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PSYCHOPHARMACOLOGY MRCPSYCH PART A > Mood Disordered > Flashcards

Mood Disordered Flashcards

1
Q

Describe the mechanism of action of Mirtazipine

A

Noradrenaline and serotonin specific antidepressant
Mianserin another example
Doesnt effect serotonin reuptake

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2
Q

Give example of SNRI

A

Venlafaxine
Duloxetine

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3
Q

Describe the mechanism of action of Reboxetine

A

NaRI

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4
Q

Describe the mechanism of action of Rivastigmine

A

reversible inhibition of cholinesterase

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5
Q

Describe the mechanism of action of Carbamezipine and Phenytoin

A

Stabilises Na channels

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6
Q

Describe the mechanism of action of Olanzapine

A

Dopamine and 5HT2 antagonism

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7
Q

Describe the mechanism of action of Aripiprazole

A

Partial agonist at 5HT1A and D2, and 5HT2A antagonist

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8
Q

Describe the mechanism of action of Methylphenidate

A

Inhibiting DA and NA reuptake

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9
Q

Describe the mechanism of action of Lamotrigine

A

NMDA receptor modulation, stabilises Na channels and blocks calcium channels, some GABA modulation

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10
Q

What are EPSEs and what is their MoA?

A

SE antipsychotics drug but they can also occur when antipsychotics are discontinued (withdrawal dystonia)

antagonism of dopaminergic D2 receptors in the basal ganglia

basal ganglia are referred to as extra pyramidal as they are separate from the axons of the pyramidal cells that connect the cortex to the spinal cord hence ‘extrapyramidal side effects’

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11
Q

What symptoms do EPSEs include and descibe four main types?

A

Dystonias - prolonged and unintentional muscular contractions of voluntary or involuntary muscles

Parkinsonism - characterized by the triad of tremor, rigidity (lead pipe or cogwheel), and bradykinesia

Akathisia - a subjective sense of restlessness, along with such objective evidence of restlessness as pacing or rocking

Tardive dyskinesia

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12
Q

What are the five main types of dystonias?

A

Torticollis - cervical muscles spasms, resulting in a twisted posturing of the neck.

Trismus (lock jaw) - contraction of the jaw musculature.

Opisthotonus - arched posturing of the head, trunk, and extremities.

Laryngeal dystonia - difficulty in breathing

Oculogyric crises - involuntary contraction of one or more of the extraocular muscles, which may result in a fixed gaze with diplopia

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13
Q

Which antidepressant lower incidence of sexual dysfunction

A

Mirtazipine

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14
Q

Blood samples for lithium should be taken XXXXX post dose

A

12 hours

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15
Q

Blood samples for lithium should be taken XXXXX post dose

A

12 hours

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16
Q

Lithium contraindications

A

Addison’s disease
Brugada syndrome
Cardiac disease associated with rhythm disorders
Clinically significant renal impairment
Untreated or untreatable hypothyroidism
Low sodium levels, including people that are dehydrated and those on low-sodium diets

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17
Q

Describe lithium tremor

A

Generally symmetric and indistinguishable from essential or physiologic tremor
Primarily occurs in the hands
Most apparent with intentional posture, such as writing or holding a coffee cup
Typically presents early in treatment but may emerge at any time
More common with older age (presumably due to the additive effects of age-related essential tremor)
Higher lithium levels correlate with greater risk of tremor
Beta-blockers may help (often propranolol)

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18
Q

second generation tricyclics (secondary amines) mechanism of side effects

A

side effects are primarily related to their noradrenergic activity and may include:
Dry mouth
Constipation
Urinary retention
Tachycardia
Mild sedation

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19
Q

second generation tricyclics (secondary amines) mechanism

A

These primarily inhibit the reuptake of noradrenaline, which increases the levels of this neurotransmitter in the synaptic cleft and enhances noradrenergic neurotransmission. This mechanism is associated with improved mood and analgesic effects, particularly useful in treating neuropathic pain.

20
Q

first generation tricyclics (tertiary amines) mechanism

A

These inhibit the reuptake of both serotonin and noradrenaline, which increases the levels of these neurotransmitters in the synaptic cleft and enhances serotonergic and noradrenergic neurotransmission. This dual action makes them effective in treating depression but also contributes to a broader side effect profile.

21
Q

first generation tricyclics (tertiary amines) side effects?

A

Sedation (due to antihistaminic activity)
Orthostatic hypotension (due to alpha-adrenergic blockade)
Anticholinergic effects such as dry mouth, blurred vision, constipation, and urinary retention
Weight gain (due to antihistaminic and anticholinergic effects)
Cardiotoxicity, particularly in overdose

22
Q

Common early adverse effects of MAOIs include

A

orthostatic hypotension, daytime drowsiness, insomnia, and nausea; later prevalent effects encompass weight gain, muscle pain, myoclonus, paraesthesia, and sexual dysfunction.

23
Q

Pharmacodynamic interactions with MAOIs can lead to two main issues:

A

Serotonin syndrome (primarily due to SSRIs)
Raised blood pressure (induced by indirectly acting sympathomimetic amine releasers, such as pseudoephedrine and phenylephrine)

24
Q

What is MAOI Cheese Reaction

A

Monoamine oxidase, located in the gastrointestinal tract, neutralises tyramine. If drugs inhibit the breakdown of ingested tyramine, it gets absorbed, displacing norepinephrine from sympathetic nerve endings and epinephrine from the adrenal glands

When large amounts of pressor amines are released, symptoms such as severe occipital or temporal headaches, sweating, pupil dilation, neck stiffness, palpitations, and elevated blood pressure might arise

Thus need specific dietary restrictions Inc cheese, fermented sausage, draught beer

25
Q

MAOIs approved by the FDA include

A

isocarboxazid, phenelzine, selegiline, and tranylcypromine

26
Q

A patient is referred with depression and is keen to start medication. You discover that they have diabetes. Which medications?

A

SSRIs are first line (most data support fluoxetine)
SNRIs are likely to be safe but there is less data
TCAs and MAOIs should be avoided

27
Q

What is the mechanism of Mirtazapine?

A

Noradrenaline and serotonin specific antidepressant (NaSSa)
5HT2A and 5HT2C antagonist, 5HT3 antagonist, H1 antagonist, alpha 1 and alpha 2 antagonist, moderate muscarinic antagonist. Presynaptic alpha 2 antagonist (which stimulates the release of NA and 5HT.

28
Q

What is the mechanism of Venlafaxine ?

A

Serotonin and noradrenaline reuptake inhibitor (SNRI)

29
Q

What is the mechanism of Duloxetine?

A

Serotonin and noradrenaline reuptake inhibitor (SNRI), also weak inhibitor of dopamine reuptake.

30
Q

What is the mechanism of Reboxetine ?

A

Noradrenaline reuptake inhibitor (NaRI)

31
Q

What is the mechanism of st johns wort?

A

Weak MAOI and weak SNRI (also considered by some to be a weak SSRI)

32
Q

What is the mechanism of Trazodone?

A

SARI (Serotonin antagonist and reuptake inhibitor). Blocks SERT (the serotonin reuptake pump) and also antagonist at 5HT2A and 5HT2C. SERT blockage at 5HT1A is thought to be responsible for the antidepressant effect of SSRI but they also block SERT at 5HT2A and 5HT2C (thought to cause the side effects). So trazadone has simultaneous effect of blocking SERT and also antagonising those receptors responsible for the SSRI side-effects such as insomnia, sexual dysfunction, and anxiety

33
Q

What is the mechanism of Moclobemide

A

Reversible inhibitor of monoamine oxidase type A

34
Q

What is the mechanism of Agomelatine

A

Melatonergic agonist (MT1 and MT2 receptors) and 5-HT2C antagonist

35
Q

What is the mechanism of Bupropion (Zyban)

A

Norepinephrine-dopamine reuptake inhibitor (NDRI), and nicotinic acetylcholine receptor antagonist

36
Q

Mirtazapine is primarily metabolised by

A

CYP1A2, CYP2D6, and CYP3A4 enzymes

37
Q

Grapefruit juice specifically inhibits

A

CYP 3A4

38
Q

Lithium is primarily excreted

A

unchanged in urine and its metabolism does not involve the cytochrome P450 system

39
Q

Lithium is primarily excreted

A

unchanged in urine and its metabolism does not involve the cytochrome P450 system

40
Q

Common side-effects of TCAs include

A

drowsiness
dry mouth
blurred vision
constipation
urinary retention

41
Q

Which antidote depression is indicated in nocturnal enuresis in children

A

Amitriptyline, Imipramine, Nortriptyline

42
Q

Which anthed preston is indicated in phobic and obsessional states

A

Clomipramine

43
Q

Which anti depression is indicated as an ad junk in treatment cataplexy associated with narcolepsy

A

Clomipramine

44
Q

Which ante depressant is indicated in panic disorder and a gopher phobia

A

Citalopram, Escitalopram, Sertraline, Paroxetine, Venlafaxine

45
Q

Which anti depressions are indicated in social anxiety

A

Escitalopram, Paroxetine, Sertraline, Moclobemide, Venlafaxine

46
Q

Which antidepressants are indicated in bulimia .

A

Flu oxine

47
Q

Which anti depressant is indicated in ptsd sd

A

PSYCHOPHARMACOLOGY MRCPSYCH PART A (7 decks)

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