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3rd Year Drugs > Mental Health Drugs > Flashcards

Mental Health Drugs Flashcards

1
Q

Name a acetylcholinesterase inhibitor

A

Donepezil (aricept), calatamine, rivastagmine

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2
Q

Indications of acetylcholinesterase inhibitors

A

1) Alzheimer’s disease

Slows down the progression but benefit is often small

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3
Q

Mechanism of acetylcholinesterase inhibitor

A

Reversible acetylcholinesterase inhibitor

The increased acetylchline at synapses which helps due to a loss chonergic system in alzheimers disease

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4
Q

Adverse effects of acetylcholinesterase inhibitosrs

A

Nausea, vomiting and diarrhoea
Fatigue
Dizziness/syncope
Urinary Problems

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5
Q

What happens in a cholinergic crisis

A 
Severe nausea, vomiting
Abdo pain
Sweating
Bradycardia
Hypotension
Collapse
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6
Q

Caution of acetylcholinesterase inhibitors in

A 
People with heart disaese
Cardiac conduction problems
COPD
Asthma
Peptic Ulcer Disease
Renal Impairment
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7
Q

Interactinos of acetylcholinesterase inhibitors

A

Theoreteically would interact with CP450 enzymes altering other drugs metabolism but no clinical evidence

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8
Q

Name tricyclic antidepressants

A

Amitryptiline, lofepramine

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9
Q

Uses of tricyclic antidepressants

A

1) moderate/severe depression - 2nd line

2) Neuropathic pain –> but at much lower dose e.g. sciatica

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10
Q

Action of tricyclic antidepressants

A

inhibit the neuronal reuptake of serotonin and noradrenaline from the synaptic cleft

This increases their availbalility for neurotransmittion

Also block a wide range of receptors –> histamine, muscarinic, adrenergic, dopamine –> which accounts for the extensive side effecst

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11
Q

Adverse effects of tricyclic antidepressants

A

Blockage of antimuscarininc receptors: dry mouth, constipation, urinary retention, blurred vision

Blockade of histamine and adrenergic recpetors: sedatino and hypotension

Cardiac adverse effects –> arrythmias and ECG changes

Neurological effects: convulsions, hallucitations, mania

Blockade of dopamine receptors: breast changes and sexual dysfunction

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12
Q

What happens if you block antimuscarininc receptors

A

dry mouth, constipation, urinary retention, blurred vision

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13
Q

What happens if you block histamine and adrenergic receptors

A

Sedation and hypotension

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14
Q

What happens in overdose of tricyclic antidepressants

A

Extremely dangerous

Lower bp and arrythmias

Coma and repiratory failure –> may be fatal!!!

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15
Q

What happens if you suddenly withdraw tricyclic antidepressants

A

GI Upset, neurological, influenza-like symptoms and sleep problems

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16
Q

Warnings of tricyclic antidepressants

A

Caution with people at high risk of adverse effects e.g. elderly, CV disease and epiplepsy

17
Q

Interactions of tricyclic antidepressatns

A

DO NOT GIVE WITH MONOAMINE OXIDASE INHIBITORS –> both increase noradrenaline and serotonin at the synapse –. together thye can precipitate hypertension and hyperthermia or SEROTNONIN SYNDROME

TCA can also increase antimuscuranic, sedative or hypotensive effects of other drugs

18
Q

What line do we usually use TCA?

A

They are usually 2nd line

This is due to a similar efficacy to other antidepressants but worse side effects and more dangerous in overdose

19
Q

How should we stop doses of TCA

A

Reduce dose over a 4 week period to avoid withdrawal symptoms

20
Q

Name some SSRIs

A

Citalopram
Fluoxetine
Sertraline
Escitalopram

21
Q

Uses of SSRIS

A

1) Depression –> first line for moderate/severe
2) Panic disroder
3) OCD

22
Q

Action of SSRIS

A

Preferentially inhibit serotonin reuptake from the synaptic cleft –> increased availability for neurotransmission –> improves mood and physical symptoms

23
Q

How do SSRIs differ from tricyclcis

A

They dont inhibit noradrenaline reuptake and cause less blockade of other receptors

Similar efficacy to TCAs but SSRIs are preferred as they have less side effects

24
Q

Advsere effects of SSRIs

A

Common: GI disturbance, appetite and weight disturbance and hypersensitivity reactions

Hyponatraemia –> mportant in elderly as may cause confusino and decreased consciousenss

Suicidal thoughts & Behaviours

Lower the threshold and some (citaloprom) prolong the QT interval –> predisposes you to arrhythmias

Increased risk of bleeding

Serotonin syndrome

25
Q

What is serotonin syndrome

A

Triad of autonomic hyperatctivity, altered mental state and neuromuscular excitation

Usually responds to treatment withdrawal and supportive therapy

26
Q

What happens if you suddenly withdraw SSRIs

A

GI Upset
Neurological & flu-like sympomts
Sleep disturbance

27
Q

Warnings of using SSRIs

A

Caution if high risk of adverse effects e.g. epilepsy and peptic ulcer disease

Caution in young people –> poor efficacy and increase suicidal thoughts

Hepatic impairment –> metabolised by liver so may need dose reduction

28
Q

Interactions of SSRIA

A

1) MAO –> both increase serotonin –> can cause serotnonin syndrome
2) Avoid in drugs that prolong the QT interval e.g. antipsychotics
3) Give gastroprotection if also taking aspirin/NSAID –> as increased risk of GI bleed
4) Anticoagulants –> both increase thebleeding risk

29
Q

Name benzodiazepines

A 
Diazepam
Midazolam (short-acting)
Temazepam (intermiediate)
Lorazepam (long-acting)
Chlordiazepoxide
30
Q

Uses of benzodiazepines

A

1) Seizures and status epilepticus –> 1st line - usually lorazepam
2) Alcohol withdrawal reactions - 1st line, usually chlordiazepoxide
3) Sedation for interventional producers –> use short-acting if GA is unnecessary or undesirable
4) Anxiety or insomina –> ONLY USE SHORT TERM TEMAZEPAM

31
Q

How do benzodiazepines work?

A

Facilitate and enhance binding of GABA to the GABAa receptor

Widespread depressent on neurotransmission –> decrease anxiety, sleepiness, sedationa nd anticonvulsant effects

32
Q

What is GABA

A

GABAa is a chloride channel that opens when GABA binds
GABA is the main inhibitory neurotransmitter in the brain
Chloride ions flow into the cell to make it more resistent to depolarisation

33
Q

How does alcohol affect GABA

A

Alcohol also acts on GABAa receptor and in chronic excessive use the patient becomes tolerant to its presence
Therefore abrupt cessation provokes an excitatory state of alcohol withdrawal –> benzodiazepiens can be used to treat this and then reduce their dose in a gradual and more controlled way!

34
Q

Adverse effects of benodiazpeines

A

Dose depndent –> drowsiness, sedation and coma
Overdose –> loss of airway refleces can lead to airway obstruction and death

DEPENDENCE –> if used weeks, then get withdrawal if abrupt cessation

35
Q

Warnings of benzodiazepiens

A

a) ELDERLY –> more susceptibly to effects so give a lower dose
b) Avoid in patients with significant respiratory problems or neuromuscuar disease e.g. myasthenia gravis
c) Avoid if liver failure –> may precipitate hepatic encephalopathy, if their use is essential (e.g. alcohol withdrawal) then use lorazepam as it relies less on the liver for its elimination

36
Q

Interactions of benzodiazepines

A

1) Additive effect to other sedative drugs e.g. alcohol and opioids
2) CP450 inhibitor (amiodarone, diltiazem, macrolides, fluconazole, protease inhibitors)
As it dependes on CP450 enzymes for elimination, hence inhibitors increase their effect

3rd Year Drugs (10 decks)

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