
29
What class of antidepressant is mirtazapine?
NaSSA - noradrenergic and specific serotonergic antidepressant (acts on alpha 2 receptors to increase release of serotonin and noradrenaline)
30
What are antipsychotics used for?
Psychotic illness bipolar affective disorder adjunctive therapy for depressive episodes ``` behavioural disturbance in dementia and learning disabilities conduct disorder personality disorder obsessive compulsive disorder PTSD Anxiety disorders ```
31
Describe the dopamine hypothesis
Dopaminergic drugs can produce symptoms similar to schizophrenia (psychotic symptoms) Dopamine blocking drugs have anti-psychotic properties (D2 receptor blockade)
32
Describe the serotonin hypothesis
Some hallucinogenic drugs have similar structure to serotonin so newer antipsychotic drugs act at serotonin receptors
33
Describe the glutamate hypothesis
PCP glutamate agonist can produce schizophrenia like symptoms. Abnormal glutamate could play a part in schizophrenia
34
Give the side effects of neuroleptics/typical antipsychotics
Extrapyramidal symptoms - parkinsonism, dystonia, akathisia | Tardive dyskinesia
35
Give some examples of typical antipsychotics
Butyrophenones - haloperidol Phenothiazones - Chlorpromazine, Trifluoperazine, Fluphenazine Thioxanthines - Flupenthixol
36
Describe atypical antipsychotics
Different mechanism of action - may act at serotonin receptors and less so at dopamine receptors Less likely to cause extrapyramidal side effects
37
Give some examples of atypical antipsychotics
Risperidone Olanzapine Quetiapine Aripiprazole
38
What are some problems with atypical antipsychotics
Metabolic syndrome and weight gain
39
List the dopamine receptor blockade symptoms
``` Extrapyramidal side effects Parkinsonism Dystonia Tardive dyskinesia Hyperprolactinemia ```
40
List the muscarinic (cholinergic) receptor blockade symptoms
``` Dizziness Impaired memory and cognition blurred vision dry eyes dry mouth tachycardia dyspepsia constipation ```
41
List the alpha adrenergic receptor blockade symptoms
orthostatic hypotension palpitations sexual dysfunction vertigo
42
Describe clozapine
Reserved for treatment resistant cases Most effective antipsychotic Need blood test monitoring - haematological side effects hypersalivation and hypotension may occur acts on d4 and serotonin systems
43
Describe rapid tranquilisation
For acute aggression /agitation where risk of harm to self or others oral first IM - antipsychotics - haloperidol or olanzapine - Benzodiazepines - lorazepam or midazolam Treat underlying cause
44
List some mood stabilisers
Lithium Valproate Carbamazepine Lamotrigine
45
List the side effects of lithium
Short term side effects Polydipsia and polyuria, nausea, fine tremor, loose stools Long term side effects Hypothyroidism, renal impairment, weight gain, acne
46
Describe lithium toxicity
Narrow therapeutic index Coarse tremor, nausea and vomiting, ataxia and cerebellar signs, confusion Precipitants: - salt depletion, dehydration (e.g. in diarrhoea) - drug interactions-thiazides, NSAIDs deteriorating renal function
47
Describe carbamazipine
Antimanic but less effective than lithium Major problems with drug interactions Induces liver enzymes so reducing levels of other agents Other agents in turn alter CBZ metabolism
48
Describe valproate
Effect on inhibition of Ca and Na channels Enhances inhibitory GABA Reduces excitatory glutamate Equal efficacy to Li in acute mania Ease of use Improved tolerability Weight gain Teratogenic Plus developmental disorders
49
List some Commonly used benzodiazepines
Diazepam Lorazepam Clonazepam Temazepam Clobazam (benzo derivative)
50
How are benzodiazepines used?
Hypnotics Anxiolytics “Minor tranquillisers”: role in acute tranquillisation Management of alcohol withdrawal Also anticonvulsant (esp. clobazam) and muscle relaxant Bind to BZP site on GABA-A receptor GABA is main inhibitory neurotransmitter in CNS
51
Describe the issues with benzodiazepine dependence
Tolerance Withdrawal: abrupt withdrawal can precipitate acute delirium, rarely psychosis, convulsions Other withdrawal symptoms: nausea, hyperacusis, dizziness and imbalance, tinnitus, depersonalization Avoid lengthy prescriptions Tapered withdrawal using ‘diazepam equivalents’
52
How do you manage alcohol withdrawal?
Reducing regimen of benzodiazepines Vitamin supplementation Oral Intramuscular/intravenous Additional aids to maintain abstinence Acamprosate – reduces cravings Naltrexone – reduces cravings/enjoyment via opiod receptors Disulfiram (antabuse) – induces severe reaction if alcohol consumed N.B. risk of fulminating hepatitis – check LFTs frequently
53
Describe BUSPIRONE
Partial agonist at 5HT_1a receptors Licensed for use in generalised anxiety disorder – doubts over efficacy May have applications in other neuro/psych contexts e.g. some evidence that it decreases side effect of medication in Parkinson’s disease; may have a role in behavioural disturbance in dementia
54
Describe PREGABALIN
Binds to, and modulates, voltage-gated calcium channels in CNS Originally developed for use in neuropathic pain but has a growing role in anxiety and panic disorder, also in partial seizures

Clinical pharmacology and therapeutics (27 decks)

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