Lecture 4 Pharmacological Treatments of Affective and Anxiety Disorder Flashcards
What is the mechanism of Tertiary Tricyclics
Inhibit both serotonin and noradrenergic reuptake
What type of drugs are Imipramime
Amitriptyline
Doxepin
Clomipramine
Tertiary TCA
What are the indications of TCA
Depressive illness (particularly where sedation is required)
What are the side effects of TCA
Antihistaminic, anticholinergic, antiadrenrgic, QT lengthening
What are the contraindications for TCA
Arrhythmias
What is the mechanism of secondary TCAs
Primarily block noradrenaline
Name 2 examples of secondary TCAs
Desipramine, notriptyline
What additional use can TCAs be used for
Neuropathic pain
What is the mechanism of Monamine Oxidase Inhibitors
Bind irreversibly to monamine oxidase and prevents inactivation of norepinephrine, dopamine and serotonin
Name 2 examples of MAOIs
Isocarboxazid
Phenelzine
What are the side effects of MAOIs
Orthostatic hypotension Weight gain Dry mouth Sedation Serotonin syndrome Cheese reaction
What is Serotonin syndrome
Serotonin syndrome occurs when the levels of a chemical called serotonin in your brain become too high
What is a Cheese Reaction
An acute attack of hypertension that can occur in a person taking a monoamine oxidase inhibitor (MAOI) drug who eats cheese, caused by an interaction of the MAOI with tyramine
What are MAOIs used to treat
Anxiety and depressive symptoms
What additional measure can you take when prescribing MAOIs
Monitor blood pressure
Name 2 contraindications of MAOIs
Cerebrovascular disease
Phaechromocytoma
What is the mechanism of SSRIs
Block presynaptic serotonin reuptake
Name 2 examples of SSRI
Fluoxetine (Prozac)
Sertaline
Citalopram
Name contraindications for SSRIs
Hepatic illness
Multi-pharmacy
Poorly controlled epilepsy
Manic phase
What is the mechanism of SNRI
Inhibit both serotnin and noradrenergic reuptake like TCA but without antihistamine, antiadrenergic or anticholinergic side effects.
Name an example of SNRI
Venlafaxine
Duloxetine
What is SNRIs used to treat
Depression
Neuropathic pain
What are the contraindication for SNRIs
High BP
Diabetes
Cardiovascular problems
What is the mechanism of Mertazapine
presynaptic a2-adrenoreceptor antagonist which increases central noradrenergic and serotonergic neurotransmission.
What are the side effects of Mirtazapine
Increased serum cholesetrol
Weight gain
What is Mirtazapine used to treat
Anxiety and Depressive symptoms
What are the contraindications for Mirtazapine
Diabetes
Cardiac disorders
Elderly
Hypotension
What is Lithium
Mood stabiliser
What is the use of lithium
Effective long term prophylaxis of both mania and depressive episodes
Can be prescribed alongside antipsychotic
What additional measures should be carried out when administering lithium
LFT
Pregnancy test
FBC
To treat BPD an antipsychotic can be prescribed alongside
Lithium
Sodium Valproate
What is the first line treatment for acute mania and mania prophylaxis
Carbamazepine (Tegretol)
What should be monitored when administering Carbamazepine
LFT, FBC and ECG
Name typical antipsychotics (4)
Fluphenazine
Haloperidol
Pimozide
Chloropromazine
What are the indications for typical antipsychotics
Schizophrenia, bipolar disorder (maintenance or acute agitation/mania) treatment resistant depression
What is the mechanism of typical antipsychotics
D2 dopamine receptor antagonists
What are the side effects of typical antipsychotics
Extrapyramida side effects, cardiotoxic and anticholinergic adverse effects
What are the first line treatments for schizophrenia
Olanzapine, Quetiapine
What is the management for treatment resistant schizophrenia
Clozapine
Name atypical antipsychotics
Olanzapine Quetiapine Clozapine Risperidone Buspirone
What is the mechanism for Olanzapine
Quetiapine
Clozapine
Risperidone
Serotonin-dopamine 2 antagonists
Susie has a nonpsychotic unipolar depression with no history of hypomania or mania. She has depressed mood, hyperphagia, psychomotor retardation and hypersomnolence. What agent would you like to use for her?
SSRI
Sertaline
Fluoxetine
Citalopram
Bob is a 55 year old diabetic man with mild HTN and painful diabetic neuropathy who has had previous depressive episodes and one suicide attempt. He meets criteria currently for a major depressive episode with some anxiety. He has been treated with paroxetine, sertraline and mirtazepine. His depression was improved slightly with each of these meds but never remitted. What would you like to treat him with?
Duloxetine (SNRI)
Act like TCAs but without side effects
Can help diabetic neuropathy
Name the side effects of Lithium
GI distress
Thyroid abnormalities
Leukocytosis
Polyuria/polydipsia
What are the side effects of Valproic acid
Thrombocytopenia and platelet dysfunction
What are the side effects of Carbamazepine
Rash
Aplastic anaemia and agranulocytosis
What is the most severe side effect of Lamotrigine
Toxic epidermal necrolysis and Stevens Johnson’s Syndrome
33 yo woman hospitalized with her first episode of mania. She has no previous history of a depressive episode. She has no drug or ETOH history and has no medical issues. What medication would you like to start?
Carbamazepine (Tegretol) + Lithium
27 yo male is admitted secondary to a manic episode. In reviewing his history you find he has 5 to 6 manic or depressive episodes a year. He has also struggled on and off with ETOH abuse. What medication would you like to start?
Valproic acid
21 yo AA male with symptoms consistent with schizophrenia is admitted because of profound psychotic sx. He is treatment naïve. You plan to start an antipsychotic- what baseline blood work would you obtain?
Fasting blood sugar
LFTs
Blood cholesterol
21 yo AA male with symptoms consistent with schizophrenia is admitted because of profound psychotic sx. He is treatment naïve. His cholesterol is elevated what treatment would you decide to give him
Risperidone, Ziprasidone or Aripiprazole are good choices.
What is a common side effect of Risperidone
Akathisia
What is Akathisia
Movement disorder characterised by a subjective feeling of inner restlessness accompanied by mental distress and an inability to sit still.
How are panic disorders, GAD and substance related disorders (withdraal, insomnias and parasominias) treated
Anxiolytics
Name 2 examples of Anxiolytics
Buspirone (Buspar)
Benzodiazapines
What are the pros of Buspirone
No sedation, 5HT1A agonist
What are the cons of Buspirone
Takes 2 weeks to notice results
No sedation effect to take the edge off
What are Benzodiazepines used for
Insomnia, parasomnias and anxiety disorders
ETOH withdrawal
