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4 - CPT > Drugs in Psychiatric Disease > Flashcards

Drugs in Psychiatric Disease Flashcards

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1
Q

Describe the symptoms of depression

A
  • Core symptoms
    • Low mood
    • Anhedonia - loss of enjoyment in activities and live
    • Low energy
  • Secondary symptoms
    • Biological - poor sleep, low appetite, poor libido
      • Cognitive - negative cognition, poor concentration, hopelessness, thoughts of self harm
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2
Q

What are non-pharmacological treatments of depression

A
  • Cognitive behavioural therapy

- Interpersonal therapy

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3
Q

Describe the theories of depression

A
  • Depression due to monoamine neurotransmitters deficiency - noradrenaline, serotonin
  • Neurotransmitter receptor hypothesis - abnormality in the receptors for monoamine transmission
  • Monoamine hypothesis of gene expression
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4
Q

List the drugs types used in depression

A
  • Selective serotonin reuptake inhibitors
  • Tricyclic antidepressants
  • Serotonin noradrenaline reuptake inhibitors
  • Monoamine oxidase inhibitors
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5
Q

Describe the use of monoamine oxidase inhibitors

A
  • Inhibit monoamine oxidase and thus reduces degradation of serotonin and noradrenaline
  • Not used much due to many side effects
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6
Q

Describe the mechanism of selective serotonin reuptake inhibitors

A
  • Eg. Fluoxetine, citalopram
  • Limit reuptake of serotonin into the presynaptic neurone, thus increasing the serotonin in the synaptic cleft available to bind to the postsynaptic receptor and carry on its action potential
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7
Q

Describe the PK of antidepressant drugs

A
  • Metabolised in the liver so can increase concentration of other drugs such as antiepileptics
  • SSRI and TCA have long half life so single doses and be aware of long elimination half life
  • SNRI has short half life
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8
Q

Describe the ADRs of SSRI

A
  • Nausea, sexual dysfunction, insomnia, anorexia, diarrhoea
  • Can precipitate mania - especially in patients with bipolar syndrome
  • Citalopram has cardiac side effects
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9
Q

Describe the mechanism of tricyclic antidepressants

A
  • Act largely as SNRI to prevent serotonin and noradrenaline reuptake (symptomatic effect)
  • Muscarinic cholinergic inhibitor - anticholinergic effect by decrease cholinergic transmission
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10
Q

Describe the ADRs of TCAs

A
  • CNS: sedation, impairment of psychomotor performance (cannot participate in skills requiring attention or motor skills), lowering of seizure threshold , hallucinations
  • Anticholingeric - constipation (lowered GI mobility), urinary retention, dry mouth, dry eyes, blurry vision
  • CVS - tachycardia, postural hypotension
  • More dangerous in overdose than SSRI
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11
Q

What is given to reverse TCA overdose

A

Sodium bicarbonate given to reverse effects of amitriptyline

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12
Q

Describe the mechanism of SNRI

A
  • Eg. Venlaflaxine, duloxetine

- Mechanism - limit reuptake of serotonin and noradrenaline, thus increasing postsynaptic propagation

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13
Q

Describe the ADRs of SNRI

A
  • SSRI side effects
  • Sleep disturbance, hypertension, dry mouth, hyponatraemia
  • Short half life - may have withdrawal effect
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14
Q

Describe the mechanism of antipsychotic drugs

A
  • D2 antagonists which prevent dopamine from acting within the basal ganglia
  • Has positive benefits on the mesolimbic pathway (reduces overactivity)
  • Has negative benefits on the mesocortical pathway, and nigrostriatal pathway (Parkinson’s symptoms)
  • Commonly given depot rather than oral as patients who are very unwell will not take medication properly
  • Action
    • Sedation - within hours
    • Tranquilisation - within hours
    • Antipsychotic - several days or weeks
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15
Q

Describe the length of antidepressant prescription

A
  • Try one anti-depressant for at least 6 weeks before switching to another and continue prescription for at least 1 year to reduce relapse risk
  • Some drugs require 6 weeks before benefits occur
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16
Q

Describe the ADRs of typical antipsychotics

A
  • Extrapyramidal side effects - dystonia, akathisia (constant restlessness), tardive dyskinesia (abnormal, involuntary, repetitive movements), pseudo-Parkinson’s (rigidity, tremor, hypertonia)
  • Anti-cholinergic
  • Serotonergic
  • Neuroleptic malignant syndrome - life threatening reaction to antipsychotics: fever, altered mental status, muscle rigidity, autonomic dysfunction (tachycardia, flushing, labile BP)
17
Q

Describe the use and mechanism of atypical antipsychotics

A
  • First line treatment of schizophrenia
  • Eg. Risperidone, olanzapine, clozapine (most effective), quetiapine
  • Mechanism - act as serotonin receptor agonists and dopamine antagonists
    - More effective in reducing negative symptoms of schizophrenia
18
Q

Describe the ADRs of atypical antipsychotics

A
  • Extrapyramidal side effects (less than typical), weight gain (olanzapine), increased prolactin (risperidone)
  • Serotonergic - nausea, sexual dysfunction, insomnia
  • Anti-cholinergic
  • Clozapine has more severe side effects including neutropenia, severe constipation - FBC monitoring needed
19
Q

Describe the symptoms of anxiety

A
  • Fear out of proportion to situation
  • Behavioural - avoidance
  • Psychological - fear of dying, going crazy
  • Physical - palpitations, sweating, chest tightness, shortness of breath, hot and cold flushes, light headedness, numbness
20
Q

Describe the treatment options for anxiety

A
  • Cognitive behavioural therapy - first line as not only treats symptoms but finds underlying cause
  • Exposure therapy - face your fears and working through a process to face them
  • Benzodiazepines
    - Eg. Diazepam, lorazepam
21
Q

Describe the ADRs of benzodiazepine

A
  • Becomes addictive in the long term as tolerance increases (greater dose needed for same effect)
  • Withdrawal symptoms - insomnia, agitation, anxiety
  • Common - drowsiness, dizziness, psychomotor impairment
  • Occasional - dry mouth, blurred vision, GI upset, reduced blood pressure
  • Cleft lip and palate in pregnancy
22
Q

How is benzodiazepine overdose treated

A
  • Flumazenil reverses effect of benzodiazepine
23
Q

Describe the symptoms of mood disorders

A
  • Includes bipolar disorder, which is a spectrum of mania/hypomania and depression
  • Mania - excited, optimistic, cannot stop talking, overactive, poor concentration, poor sleep, poor appetite, short attention span
24
Q

List the treatments for mood disorders

A
  • Lithium
  • Sodium valproate
  • Carbamazepine
  • Lamotrigine
  • Antipsychotics
25
Q

Describe the PK of lithium

A
  • Eg. Lithium carbonate
  • Renal secreted, slow release so 1 dose a day
  • Lithium doses need to be monitored - narrow therapeutic window
  • Renal and thyroid function need to be assessed before dosing
26
Q

List the ADRs of lithium

A
  • Memory problems, thirst, polyuria, tremor, drowsiness, weight gain
  • Toxic effects - vomiting, diarrhoea, coarse tremor, restlessness, agitation
27
Q

Give examples of antiemetic drugs

A
  • Cyclizine - H1 antagonist (anticholinergic + antihistamine)
  • Metoclopramide, domperidone - dopamine D2 antagonist
  • Ondansetron - selective serotonin receptor antagonists (antagonize vagal input to gut stimulating vomiting)
  • Hyoscine
28
Q

Give examples of antipsychotic drugs

A
  • Typical - Haloperidol, chlorpromazine

- Atypical - Risperidone, olanzapine, clozapine (most effective), quetiapine

29
Q

Give examples of antidepressant drugs

A
  • SSRI - Fluoxetine, citalopram, sertraline
  • TCA - Amitriptyline, imipramine, lofepramine
  • SNRI - Venlaflaxine, duloxetine

4 - CPT (23 decks)

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