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Yr 3 - Pharmacology > Drugs - Mental Health > Flashcards

Drugs - Mental Health Flashcards

1
Q

Give 4 examples of SSRIs

A
  1. Sertraline
  2. Citalopram
  3. Fluoxetine
  4. Escitalopram
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2
Q

Main indication for SSRIs?

A

1st line pharmacological treatment for moderate to severe depression, and mild depression if psychological treatments alone are insufficient

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3
Q

Give 2 other indications for SSRIs

A

Anxiety/panic disorder

OCD

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4
Q

MOA of SSRIs?

A

SSRIs preferentially inhibit neuronal reuptake of 5-HT (serotonin) from synaptic cleft, increasing its availability for neurotransmission.

This improves mood and physical symptoms in depression and anxiety

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5
Q

Why are SSRIs generally preferred over tricyclic antidepressants despite having similar efficacy?

A

SSRIs do not inhibit noradrenaline uptake and cause less blockage of other receptors → fewer adverse effects and less dangerous in overdose

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6
Q

Common electrolyte abnormality caused by SSRIs?

A

Hyponatraemia

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7
Q

Who is most at risk of developing hyponatraemia with SSRIs?

A

Elderly (>65 y/o)

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8
Q

What can severe hyponatraemia predispose to?

A

Seziures

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9
Q

Give some side effects of SSRIs

A
  • GI upset
  • Changes in appetite & weight (loss/gain)
  • Hypersensitivity reactions e.g. rash
  • Suicidal thoughts & behaviours may be increased
  • May lower the seizure threshold
  • Sexual problems e.g. reduced sexual desire, erectile dysfunction, difficulty reaching an orgasm
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10
Q

How may hyponatraemia caused by SSRIs present in the elderly?

A

Confusion, reduced consciousness

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11
Q

What is serotonin syndrome?

A

This is a triad of autonomic hyperactivity, reduced mental state and neuromuscular excitation

Cause → High doses/overdose of SSRIs or in combination with other serotonergic drugs (e.g. other antidepressants, tramadol)

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12
Q

Contraindications for SSRIs?

A
  • Epilepsy
  • Peptic ulcer disease
  • Young people (caution)
  • Hepatic impairment
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13
Q

What are SSRIs metabolised by?

A

Liver

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14
Q

Why should SSRIs be used with caution in young people?

A

associated with increased risk of self-harm and suicidal thoughts so should only be prescribed by specialists

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15
Q

Why are SSRIs contraindicated in epilepsy?

A

Can lower seizure threshold

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16
Q

Why are SSRIs contraindicated in peptic ulcer disease?

A

SSRIs have been associated with increased risk for bleeding peptic ulcers.

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17
Q

How do SSRIs affect bleeding?

A

increase risk of bleeding

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18
Q

What can sudden withdrawal from SSRIs cause?

A

Sudden withdrawal can lead to GI upset, neurological and influenza-like symptoms and sleep disturbance

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19
Q

Why should SSRIs not be given with monoamine oxidase inhibitors?

A

both increase synaptic serotonin levels so together may precipitate serotonin syndrome

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20
Q

Give 2 examples of tricyclic antidepressants

A
  1. Amitriptyline
  2. Lofepramine
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21
Q

Main indication for tricyclics?

A

2nd line treatment for moderate-to-severe depression where 1st line SSRIs are ineffective

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22
Q

What is an unlicensed indication for tricyclics?

A

Neuropathic pain

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23
Q

MOA of tricyclics?

A

Inhibits neuronal reuptake of serotonin (H-HT) and noradrenaline from the synaptic cleft, increasing their availability for neurotransmission

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24
Q

Tricyclic antidepressants block a wide array of receptors. Which receptors?

A
  1. Blocks serotonin reuptake
  2. Blocks NA reuptake
  3. Dopamine (D2) receptors
  4. Muscarinic
  5. Histamine (H1)
  6. a-adrenergic (a1 and a2)
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25
Q

Why are tricyclics associated with a wide array of adverse effects?

A

Due to blocking a wide array of receptors → this limits their clinical use

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26
Q

Blockage of which receptor can cause sedation with tricyclics?

A

H1

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27
Q

Blockage of which receptor can cause hypotension with tricyclics?

A

alpha (a1)

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28
Q

Side effects of blockage of muscarinic receptors tricyclics?

A
  • Urinary retention
  • Blurred vision
  • Constipation
  • Dry mouth
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29
Q

Blockage of which receptor can cause breast changes & sexual dysfunction with tricyclics?

A

Dopamine

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30
Q

Blockage of which receptor can cause extrapyramidal symptoms (tremors,dyskinesia) with tricyclics?

A

Dopamine

31
Q

Tricyclics are very dangerous in overdose. What can they cause?

A

severe hypotension, arrhythmias, convulsions, coma, respiratory failure, death

32
Q

What can sudden withdrawal from tricyclics cause?

A

Sudden withdrawal can cause GI upset, neurological and influenza-like symptoms and sleep disturbance

33
Q

Give some examples of benzodiazepines

A

Diazepam, Temazepam, Lorazepam, Chlordiazepoxide, Midazolam

34
Q

Give some indications for benzos

A
  • 1st line management of seizures and status epilepticus
  • 1st line management of alcohol withdrawal reactions
  • Common choice for sedation for interventional procedures (if general anaesthesia is unnecessary/undesirable)
  • Short-term treatment of severe, disabling, or distressing anxiety
  • Short-term treatment of severe, disabling, or distressing insomnia
35
Q

What 2 conditions are benzos the 1st line management for?

A
  1. Seizures and status epilepticus
  2. Alcohol withdrawal reactions
36
Q

What receptor is the target of benzos?

A

y-aminobutyric acid type A (GABAa) receptor

37
Q

What is the GABA receptor?

A
  • GABAa is a chloride channel that opens in response to binding by GABA (the main inhibitory neurotransmitter in the brain)
  • Opening the channel allows chloride to flow into the cell, making the cell more resistant to depolarisation
38
Q

What is the main inhibitory neurotransmitter in the brain?

A

GABA

39
Q

How do benzos initiate a widespread depressant effect on synaptic transmission?

A

Benzos facilitate and enhance binding of GABA to GABAa receptor

40
Q

Effects of benzos?

A

reduced anxiety, sleepiness, sedation, and anticonvulsive effects

41
Q

How does alcohol interact with the GABA receptor?

A

Alcohol also acts on GABA receptor, and in chronic excessive use the patient becomes tolerant to its presence

42
Q

Why can abrupt withdrawal from alcohol in chronic alcohol use induce an excitatory state of alcohol withdrawal?

What is this treated with?

A

Abrupt cessation provokes the excitatory state of alcohol withdrawal due to alcohol’s effect on GABA receptor

This can be treated with benzos (which can then be withdrawn in a gradual and more controlled way)

43
Q

Describe cardiorespiratory depression in benzo overdose compared to opioid overdose

A

Little cardiorespiratory depression in benzo overdose (in contrast to opioid overdose), BUT a loss of airway reflexes can lead to airway obstruction and death

44
Q

What can abrupt withdrawal of benzos lead to?

A

abrupt cessation can produce withdrawal reaction

45
Q

Why should benzos be avoided in liver failure?

A

may precipitate hepatic encephalopathy

46
Q

If the use of benzos in liver failure is essential (e.g. alcohol withdrawal), which one should be used? Why?

A

Lorazepam - depends less on liver for elimination

47
Q

Give 2 contraindications for benzos?

A
  1. Neuromuscular disease e.g. Myasthenia gravis
  2. Significant respiratory impairment
48
Q

What can concurrent use of benzos with P450 inhibitors (e.g. amiodarone, diltiazem, macrolides, fluconazole, protease inhibitors) cause?

A

may increase effects as depend on P450 system for elimination

49
Q

Which benzos are indicated in seizures?

A

long-acting benzos are preferred such as IV lorazepam or diazepam (IV or rectal)

50
Q

Which benzo is indicated in alcohol withdrawal?

A

oral chlordiazepoxide

51
Q

Which benzo is indicated for sedatin for interventional procedures?

A

Midazolam

52
Q

Which benzo is indicated for sedatin for insomnia & anxiety?

A

temazepam

53
Q

What is the specific antagonist for benzos?

A

Flumenazil

54
Q

Why is flumanzil rarely given to reverse benzo overdose?

A

as may precipitate seizures (which may be difficult to treat as will have then blocked benzo receptor)

55
Q

What class of drug is Donepezil?

A

Acetylcholinesterase inhibitor

56
Q

Indication for Donepezil?

A

1st line in patients presenting with mild-moderate Alzheimer’s disease

57
Q

MOA of Donepezil?

A

Selectively and reversibly inhibits the acetylcholinesterase enzyme, which normally breaks down ACh. This inhibition is believed to enhance cholinergic transmission, which relieves the symptoms of Alzheimer’s dementia.

58
Q

Function of acetylcholinesterase enzyme?

A

Breaks down ACh

59
Q

Effect of Donepezil on cholinergic activity?

A

increased cholinergic activity in the PNS

60
Q

Why can donepezil lead to GI upset?

A

due to increased cholinergic activity in the PNS

61
Q

Side effects of donepezil?

A
  • GI upset
  • Asthma or COPD – patients may experience an exacerbation of symptoms
  • Hallucinations and altered/aggressive behaviour
  • Vivid dreams (potentially advise to take in morning)
62
Q

Who should Donepezil be used with caution in?

A

Use with caution in asthma and COPD and those at risk of developing peptic ulcers

63
Q

What can concomitant therapy of Donepezil with NSAIDs and corticosteroids cause?

A

may increase risk of peptic ulceration

64
Q

What can concomitant therapy of Donepezil with other rate-limiting drug cause?

A

Bradycardia and/or heart block

65
Q

Give 3 examples of 1st line antipsychotics

A
  1. Haloperidol
  2. Chlorpromazine
  3. Prochlorperazine
66
Q

Indications for Haloperidol?

A
  • Urgent treatment of severe psychomotor agitation (e.g. delirium) that is causing dangerous or violent behaviour, or to calm patients to permit assessment
  • Schizophrenia
  • Bipolar disorder
  • N&V – particularly in the palliative care setting
67
Q

Mechanism of antipsychotics (e.g. Haloperidol)?

A

block post-synaptic D2 receptors

68
Q

What is the main drawback of 1st generation antipsychotics?

A

Extra-pyramidal effects (movement abnormalities that arise from D2 blockade in the nigrostriatal pathway):

  • Acute dystonic reactions – involuntary parkinsonian movements, muscle spasms
  • Tardive dyskinesia – late reaction (months/years) e.g. lip smacking (involuntary, repetitive movements)
69
Q

What causes extra-pyramidal effects with 1st generation antipsychotics?

A

from D2 blockade in the nigrostriatal pathway

70
Q

2 main contraindications for 1st generation antipsychotics?

A
  1. Parkinson’s disease
  2. Dementia with Lewy bodies
71
Q

Why are 1st generation antipsychotics contraindicated in Parkinson’s?

A

can exacerbate symptoms (due to extrapyramidal effects)

72
Q

Why are 1st generation antipsychotics contraindicated in dementia with Lewy bodies?

A

may increase risk of stroke/death

73
Q

What drugs commonly cause tardive dyskinesia?

A

Antipsychotics

Yr 3 - Pharmacology (18 decks)

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