Mental Health Pharmacology Flashcards
What are the most commonly prescribed SSRIs for anxiety disorders?
Sertraline
Citalopram
Fluoxetine
Escitalopram
Fluvoxamine maleate
Paroxetine
What kinds of medications are used as anxiolytics?
GABA agonists (e.g. benzodiazapines)
Serotonin agonists (e.g. Busiprone)
Dopamine agonists (e.g. Amantadine)
Antidepressants (SSRIs, SNRIs, TCAs)
Antihistamines (e.g. Promethazine)
Beta-blockers (Low doses usually)
Anti-epileptic drugs (e.g. Pregablin)
Sleeping medication (e.g. Zopiclone)
What are the key pre-hospital considerations for anxiety medication?
Potential for increase in symptoms during first 14 days
after commencing prescription.
Key changes to HR and BP.
Overdose of benzodiazepines / betablockers.
What are the most common SSRIs and SNRIs?
SSRIs:
Fluoxitine
Certraline
Citalopram
SNRIs:
Duloxetine
Venlafaxine
What are some of the most common and most serious adverse side effects of SSRIs?
Common side effects:
Aggitation
GI disturbance (D&V or Constipation)
Dissiness
Blurred vision
Headaches
Sleeping problems
Serious side effects:
Cardiac arrythmias
Serotonin syndrome
Confusion
Haemophilic effects
Hallucinations
Seizures
Pyrexia
What is the mode of action of Tricyclic Antidepressants (TCAs)?
They inhibit serotonin and norepinephrine reuptake
What are the most common TCAs?
Amitriptyline
Clomipramine
Dosulepin
Imipramine
Lofepramine
Nortriptyline.
What are the possible adverse effects of TCAs?
Sedation
Cardiac arrhythmia
Urinary retention
Constipation
Increased likelihood of seizure in epileptic patients
What are alpha blockers and how do they treat depression?
What else are they used to treat?
Alpha blockers are alpha adrenoceptor antagonists (AAAs), Alpha-2 antagonists are licensed for treatment of major depressive disorder. Blocking alpha receptors increases the availibilty of norepiniphrine and serotonin whilst blovking some anxiety inducing serotonin and histamine recpetors.
A specific mode of action for depression is unknown.
In the UK they come under Noradrenaline and specific serotonergic antidepressants (NASSAs).
Some AAAs (Alpha-1 antagonists) are also used to treat hypertension and BPH due to their smooth muscle effects
What are some severe side effects of Mirtazapine?
Pancreatitis
Hyponatraemia
Liver problems and jaundice
Infection
What are some example of alpha-2 blockers?
Mirtazapine
Yohimbine
What are MAOIs and their mode of action?
Monoamine Oxidase Inhibitors (MAOIs) stop the enzyme monoamine oxidase from breaking down neurotransmitters norepinephrine, serotonin and dopamine in the brain
What are some examples of MAOIs?
Tranylcypromine
Phenelzine
Isocarboxazid
What are some of the possible serious side effects of MAOIs?
Serotonin syndrome
Seizures
Low blood pressure
Seizures
Pyrexia
How is lithium used in medicine?
As a mood stabiliser to treat mood and bipolar disorders
How does lithium work?
Mechanism is unkown but may involve reducing excitory neurotransmitters and increasing inhibatory neurotransmitters. It may protect neurons and help create more of them.
What are the possible serious side effects of lithium?
Lithium toxicity (theraputic dose is close to toxic dose)
-GI disturbance
-Dizziness/LoC/blurred vision
-Confusion
-Muscle problems (weakness, spasms etc.)
Anaphylaxis
What are some long term side effects of lithium?
Weight gain and T2DM
Kidney and liver problems
Hypothyroidism
What drugs are used as mood stabilisers?
Lithium
Anti-epileptics (e.g. Lamotrigine, Valproate)
Anti-pyschotics (e.g. Haloperidol, Olanzapine)
What are the first line medications for episodes of mania and dpression in BD?
Mania: Valproate
Depression: Lamotrigine
How do anti-pyschotic medications generally work and how are they classified?
Generally act on reducing dopamine
Classified as 1st generation (typical) - introduced in the 1950’s or 2nd generation (atypical) - introduced in the 1980’s
SGAs are generally preferred but FGAs may be a better choice for individuals who are not responding well to SGAs or have a history of movement disorders.
What are the main side effects of 1st gen anti-pyschotics?
Extra Pyramidal Symptoms (EPS) e.g. involuntary body movements and restlestness
What are the main side effects of 2nd gen anti-pyschotics?
Metabolic and immune symptoms:
Weight gain
Hyperlipidemia
Diabetes mellitus
QTc prolongation
Extrapyramidal side effects
Myocarditis
Agranulocytosis
Cataracts
Sexual adverse effects
