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Yr3 Pharmacology > Mental health drugs > Flashcards

Mental health drugs Flashcards

1
Q

What kind of drug is amitriptyline?

A

Tricyclic antidepressant

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2
Q

How does amitriptyline work?

A

Inhibits neuronal uptake of seratonin and noradrenaline from synaptic cleft (leaving more available for neurotransmission)
Block a wide array of receptors (muscarinic, histamine, adrenergic, dopamine etc) - accounts for lots of side effects

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3
Q

Name a licenced and unlicensed indication of amitriptyline

A

Licenced: 2nd line moderate to severe depression when ssri’s ineffective
Unlicenced: neuropathic pain

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4
Q

When is amitriptyline contraindicated?

A

Those at risk of adverse effects: elderly, CVD, constipation, prostatic hypertrophy,

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5
Q

What happens when tricyclic antidepressants and monoamine oxidase inhibitors are prescribed together?

A

Both drugs increase seratonin and noradrenaline levels in the synapse: hypertension: seratonin syndrome

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6
Q

List amitriptyline’s side effects (lots!)

A

Block muscarinic receptors: dry mouth, constipation, urinary retension, blurred vision
Block alpha1 receptors: sedation and hypotension
Cardiac arrhythmias, ECG changes
Convulsions, hallucinations, mania
Overdose: Severe hypotension, arrhythmias, convulsions, coma, respiratory failure, death

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7
Q

How do SSRIs work?

A

Inhibit neuronal reuptake of seratonin from synaptic cleft, so more for transmission (no noradrenaline unlike tricyclic)

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8
Q

When are SSRIs indicated? 3

A

moderate to severe depression first line
panic disorder
OCD

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9
Q

When are SSRIs contraindicated

A

In risk of adverse effects eg peptic ulcer disease and epilepsy
Hepatic impairment

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10
Q

What do SSRIs interact with?

A

MAOIs (seratonin in cleft too)seratonin syndrome
NSAIDs, peptic ulcers or aspirin: need gastroprotection
Drugs that prolong QT interval eg antipsychotics)

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11
Q

SSRI side effects:

A

GI upset, appetite and weigh disturbances
Hypersensitivity
Lower seizure threshold
Seratonin syndrome: autonomic hypersensitivity, altered mental state, neuromuscular excitation

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12
Q

How are SSRIs eliminated?

A

Metabolised in liver, excreted by kidneys

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13
Q

What would you tell someone starting on SSRI?

A

Will take a few weeks to get going
Discuss non medication options
Continue for 6months+ after get better
Dont stop suddenly: GI upset

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14
Q

What suffix is used for benzodiazepines?

A

-pam, eg Diazepam

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15
Q

How do benzodiazepines work?

A

Target GABA receptors, enhancing and facilitating GABA (the main inhibitory neurotransmitter in the brain) to bind to it.

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16
Q

Indications for Benzos?

A

First line for seizures and status epilepticus
First line alcohol withdrawal
Sedation for proceidures
Short term extreme anxiety and insomnia

17
Q

Contraindications for benzos?

A

Respiratory impairment
Neuromuscular disease
Liver failure (use lorazepam in alcohol withdrawal, least hepatic effect)

18
Q

Benzo interactions:

A

Additive to other sedating drugs eg Alcohol, opioids

Cytochrome p450 inducers may increase its effects

19
Q

Side effects of Benzos

A

Drowsiness, sedation, coma

Dependance

20
Q

How are benzos metabolised and eliminated?

A

cytochrome p450 in liver

Urine

21
Q

Info for someone starting them:

A

Dangerous!
Dependance!
Don’t drive after taking

22
Q

Name a acetylcholinesterase inhibitor

A

Donepezil

23
Q

How do acetylcholinesterase inhibitors work?

A

stop acetylcholinesterase breaking down acetylcholine, so more acetylcholine available in synapse

24
Q

When are aceytlcholinesterase inhibitors indicated?

A

Alzheimers

25
Q

Name some side effects of donpezil

A 
Diarrhoea
Muscle cramps
fatigue
nausea and vomiting
Insomnia
26
Q

With what is L-dopa always prescribed?

A

Peripheral dopa decarboxylase inhibitor eg Carbidopa

So its not converted into dopamine outside the brain

27
Q

In parkinsons, where is there a dopamine deficiency?

A

Nigrostriatal pathway, which links substantia nigra in the midbrain to the corpus striatum in the basal ganglia

28
Q

When should L-dopa be used in caution?

A

Caution in elderly/psych: hallucinations and confusion

Caution in cardiac patients, risk of hypotension

29
Q

Name some side effects of L-dopa

A

Nausea, drowsiness, confusion, hallucinations and hypotension

30
Q

Why is it essential that L-dopa is taken at a specific time each day?

A

Symptoms worsen at the end of the dosage interval, cant be a long time after the drug is due. Called the “on-off” effect

31
Q

What kind of drug is carbemazepine? How does it work?

A

Anti convulsant
Not completely understood, but it inhibits neuronal sodium channels, stabilising the resting membrane potentials and reducing neuronal exciteability

32
Q

What is the first choice treatment for focal seizures?

A

Carbemazepine

33
Q

Apart from focal seizures, what what is carbemazepine indicated?

A

Trigeminal neuralgia

Bipolar, when patients resistant to other meds

34
Q

When is carbemazepine contraindicated? What happens if taken in pregnancy?

A

Antiepileptic hypersensitivity syndrome
Renal, liver and cardiac disease: can be toxic
Pregnancy: Neural tube defects, cardiac and urinary tract deformities and cleft lip

35
Q

Is carbemazepine a cytochrome P450 inducer, inhibitor or none of these?

A

Inducer! So it reduces the efficacy of drugs metabolised by it eg warfarin.

36
Q

Name two kinds of drug which reduce the efficacy of carbemazepine

A

Cytochrome p450 inhibitors (metabolised by cytochrome p450)

Drugs which lower the seizure threshold eg SSRIs, tricyclic antidepressants, tramadol

37
Q

Name some side effects of carbemazepine:

A

GI upset
Dizziness
Ataxia
Hypersensitivity in 10% Mild macropapular skin rash
Antiepileptic hypersensitivity in 1 in5000
oedema and hyponatraemia

Yr3 Pharmacology (6 decks)

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