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PHRM2012 > Mental Health > Flashcards

Mental Health Flashcards

1
Q

Name the 5 Ds involved in diagnostic approaches

A 
Deviation (from normal behaviours) 
Dysfunction (inability to complete normal tasks)
Distress 
Danger 
Duration (long duration of symptoms)
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2
Q

What are the 4 Ps in the aetiology (cause) of mental illnesses?

A

Predisposition
Precipitating factors
Perpetuating behaviours
Protective (do they have support / protection)

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3
Q

Which two manuals are used to diagnose mental illnesses?

A

DSM 5

ICD 11 - chapter 6

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4
Q

Compare prevalence and incidence

A

Prevalence = proportion of people who have a condition at a particular time

Incidence = proportion or rate of people who develop a condition at a particular time

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5
Q

How can pharmacotherapy aid non-pharmacological therapy?

A

Drugs may calm patients down which opens them up more to the psychotherapy and increases the efficacy of other treatment methods

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6
Q

What does RIMA stand for

A

Reversible inhibitor of mono-amines

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7
Q

Imipramine and clomipramine are examples of…

A

Tricyclic antidepressants

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8
Q

Amitriptyline is a…

A

TCA

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9
Q

Mirtazapine belongs to which class of antidepressants

A

5-HT inhibitor

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10
Q

Fluoxetine, setraline and citalopram are examples of which antidepressant class?

A

SSRI

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11
Q

Name 2 SNRIs

A

Venlafaxine and nefazodone

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12
Q

Symptoms of depression can be categorised into which 3 categories?

A

Activity
Cognition
Emotion

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13
Q

How many symptoms are required for diagnosis? What duration of the symptoms is required?

A

Need to display at least 5 symptoms for at least 2 weeks

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14
Q

Define anhedonia

A

Inability to feel pleasure in normally pleasurable activities

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15
Q

In addition to blocking the reuptake of NA and 5-HT, which other receptor do TCAs act on?

A

M1 and H1

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16
Q

How does the vomiting reflex get suppressed in TCA overdose

A

Increase in 5-HT3 increases nausea and vomiting, but antagonism of M1 and H1 cause anti-nausea and in overdose, you cannot vomit

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17
Q

TCAs act on H1 receptors which causes what ADRs?

A

Sedation and weight gain

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18
Q

What ADR arises from TCAs acting on alpha1 adrenoreceptors?

A

Postural hypotension

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19
Q

TCAs act on M1 receptors. What ADRs does this cause

A

Dry mouth, urinary retention, constipation, pupil dilation / blurred vision, etc
Like the SNS

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20
Q

TCAs block sodium channels, which causes what side effects?

A

Arrhythmia

Seizures

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21
Q

Which TCA is the most sedating?

A

Amitryptiline

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22
Q

Which PK characteristic would increase the likelihood of a drug having withdrawal symptoms?

A

Short half life

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23
Q

Bruxism, a side effect of SSRIs, is what?

A

Clenching jaw / grinding teeth

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24
Q

Name 3 common side effects of SSRIs.

A
  • sexual dysfunction
  • irritability, agitation, anxiety
  • disturbed sleep (either insomnia or too much sleep)
  • serotonin toxicity
  • nausea
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25
Q

What is the indication for use of an SNRI

A

It is a second line treatment to depression when multiple SSRIs have failed
E.g. venlafaxine, duoloxetine

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26
Q

SNRIs have a high risk of which ADR?

A

Arrhythmias + high BP

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27
Q

Duloxetine and venlafaxine are examples of which class of drugs?

A

SNRIs

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28
Q

Roboxetine belongs to which class of medications?

A

NRI - noradrenaline reuptake inhibitor

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29
Q

If a patient starts on an SSRI and has no response after 2 weeks, what is the next step? If no response after that, what next?

A

First increase the dose.

If still no response, try another SSRI

30
Q

If a patient has tried 2 SSRIs and had no response, what would the next step be?

A

Change class of medication (e.g. SNRI)

31
Q

What are some reasons that patients might stop taking their antidepressants?

A
  • feeling better
  • not feeling better
  • side effects
  • social stigma surrounding antidepressants
32
Q

Some of the first symptoms a patient starting on SSRIs will see are…

A

Headache, GI upset, dizziness, bruxism

33
Q

Some delayed side effects of SSRIs that will occur several weeks after starting treatment are…

A

Weight gain

Sexual dysfunction

34
Q

List some counselling points on antidepressant withdrawal

A
  • the symptoms are only transient
  • it is not the reappearance of the depression
  • it is not the same as substance dependence
35
Q

What are some symptoms of antidepressant withdrawal syndrome?

A

Sleep disturbances, GI upset, flu-like symptoms, etc

36
Q

What is agoraphobia

A

Fear and avoidance of places and situations that may cause panic, helplessness or embarrassment. Involves anxiety / panic attacks

37
Q

What type of neurotransmitter is GABA

A

Inhibitory

38
Q

Which neurotransmitter is partly responsible for panic attacks? Where does it bind to

A

CCK. Binds to a receptor in the basolateral amygdala

39
Q

What are some of the physical symptoms of anxiety?

A

Palpitations, sweating, trembling, dry mouth, shortness of breath, etc

40
Q

Which medication class helps with the physical symptoms of anxiety? List an example.

A

Beta blockers.

E.g. propranolol

41
Q

How long do symptoms need to be present before a GAD diagnosis is made?

A

Needs excessive anxiety most days for at least 6 months

42
Q

Explain how activation of the GABA-A receptor alters a cells’ polarisation.

A

GABA-A receptor in an ion channel. It requires 2 GABA molecules to be bound in order for the central pore to open (through a conformational change). Once open, there is an influx of chloride ions, which hyperpolarises the cell making an AP less likely.

43
Q

What allosteric binding sites are present on the GABA-A receptor?

A

Benzodiazepines
Barbiturates
Ethanol

44
Q

What differentiates clomipramine from other TCAs?

A

It has a more potent 5-HT reuptake ability

45
Q

What is different about the dosing of SSRIs for OCD compared to depression?

A

Much higher. 60mg per day compared to 20-40

46
Q

Adverse effects of TCAs are due to activation of which receptors?

A

H1 -> drowsiness

47
Q

Is mirtazapine first line treatment for anxiety?

A

No. It is a TCA, therefore more second line

48
Q

Lorazepam, temazepam and oxazepam are some of the —- acting benzodiazepines.

A

Shortest

49
Q

Which are the longest acting benzodiazepines?

A

Diazepam and nitrazepam

50
Q

Why is benzodiazepine use in the elderly so concerning?

A

Extended time in the system due to reduced metabolism. Could lead to confusion, delirium, and falls

51
Q

Explain the ideal dosage regimen for benzodiazepines

A

No more than 4 weeks… 2 times per week only

52
Q

How can benzodiazepine sensitisation occur and what might cause this

A

Sensitisation occurs with repeated use of benzodiazepines (I.e. the patient has withdrawn from the drugs several times). It means the withdrawal process gets worse with repeated use.

53
Q

What class of drugs does nefazodone belong to?

A

SNRI

54
Q

What class of drugs does venlafaxine belong to?

A

SNRI

55
Q

List treatment options for obstructive sleep apnoea (OSA)

A

Weight loss, reduced alcohol, CPAP, modafinil

56
Q

Define narcolepsy

A

Sudden onset of sleep or EDS (excessive daytime tiredness)

57
Q

Name the 3 main sleep promoting neurotransmitters

A
  • adenosine
  • GABA
  • ACh
58
Q

Name medications that promote wakefulness

A

Caffeine
Modafinil
Amphetamines
Etc

59
Q

Describe the main role of pharmacists in sleep disorders

A

Counselling on good sleep hygiene. Daily routine, reduce screen time, exercise, dark room, etc

60
Q

What are some of the risks of benzodiazepine use

A

Risk of dependence and abuse, tolerance, accumulation, difficult to withdraw from

61
Q

Explain benzodiazepine sensitisation

A

Repeated BDZ use (and therefore, repeated withdrawal) can increase the severity of the withdrawal symptoms

62
Q

What is the best benzodiazepine? (Shortest acting without any active metabolites)

A

Oxazepam

63
Q

Ideal benzodiazepine duration of use?

A

4 weeks, only twice a week

64
Q

Would suvorexant be ok to prescribe in a patient with poor liver function?

A

No. Has a long half life, and therefore has a risk of accumulation (risk is increased in liver dysfunction)

65
Q

Describe orexin action

A

Wake promoting neurotransmitter

66
Q

MOA of suvorexant

A

Orexin antagonist

67
Q

Compare organic and functional psychotic disorders

A

Organic is where there is a clear cause and functional is where there is no cause

68
Q

Second generation antipsychotics have a lower risk of which side effect compared to first generation?

A

Extrapyrimidal side effects

69
Q

Define adjuvant

A

A drug, or other substance, that is used to increase the efficacy or potency of certain drugs

70
Q

What determines use of a SGA compared to FGA?

A

They have similar efficacy but SGAs tend to have less side effects

71
Q

Which drug in bipolar requires regular monitoring?

A

Lithium

PHRM2012 (6 decks)

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