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할수있어 > Drugs Used in Psychiatric Disorders > Flashcards

Drugs Used in Psychiatric Disorders Flashcards

1
Q

What is the class of drugs commonly used as anxiolytics and as sleeping pills to treat the symptoms and behaviors caused by anxiety disorders?

A

Benzodiazepines

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2
Q

Name 5 examples of Benzodiazepines

A

Short acting: Midazolam
Intermediate acting: Lorazepam, Alprazolam
Long acting: Diazepam, Clonazepam

think lam and pam

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3
Q

What is the Mechanism of Action of Benzodiazepines?

A

BZD binds to specific BZD sites in the CNS and potentiates GABA actions by increasing the frequency of chloride channel opening induced by GABA.

It is GABA dependent. It does not open the channels in the absence of GABA so Cl- doesn’t enter the cells in the overdose of Benzodiazepines.

∴ Benzodiazepine is a safe drug in overdose

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4
Q

What is the route of administration for benzodiazepines?

A

Oral - fast onset 0.5 - 1 h
IV - immediate onset

Parenteral IV: Midazolam, Lorazepam, Diazepam

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5
Q

What are the active compounds of Diazepam, Lorazepam, Alprazolam and Midazolam?

A

Diazepam -> Nordazepam (L) -> Oxazepam (I)

Lorazepam (I) - active compound, trick question

Alprazolam (S) -> alpha-Hydroxyalprazolam (S)

Midazolam (S) -> alpha-Hydroxymidazolam (S)

NOTE: all active compounds then undergo glucuronidation

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6
Q

List 6 adverse effects of Benzodiazepines

A
  1. CNS: ↑ drowsiness, ↓ motor skills, ↑ reaction time
  2. CNS: Anterograde amnesia. Memory disturbances are particularly profound after IV sedation
  3. CVS: ↓ BP, ↓ respiration in predisposed patients
  4. Paradoxical effects: excitement, garrulousness (talkative), irritability, hallucination, outburst of rage.
    Violent behaviour has been attributed to disinhibition by BZD (behaviour normally suppressed)
  5. Neonatal toxicity: Floppy child syndrome
  6. Tolerance, dependence and withdrawal
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7
Q

What is the elimination half-lives of Benzodiazepine hypnotics?

A

2 - 24 h

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8
Q

What is insomnia?

A

Not able to fall asleep, maintain sleep or early morning wakening, affecting the function of next day

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9
Q

What causes insomnia?

A

A + 3Ds
Anxiety - increased emotional arousal
Depression
Drugs-induced (caffeine)
Drug withdrawal - after chronic use of alcohol or sleeping pills

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10
Q

What are the characteristics of Benzodiazepine - induced sleep?

A

Reduced REM and deep (stage 4) sleep when compared to natural sleep

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11
Q

Name 2 non-benzodiazepine hypnotics, their MoA and hypnotic effect

A

Zolpidem, Zopiclone

MoA & hypnotic effect similar to BZ

binds to specific BZD sites in the CNS and potentiates GABA actions by increasing the frequency of chloride channel opening induced by GABA

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12
Q

Name 2 adverse effects of non-benzodiazepine hypnotics

A

Withdrawal anxiety
Abuse potential

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13
Q

What is the elimination half-life of non-benzodiazepine hypnotics?

A

2 - 4 h

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14
Q

What are the symptoms of depression?

A

Mood down
Interest down
Feeling of shame / guilt
Suicidal ideation

Sleep less (or more)
Psychomotor retardation
Appetite down (or up)
Concentration down
Energy down

Symptoms persist for at least 2 weeks, and severity of symptoms interfere with normal functioning

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15
Q

What are non-pharmacological treatment for depression?

A

Psychological: Cognitive Behavioural Therapy, Interpersonal
Social
Behavioural
Relaxation

Counselling

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16
Q

Name 4 classes of antidepressants

A
  1. Selective Serotonin Re-uptake Inhibitors (SSRIs)
  2. TriCyclics Antidepressants (TCAs)
  3. Serotonin Norepinephrine Re-uptake Inhibitors (SNRIs)
  4. NorAdrenergic & Specific Serotonergic Antidepressants (NaSSAs)
17
Q

Name 4 examples of SSRIs

A

Fluoxetine, escitalopram, sertraline, paroxetine

18
Q

Name 2 examples of TCAs

A

Amitriptyline, imipramine

19
Q

Name 1 example of SNRIs

A

Venlafaxine
Act like TCAs

20
Q

Name 1 example of NaSSAs

A

Mirtazapine
Antagonist of alpha2-adrenergic receptor and certain serotonin receptors

21
Q

MoA of SSRIs / SNRIs / TCAs

A

SSRI blocks serotonin transporter → ↑ serotonin in the brain

SNRI and TCA block serotonin transporter and norepinephrine transporter
→ ↑ serotonin and norepinephrine in the brain

22
Q

List 5 adverse effects of SSRIs

A
  1. Anxiety
  2. Weight loss / gain
  3. Headache, nausea
  4. Sexual dysfunction
  5. Hyponatremia

No fatality in overdose (unlike TCAs)

23
Q

What is the blood test that you need to do when a patient is treated with SSRI?

A

Blood Na+ levels

24
Q

SSRIs - DDIs

A
  1. SSRIs inhibit various P450 enzymes
    Fluoxetine > paroxetine > sertraline > escitalopram
    ask for medication history when prescribing
  2. Don’t take SSRIs with MAOI or St John’s wort

Risk of Serotonin syndrome: confusion, agitation, restlessness, stomach or intestinal symptoms, a sudden high body temperature, an extremely high BP or severe seizures

25
Q

List 5 adverse effects of TCA

A
  1. CNS effects: sedation, fatigue
  2. Cardiac rhythm: tachycardia, arrhythmias
  3. Postural hypotension
  4. Anticholinergic effects: glaucoma, blurred vision, urinary retention, constipation
  5. FATALITY IN OVERDOSE

don’t give TCA to old man bc of anticholinergic effects

26
Q

List 3 adverse effects of SNRIs

A
  1. CNS effects: agitation, irritable or drowsy
  2. CVS effects: BP may be raised at higher dose
  3. Hyponatremia

Unlike TCA, SNRI doesn’t have anticholinergic effects, postural hypotension and cardiac rhythm abnormalities

27
Q

What are the symptoms of anxiety disorders?

A

Psychological symptoms:
- Apprehension and fear

Somatic symptoms:
- CVS: Palpitations
- Resp: Chest pain and shortness of breath
- GIT disturbance
- Headaches and dizziness
- Tense muscle
- Insomnia

28
Q

What are the symptoms of schizophrenia?

A

Positive symptoms:
- delusion (abnormal belief), hallucination
- disorganized thinking, speech and behavior

Negative symptoms:
- no volition, no emotion, no expression
- no ability to plan, poor concentration

duration of disturbances: 6 months
deterioration in social / occupational function

29
Q

List 2 classes of antipsychotic drugs to treat symptoms of psychoses and examples

A
  1. Typical (first generation):
    high potency
    Haloperidol
  2. Atypical (second generation):
    Risperidone
    Olanzapine
    Quetiapine
    Clozapine
    Aripiprazole
30
Q

What is the MoA for typical (first generation) antipsychotics?

A

block D2 > serotonin (5-HT2) receptors
block D1, cholinergic, histaminic and alpha adrenergic

31
Q

What is the MoA for atypical (second generation) antipsychotics?

A

block serotonin (5-HT2) > D2 receptors
block D1, cholinergic, histaminic and alpha adrenergic

32
Q

List 4 adverse effects of typical (first gen) antipsychotic drugs / Haloperidol

A
  1. Extrapyramidal side effects (blocks dopamine) - characteristic of haloperidol
  2. Sedation
  3. Anticholinergic (blocks acetylcholine)
  4. Rare cases of neuroleptic malignant syndrome
33
Q

List ADRs of atypical (2nd gen) antipsychotics

A

Less extrapyramidal side effects than typical (1st gen) antipsychotics

Clozapine: agranulocytosis in 2% of patients, weight gain, sedation

Olanzapine: severe WEIGHT GAIN and severe SEDATION

Risperidone: Extrapyramidal side effects (dose dependent), weight gain

Quetiapine: weight gain

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