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Clinical Pharmacology, Therapeutics & Principles of Prescribing > Drugs used in Psychiatric Disease > Flashcards

Drugs used in Psychiatric Disease Flashcards

1
Q

What are the core and secondary symptoms of depression and how to they relate to making a diagnosis?

A

Core symptoms: (need 2 of 3 of these)

Low mood

Anhedonia

Decreased energy

Secondary symptoms:

Sleep disturbance, Hopelesness, Reduced concentration, Irritibility, Self-harm/suicidal thoughts

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2
Q

Explain what is meant by the “monoamine hypothesis” of depression

What are the other 2 theories for the pathophysiology of depression?

A

Depression thought to be due to deficiency of monoamine neurotransmitters (NA and serotonin)

Neurotransmitter Receptor Hypothesis

The Monoamine Hypothesis of Gene Expression

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3
Q

What are the 4 types of antidepressant that can be used clinically?

A

Tricyclic antibiotics (TCAs)

Serotonin and Noradrenaline reuptake inhibitors (SNRIs)

Noradrenaline reuptake inhibitors (NARIs)

Selective Serotonin reuptake inhibitors (SSRIs)

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4
Q

Give some examples of SSRIs

A

Sertraline

Fluoxetine

Citalopram

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5
Q

How are SSRIs absorbed?

Where are they metabolised?

A

In the gut

Metabolised in the liver

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6
Q

List some common and some rare side effects of SSRIs

A

Common: anorexia, nausea, diarrhoea

Rare: precipitation of mania, increased sucicidal intention

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7
Q

How to TCAs work?

A

Inhibit the reuptake of NA at the nerve terminals

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8
Q

Give some examples of TCAs

A

Amitriptyline

Clomipramine

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9
Q

How are TCAs absorbed?

Where are they metabolised?

A

The gut

Metabolised in the liver

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10
Q

List some of the side effects of TCAs

A

CNS: sedation, lowering of seizure threshold

CVS: tachycardia, postural hypotension

GI: constipation

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11
Q

What would be some of the consequences of a TCA overdose?

A

Hypotension

Seizure

Arrhythmias

Tachycardia

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12
Q

Give some named examples of SNRIs

A

Duloxetine

Venlafaxine

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13
Q

What is the definition of psychosis?

A

Lack of contact with reality

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14
Q

What are the symtoms of paranoid schizophrenia?

A

Disturbances in thinking

Hallucinations

Delusions

Unusual speech

Lack of insight

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15
Q

What is the definition of a “hallucination”?

A

A perception in the absence of an external stimulus

(auditory, olfactory, visual, gustatory, tactile)

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16
Q

What is the definition of a “delusion”

A

A fixed false belief that is out of keeping with someones culute or religious belief

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17
Q

Briefly explain the dopamine theory of schizophrenia

A

Theory of disturbed and hyperactive dopaminergic signal transduction leading to schizophrenia

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18
Q

What is the evidence that supports the dopamine hypothesis of schizophrenia?

A

Amphetamine (increases dopamine) causes very similar symptoms to + schizophrenia symptoms

Parkinson’s disease treatment that do the same can induce schizophrenia like symptoms

Dopamine antagonists are used in the treatment of schizophrenia

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19
Q

What are the main dopamine pathways and what are they each responsible for?

A

Mesolimbic: emotional response and behaviour

Meso-cortical: important in arousal and mood

Nigrostriatal: key pathway damaged in PD

Tuberoinfundibular: in hypothalamus and pituitary gland

20
Q

Name some first generation or “typical” antipsychotics

A

Haloperidol

Chloropromazine

21
Q

Name some atypical antipsychotics

A

Olanzapine
Risperidone
Quetiapine

Clozapine

22
Q

What is the definition of bipolar disorder?

A

A mental illness that is assoicated with periodic episodes of depression and hypomania/mania

23
Q

What kind of things might you notice in a patient with mania?

A

Unusal excitement, happiness or optimism

Overactivity

Poor concentration and short attention span

Poor sleep

Rapid, disordered, caotic speech

Poor judgement

Increased interest in sex

Psychotic symptoms

24
Q

Give some examples of mood stabilisers that might be used in the treatment of bipolar disorder

A

Lithium - most effective

Sodium valporate - antiepileptic

Carbamazepine- antiepileptic

Lamotrigine - antiepileptic

25
Q

How does Lithium work?

A

May compete with magnesium and calcium ions

Increases 5HT and possibily their receptor sites in long term use

Attenuates the effect of neurotransmitters

26
Q

Where is Lithium excreted?

What needs to be checked before starting Lithium and every 6 months after?

A

Via the kidneys

Renal function

27
Q

List some of the side effects of Lithium

A

Memory problems

Thirst

Polyuria

Tremor

Weight gain

Drowsiness

Hair loss

Rashes

28
Q

What are the toxic effects of Litihum and how can they be treated?

A

Vomiting, diarrhoea, coarse tremor, cognitive impairment

Treat supportively, anticonvulsants, increase fluid intake, haemodialysis

29
Q

What are the two types of drug used to slow the progression of dementia, give examples of each

A

Acetyl Cholinesterase Inhibitors:

  • Donepezil
  • Galantamine
  • Rivastigmine

NMDA antagonist:

-Memantine

30
Q

What is the mechanism of action of Acetyl-cholinesterase inhibitors?

A

Prevents the production of acetyl-cholinesterase which would normally break down acetylcholine

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

31
Q

According to NICE Acetyl Cholinesterase inhibitors can be used to treat what?

A

Mild- moderate dementia

32
Q

According to NICE Memantine can be used to treat what?

A

Moderate- severe dementia

33
Q

What are the actions of all antipsychotics overtime?

A

Hours: sedation

Hours: tranquilisation

Days-weeks: antipsychotic

Weeks: activation of negative symptoms

Hours/days: extrapyramidal side effects

34
Q

Why might an atypical antipsychotic be more acceptibe to patients that a “typical” antipsychotic such as Haloperidol?

A

Less extrapyramidal side effects

Can be taken once daily

Can get as dissolvable preparations

35
Q

List some extrapyramidal side effects (EPSEs)?

A

Parkinsonism

Acute dystonia

Akathisia

Tardive dyskinesia

36
Q

List some of the things you might see in typical antipsychotic toxicity

A

CNS depression

Cardiac toxicity

Risk of sudden death

37
Q

List some of the behavioural, psychological and physical symptoms of anxiety

A

Behavioural: avoidance

Psychological: fear of dying, going crazy

Physical symptoms: light headedness, hot/cold flushes, SOB, numbness, nausea

38
Q

What is the first line treatment for anxiety?

A

Non-pharmacological approaches e.g. CBT

39
Q

Give some examples of benzodiazepines

A

Diazepam

Lorazepam

40
Q

How do benzodiazepines work?

A

Full agonist of GABA receptor site which leads to enhancement of GABA effects

This has inhibitory effects on the brain

41
Q

What property of benzodiazepines means that they diffuse into the CNS rapidly?

A

They are highly lipid soluble

42
Q

When prescribing benzodiazepines, you should be aware that they can cause the need for an increased dose to have the same effect, known as _________. Discontinuation of treatment can cause withdrawl, known as ___________.

A

Tolerance

Dependence

43
Q

List some common, occassional and rare side effects of Benzodiazapines

A

Common: Drowsiness, dizziness, psychomotor impairment

Occassional: dry mouth, blurred vision, GI upset, ataxia, headache

Rare: amnesia, restlessness, rash

44
Q

Why should benzodiazapines not be used in pregnancy?

A

They can cause cleft lip and palate

Late in pregnancy: respiratory depression, feeding difficulties in baby

45
Q

Which drug might be useful in reversing the effects of benzodiazapine overdose?

A

Flumazenil

46
Q
A

Clinical Pharmacology, Therapeutics & Principles of Prescribing (22 decks)

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