Drugs used in Psychiatric Disease Flashcards

1
Q

What are the key symptoms of depression?

A

Core = low mood, anhedonia, decreased energy

Secondary = decreased appetite, sleep disturbance, hopelessness, irritability, reduced libido

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2
Q

Outline the pathophysiological theories of depression

A

1) Monoamine hypothesis = def of monoamine neurotransmitters (NA, serotonin). Monoamine oxidase inhibitors (MAOIs) block the enzyme monoamine oxidase from destroying neurotransmitters
2) Receptor hypothesis = abnormality in receptors for monoamine transmission leads to depression
3) Gene expression = problem within the molecular events distal to the receptor

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3
Q

Give an example of an SSRI

A

Citalopram

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4
Q

What is the mechanism of SSRIs?

A

Inhibit the reuptake of serotonin into the presynaptic cell

Increased serotonin the synaptic cleft

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5
Q

What are the ADRs of SSRIs?

A

Anorexia, nausea, diarrhoea

Overdose = reasonable safe on its own

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6
Q

Give an example of a TCA

A

Amitriptyline

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7
Q

What is the mechanism of TCAs?

A

1) inhibition of NA uptake = enhanced NA neurotransmission
2) muscarinic cholinergic blockade = reduced cholinergic neurotransmission
3) A1-adrenoceptor blockade = suppression of NA neurotransmission

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8
Q

What are the ADRs of TCAs?

A

CNS – sedation, lower seizure threshold

ANS – reduction in glandular secretions

CVS – tachycardia, postural hypotension, impair myocardial contractility

GI - constipation

Overdose = Seizures, tachycardia, elevated temperature (pyrexia), cardiac arrest.

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9
Q

Give an example of an SNRI

A

Venlafaxine

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10
Q

What is the mechanism of SNRIs?

A

Developed as SSRIs with property of noradrenaline uptake inhibition grafted on

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11
Q

What are the ADRs of SNRIs?

A

anorexia, nausea, diarrhoea

Sleep disturbance, increased BP, dry mouth, hyponatraemia

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12
Q

Briefly outline the progression in medication one should follow when treating depression

A

FIRST LINE = SSRI’s (serotonin selective reuptake inhibitor)

TCAs = Tricyclic Antidepressants

SNRI’s (serotonin/noradrenergic reuptake inhibitor)

MAOI’s (monoamine oxidase inhibitor)

Try one antidepressant for at least 6 weeks before switching to another

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13
Q

What are the key symptoms of schizophrenia?

A

Disturbances of thinking

Hallucinations = perception in the absence of an external stimulus-auditory, olfactory, visual, gustatory, tactile

Delusions = fixed false belief that it out of keeping with someone’s culture or religious beliefs

Unusual speech- thought disorder

Behavioural changes

Lack of insight

Negative symptoms

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14
Q

Describe the pathophysiological mechanism underlying schizophrenia

A

1) dopamine theory = amphetamine causes symptoms very similar to positive symptoms of schizophrenia, some evidence of increased dopamine function in schizophrenics

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15
Q

What are the main dopamine pathways?

A

Mesolimbic = emotional response and behaviour

Meso-cortical = important in arousal and mood

Nigrostriatal = key pathway damaged in Parkinson’s disease

Tuberoinfundibular = in hypothalamus and pituitary gland

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16
Q

Outline the mechanism is dopamine D2 antagonists

A

Block D2 receptors present in dopamine pathways

17
Q

What are the ADR of dopamine D2 antagonists?

A

Haloperidole = tardive dyskinesia (involuntary repetitive body movements), QT interval prolongation, motor restlessness, muscle rigidity, parkinsonism (extra-pyramidal effects)

18
Q

What is the mechanism of 5-HT antagonists?

A

antagonists at 5HT-2A receptors

19
Q

What are the ADRs of 5-HT antagonists?

A

Clozapine = severe constipation, sedation, hypersalivation, weight gain ++++

20
Q

How do stats should an overall effectiveness for the treatment for schizophrenia over a 10 year period?

A

~1/4 improved but need support

~1/4 improved and relatively independent

~1/4 fully recovered

21
Q

What are the key symptoms of anxiety?

A

Fear out of proportion to situation

light headedness,

shortness of breath

hot and cold flushes

nausea

palpitations

numbness, pins and needles

22
Q

Describe the mechanism of GABA agonists

A

Binds GABA-BDZ receptor complex = enhanced GABA

23
Q

Give examples of benzodiazepines (GABA agonists)

A

Diazepam

Lorazepam

24
Q

What are the ADRs of benzodiazepine?

A

Drowsiness, dizziness, psychomotor impairment

Tolerance = need to increase dose to achieve the same effect

Withdrawal = insomnia, agitation, anxiety

25
Q

How can benzodiazapine be toxic?

A

Cleft lip/palate if used in preg

If taken late in preg = resp depression, feeding diff in baby

26
Q

How is a benzodiazepine overdose treated?

A

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

27
Q

What are the symptoms of bipolar disorder?

A

Episodes of depression and mania

Mania = unusually excited, happy, overactive, poor concentration, poor sleep, rapid speech, poor judgement

28
Q

Name the range of drugs that can be used to treat mood disorders

A

Lithium

Sodium valproate

Carbamazepine

Lamotrigine

Antipsychotics

29
Q

What is lithium used to treat?

A

Prophylaxis of Mania and Depression in bipolar disorder

Augmentation of antidepressants in unipolar depression

Good evidence for reducing suicidality

Of all mood stabilisers Lithium has the best evidence

30
Q

What are the ADRs of lithium?

A

Memory problems

Thirst

Polyuria

Tremor

Drowsiness

Weight gain

31
Q

Online the toxic effect of lithium

A

Need to monitor blood levels closely

D+V, coarse tremor, dysarthria, cognitive impairment, restlessness, agitation