Mental Health Drugs Flashcards
Amitriptyline, Lofepramine
TRICYCLIC ANTI-DEPRESSANTS: These prevent the re-uptake of serotonin and noradrenaline from the synapse hence increasing synaptic concentration. They also inhibit adrenergic and histamine receptors and this is the mechanism behind a lot of their adverse effects.
IND: 2nd line treatment for moderate to severe depression where SSRIs have been tried first
Neuropathic pain (not licensed for this use)
AE: They act on anti-muscarinics and hence cause dry mouth, constipation and urinary retention
There action on histamine and adrenergic receptors can also lead to profound hypotension and mild sedation as well as arrhythmias and ECG changes
Severe withdrawal can cause gastric upset and they should be AVOIDED in: the elderly, CVD, epilepsy of gastric pathology
USE: They are not often used because of their numerous long term side effects.
Citalopram, Fluoxetine, Sertraline, Escitalopram
SELECTIVE SEROTONIN REUPTAKE INHIBITORS. SSRIs work by stopping serotonin (5-HT) from being reabsorbed into the pre-synaptic neurone hence increasing the cleft concentration of 5-HT and helping to relieve symptoms of low mood, anxiety and panic.
IND: 1st line treatment for moderate-severe depression
Also useful in panic disorders and OCD
AE: they can cause GI upset and weight change
They can cause long QT syndrome
Hypersensitivity reactions
Lowers the seizure threshold
Can cause hyponatraemia which can lead to dizziness, drowsiness and confusion
DOSE: 15mg sertaline 20mg citalopram (start low and then build up) - tell people that they will NOT work straight away and it can take 4-6 weeks before people start to notice a difference
Diazepam, Temazepam, Lorazepam, Midazolan, Chlordiazepoxide
BENZODIAZEPINES: These work by stimulating the GABA receptor on neurones. Stimulation of this receptor opens chloride channel - chloride moves in and makes the potential of the neurone more negative hence leaving it more resistant to depolarisation - DEPRESSANT EFFECT (just the same as alcohol)
IND: very good in seizures and severe anxiety as it decreases the level of disordered electrical activity
Also good as a sedative
Used in alcohol withdrawal
Can also be used in the SHORT term as treatment of severe anxiety and severe, disabling insomnia
AE: VERY ADDICTIVE with withdrawal very similar to alcohol withdrawal
Overdose can lead to confusion and coma. However, it does not have a lot go cardiopulmonary depressive effects when used in excess (unlike opioids)
Try and avoid in the ELDERLY (more prone to AEs) and also in renal and liver impairment. This can be difficult when treating alcohol withdrawal because pts. often have liver damage - in this case LORAZEPAM is the beat choice because it is the easiest on the liver
DOSE: Nearly always IV but if treating seizures this might not be possible and so give PR (diazepam or lorazepam)
For sedation midazolan is best. For alcohol withdrawal use Lorazepam or Chlordiazepoxide
Rivastigmine, Donepezil
ACETYLCHOLINESTERASE INHIBITORS: These work by inhibiting the enzyme with breaks down ACh and prepares it to be reabsorbed into the presynaptic neurone. Increasing ACh synaptic concentration and duration of action.
IND: Alzheimer’s and Parkinson’s disease (most common indication), Myasthenia gravis and Glaucoma
AE: GI Upset and PARASYMPATHETIC EFFECTS: bradycardia, hypotension, bronchoconstriction and anorexia.
Urinary outflow obstruction and RETENTION
Peptic ulcers
DOSE: Start low (1.5mg) and then titrate up
