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PPE - Pharmacology > Drugs Used in Psychiatric Disease > Flashcards

Drugs Used in Psychiatric Disease Flashcards

1
Q

How is depression diagnosed in terms of symptoms?

A

2 of 3 core symptoms needed:
Low mood
Anhedonia
Decreased energy

Secondary symptoms:
Decreased appetite
Sleep disturbance
Hopelessness (depressive cognitions)
Reduced concentration
Irritability
Self harm or suicidal ideas or acts
Reduced libido
Can have psychotic symptoms
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2
Q

What are the different classes of antidepressants?

A

Monoamine oxidase inhibitors
Monoamine uptake inhibitors
- Non selective
- Selective

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3
Q

Tell me about selective serotonin reuptake inhibitors.

A

SSRIs
Fluoxetine, citalopram, paroxetine, sertraline

Almost completely absorbed
long half life

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4
Q

What are some of the ADRs of SSRIs?

A

Common
Anorexia
Nausea
Diarrhoea

Rare
Precipitation of mania
Possible increased ideation
Neurological side effects (tremor, extrapyramidal syndromes)

(Reasonably safe in overdose if taken on own)

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5
Q

Tell me about tricyclic antidepressants.

A

Imipramine, lofepramine, amitriptyline

Not used as often, not first line

Has a few actions:
Inhibition of noradrenaline uptake
Muscarinic cholinoceptor blockade - reduced cholinergic neurotransmission
Alpha 1-adrenoceptor blockade - suppression of noradrenergic neurotransmission

Lipid soluble
Absorbed from gut
Long half lives

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6
Q

What are some of the ADRs of TCAs?

A

CNS
Sedation
impairment of psychomotor performance
Lowering of seizure threshold

Autonomic nervous sytem
Reduction in glandular secretions
Eye accommodation block

CVS
Tachycardia
Postural hypotension
Impair myocardial contractility

GI
Constipation

Extremely toxic in overdose

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7
Q

Tell me about ‘pure’ non-selective monoamine uptake inhibitors (SNRIs).

A

Venlafaxine (duloxetine)

Serotonin - Noradrenaline reuptake inhibitors

Second/third line drugs

Dose dependant - lower doses serotonin action, higher doses noradrenaline

Relatively short half-life

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8
Q

What are some of the ADRs of SNRIs

A

Same as SSRIs
Anorexia, nausea, diarrhoea

Precipitation of mania, increased suicidal ideation and tremors

ALSO has other ADRs:
sleep disturbances, increased BP, dry mouth, hyponatraemia

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9
Q

What are the symptoms of paranoid schizophrenia?

A 
Disturbances of thinking
Hallucinations
Delusions
Unusual speech-thought disorder
Behavioural changes
Lack of insight
Negative symptoms
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10
Q

What are the different theories of schizophrenia?

A

Dopamine hypothesis
- Dopamine hyperfunction

Increased 5-HT function??

Glutamate hypofunction

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11
Q

What are the general actions of all antipsychotics?

A 
Sedation (within hours)
Tranquilisation (within hours)
Antipsychotic (several days or weeks)
Negative symptoms (weeks)
Production of extrapyramidal side effects (hours or days)
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12
Q

What are the advantages of atypical antipsychotics?

A

Less EPSE side effects therefore more acceptable to patient
Different preparations
Some once daily dosage
Differing side effect profiles can be matched o patient characteristics
First line treatment in schizophrenia

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13
Q

What are some of the ADRs of atypical antipsychotics?

A 
Vary between drugs
Can have extrapyramidal side effects at high doses
Weight gain -e.g. olanzapine
Increased prolactin e.g. risperidone
Sedation
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14
Q

Tell me about typical antipsychotics.

A 
Haloperidol safe in emergencies
Chloromazine
More sedating
Well known side effects
Wide range of pharmacological action:
Dopamine blockade
Anticholinergic
Alpha adrenergic blockade
Antihistamine effect
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15
Q

Name some atypical antipsychotics.

A

Olanzapine
Risperidone
Clozapine
Quetiapine

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16
Q

What are some of the ADRs typical antipsychotics/

A 
Extrapyramidal side-effects
Parkinsonism
Acute dystonia
Akathasia
Tardive dyskinesia
Neuroleptic malignant syndrome
Severe rigidity
Hyperthermia
Increased CPK
Autonomic liability

Postural hypotension
Weight gain
Endocrine changes (prolactinaemia)
Pigmentation

17
Q

What are some of the toxicities of atypical antipsychotics?

A

Central nervous system depression
Cardiac toxicity
Risk of sudden death with high dose

18
Q

What are some of the characteristics of anxiety disorders?

A 
Fear out of proportion to situation
Avoidance
Fear of dying, going crazy
Physical symptoms
- Light headedness
- Shortness of breath
- Hot and cold flushes
- Nausea
- Palpitations
- Numbness
- Pins and needles
19
Q

What are the overall treatments for anxiety?

A

Non pharmacological approaches first line
- CBT
Treat any coexistent disorder
Drugs - antidepressants, anxiolytics, occasionally antipsychotics

20
Q

What are the principle neurotransmitter systems involved in anxiety disorders?

A

Gamma-aminobutyric acid - GABA
Serotonin (5-HT)
Noradrenaline

21
Q

Tell me about benzodiazepines and their use in anxiety disorders.

A

Anxiolytics
Diazepam, Lorazepam

Exerts effects through structure known as GABA-BDZ receptor complex

Benzodiazepines only bind to BDZ receptor of which there are 2 main groups - high and low affinity

High affinity group - Important in anxiolytic, hypnotic and anticonvulsant effects of BDZs

Inhibitory effects in brain

BDZs act as full agonists at these receptor sites
Lead to enhancement of GABA
Highly lipid soluble
Long half-life

22
Q

Tell me about tolerance and dependence of benzodiazepines.

A

Tolerance can occur
i.e. need to increase the dose to achieve the same effect

Dependence - on discontinuation of treatment can get withdrawal effects
e.g. insomnia, agitation, anxiety

23
Q

What are the ADRs of benzodiazepines?

A

Common
Drowsiness
Psychomotor impairment

Occasional
Dry mouth
Blurred vision
Gastrointestinal upset
Ataxia
Headache
Reduced blood pressure

Rare
Amnesia
Restlessness
Rash

24
Q

What are the possible toxicities of benzodiazepines?

A

Cleft lip and palate if used in pregnancy??

If taken late in pregnancy may7 cause respiratory depression and feeding difficulties in babies

25
Q

How do you treat an overdose of benzodiazepines?

A

Deaths are rare
- Respiratory depression
Support

Flumazenil an antagonist/partial inverse agonist at BDZ receptors may be useful in reversing effects

26
Q

What is bipolar disorder?

A

Episodes of depression and hypomania/mania

Mania
- Feeling unusually excited, happy, optimistic or feeling irritable
-Overactive
- Poor concentration and short attention span
- Poor sleep
- Rapid speech, jump from one idea to another
- Poor judgement (overspending)
- Increases interest in sex
Psychotic symptoms - hallucinations, grandiose delusions

27
Q

List some mood stabilisers.

A 
Lithium
Sodium valproate
Carbamazepine
Lamotrigine
Antipsychotics
28
Q

Tell me how it is believed lithium works as a mood stabiliser?

A

Electrolytes and channels - may compete with magnesium and calcium ions

Neurotransmitters - Li increases 5HT, chronic Li may reduce 5HT receptor sites

Second messenger systems - lithium attenuates the effects of certain neurotransmitters on their receptors without altering receptor density

29
Q

Tell me about the use of lithium as a mood stabilisers.

A

Renal excretion
Slow release preparations can be given once daily
Lithium levels need to be monitored
- Narrow therapeutic window

need to check renal function and thyroid function before starting and every 6 months

Uses:
Prophylaxis of mania and depression in bipolar
Augmentation of antidepressants in unipolar depression
Good evidence for reducing suicidality
Of all mood stabilisers Lithium has the best evidence

30
Q

What are some of the ADRs of lithium?

A 
Memory problems
Thirst
Polyuria
Tremor
Drowsiness
Weight gain

Other effects:

  • Effect on kidneys
  • Endocrine changes - hypothyroidism
  • Hair loss
  • Rashes
31
Q

What are some of the toxic effects of lithium?

A 
Vomiting
Diarrhoea
Dysarthria
Cognitive impairment
Restlessness
Agitation
32
Q

How do you treat lithium toxicity?

A

Supportive measures
Anticonvulsants
Increase fluid intake/IV fluid etc.
Haemodialysis may be necessary

33
Q

What are some dementia medications?

A

Acetyl Cholinesterase Inhibitors

  • Donepezil
  • Galantamine

NMDA antagonist
- Memantine

34
Q

Tell me a little about acetyl-cholinesterase inhibitors (AchE-I)

A

ACh plays a role in arousal, memory, attention and mood

Slows down progression of Alzheimers Disease

ADRS:

  • Nausea, vomiting, anorexia, diarrhoea
  • Fatigue insomnia, headache
  • Bradycardia
  • Worsening of COPD
  • Gastric/duodenal ulcers
35
Q

Tell me a little about Memantine.

A

Licensed for moderate to severe dementia

Usually well tolerated

ADRs:

  • Hypertension
  • Dyspnoea
  • Headache
  • Dizziness
  • Drowsiness

PPE - Pharmacology (24 decks)

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