Pharma In Psychiatry Flashcards
Important issue in psychiatry pharma? What is %
Non-compliance, partial or complete
50% discontinue
Antidepressants used in what disorders?
Major depression Panic disorder OCD (SSRIs) Generalized anxiety disorder (venlafaxine) PTSD Narcolepsy
Neuropathic pain states (TCAs)
How long antidepressants take to work?
2-4 weeks
Any difference in response rates between members of same class? Or between classes?
No if you’re doing group studies.
Can make a difference in individuals.
What improves in first week for antidepressants?
Sleep disturbance
Side effects of antidepressants? Antimuscarinics/anticholinergic?
Dry mouth Blurred vision Constitution Urinary hesitancy Glaucoma Delirium Cog disturbance Cardiovascular effects
H1 receptor SFx? Antihistaminergic
Sedation
Weight gain
Drowsiness
Metabolic syndrome
SFx of a1/2 receptor, antiadrenergics
Hypotonia
Inhibition of noradrenaline reuptake SFx?
Tremor
Tachy cardia
Restless
SSRI SFx?
Gastro upset Nausea Less appetite Weight loss Headache Motor restlessness Serotonin syndrome Sexual dysfunction SIADH (older patients) Risk of bleeding (on warfarin)
When are SSRIs given?
During day to prevent sleep disturbance
How to treat SFx sexual dysfunction from SSRI drugs?
Adjust dose
Change drug
Important rare SFx of antidepressants ?
change in Electrical conduction of heart.
Esp. In ppl with preexisting heart condition
Withdrawal syndrome
What drug is Citalopram?
SSRIs
What drug is paroxetine?
SSRIs
What drug is sertraline?
SSRI
Which SSRI drug most likely to cause withdrawal?
Paroxetine
What drug is Prozac?
Fluoxetine
How many half-lives take to leave body?
7 half-lives
Which SSRI can be used in paeds?
Fluvoxamine
risk of SSRIs in adolescents?
Increased risk of suicide
3 SNRIs?
Venlafaxine
Duloxetine
Desvenlafaxine
What dose needed in SNRIs to get actual noradrenergic effects?
150-225mg that you get noradrenergic
SNRI has what SFx?
Withdrawal effect
Sweating - dose dependednt
Name an alpha - 2 antagonist.
Mirtazepine
indirect effects on: 5HT, noradrenaline,
H1, 5HT2C receptors - weight gain
Mirtazepine Sfx?
Very sedative
Mirtazepine used for what?
Anti-anxiety effect
Effects on which receptors cause weight gain?
H1
5TH2C
Mirtazepine risk on blood?
Blood dyscrasias
What is Agomelatine? How does it work?
Used for?
When given?
Multimodal agents
Melatonin agonist
5HT2C antagonist
Used for sleep disturbance
Given at night
What is reboxetine?
NA reuptake inhibitor
Not used. Much
What is vortioxetine?
5HT reuptake inhibitor
5HT1A agonist
5HT3 antagonist actions
Indications for anxiolytics?4 things
Generalized anxiety disorder
Phobias
Sleep disturbance
Anxiety from med disorder
4 classes of anxiolytics
Benzos
Buspirone
Antidepressants
Beta blockers
Main use of benzos? Chloride ion
Sleep disturbance
Panic attacks
Phobias
Main SFx prob with benzos?
bad Withdrawal
Addictive
Benzos NOT used in 3 things:
Simple phobias
PTSD
OCD
Most important benzos SFx?
- Behavioural disinhibition (rage, hostility, aggressiveness)
- Psychomotor impairment
- Cognitive impairment
- Abrupt Withdrawal phenomena (seizures)
- Rebound insomnia
Suffix for benzos?
- pam
- lam
Most used benzo hypnotic?
Temazepam
Flunitrazepam important how?
‘Date rape’ drug
Long half life
Short duration of action
What are zopiclone and zolpidem? How long to use?
Hypnotic agents for sedation
Short term use (Max 10 days)
Benzos work on what receptor?
GABA-A
Buspirone works on what?
Takes how long?
5HT-1A partial agonist
Take weeks to work
When is Busiprone used for?
PTSD
Social phobia
Important SFx with Buspirone?
Dysphoria on initiation
Not useful for benzo withdrawal
Indications for antipsychotics?
Schizophrenia (Psychotic symptoms only) Bipolar disorder manic psychotic Brief psychosis Depression (psychotic) Delirium
Methamphetamine overdose
When use haloperidol?
Delirium in ICU
Haloperidol risk?
Extrapyramidal symptoms
When use intramuscular injection for antipsychotics?
Non-compliance
When use atypical antipsychotics?
First line Positive Negative Relapse Restablisation Maintenance
3 most important drugs of atypical antipsychotics
Olanzipine
Risperidone
Then clozapine if failed
Clozapine serious SFX?
Agranular cytosis
Cardiomyopathy, myocarditis
Quetiapine in low dose used for what
Hypnotic agent.
Quetiapine indicated for
Bipolar Depression Schizo PTSD Generalized anxiety disorder Sleep disturbances
Notable SFx of atypical antipsychotics?
Weight gain (Olanzapine and clozapine)
T2DM
main Risperodone side effects?
Extrapyramidal SFx
Increase prolactin
QTc
2 classes for mood stabilizing for bipolar?
Lithium
Anticonvulsants
Name 4 anticonvulsants
Sodium valproate
Carbamazepine
Lamotrigine
Topiramate
Lithium needs two things before starting:
Need
thyroid/FBE, ECG, renal function
Baseline
Checked every 6 months
Why is renal function important in lithium?
Lithium not metabolized, only removed by kidneys
When take bloods for lithium?
12 hours after dose to get trough 0.4-0.8
Optimal dose in psychiatry?
Titration to dose response
Dose that gets them better
