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Jason's MD3 Psychiatry Rot > Pharma In Psychiatry > Flashcards

Pharma In Psychiatry Flashcards

1
Q

Important issue in psychiatry pharma? What is %

A

Non-compliance, partial or complete

50% discontinue

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2
Q

Antidepressants used in what disorders?

A 
Major depression
Panic disorder
OCD (SSRIs)
Generalized anxiety disorder (venlafaxine)
PTSD
Narcolepsy

Neuropathic pain states (TCAs)

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3
Q

How long antidepressants take to work?

A

2-4 weeks

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4
Q

Any difference in response rates between members of same class? Or between classes?

A

No if you’re doing group studies.

Can make a difference in individuals.

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5
Q

What improves in first week for antidepressants?

A

Sleep disturbance

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6
Q

Side effects of antidepressants? Antimuscarinics/anticholinergic?

A 
Dry mouth
Blurred vision
Constitution
Urinary hesitancy
Glaucoma
Delirium
Cog disturbance
Cardiovascular effects
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7
Q

H1 receptor SFx? Antihistaminergic

A

Sedation
Weight gain
Drowsiness
Metabolic syndrome

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8
Q

SFx of a1/2 receptor, antiadrenergics

A

Hypotonia

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9
Q

Inhibition of noradrenaline reuptake SFx?

A

Tremor
Tachy cardia
Restless

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10
Q

SSRI SFx?

A 
Gastro upset
Nausea
Less appetite
Weight loss
Headache
Motor restlessness
Serotonin syndrome 
Sexual dysfunction
SIADH (older patients)
Risk of bleeding (on warfarin)
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11
Q

When are SSRIs given?

A

During day to prevent sleep disturbance

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12
Q

How to treat SFx sexual dysfunction from SSRI drugs?

A

Adjust dose

Change drug

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13
Q

Important rare SFx of antidepressants ?

A

change in Electrical conduction of heart.
Esp. In ppl with preexisting heart condition
Withdrawal syndrome

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14
Q

What drug is Citalopram?

A

SSRIs

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15
Q

What drug is paroxetine?

A

SSRIs

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16
Q

What drug is sertraline?

A

SSRI

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17
Q

Which SSRI drug most likely to cause withdrawal?

A

Paroxetine

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18
Q

What drug is Prozac?

A

Fluoxetine

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19
Q

How many half-lives take to leave body?

A

7 half-lives

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20
Q

Which SSRI can be used in paeds?

A

Fluvoxamine

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21
Q

risk of SSRIs in adolescents?

A

Increased risk of suicide

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22
Q

3 SNRIs?

A

Venlafaxine
Duloxetine
Desvenlafaxine

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23
Q

What dose needed in SNRIs to get actual noradrenergic effects?

A

150-225mg that you get noradrenergic

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24
Q

SNRI has what SFx?

A

Withdrawal effect

Sweating - dose dependednt

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25
Q

Name an alpha - 2 antagonist.

A

Mirtazepine

indirect effects on: 5HT, noradrenaline,

H1, 5HT2C receptors - weight gain

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26
Q

Mirtazepine Sfx?

A

Very sedative

27
Q

Mirtazepine used for what?

A

Anti-anxiety effect

28
Q

Effects on which receptors cause weight gain?

A

H1

5TH2C

29
Q

Mirtazepine risk on blood?

A

Blood dyscrasias

30
Q

What is Agomelatine? How does it work?
Used for?
When given?

A

Multimodal agents
Melatonin agonist
5HT2C antagonist

Used for sleep disturbance

Given at night

31
Q

What is reboxetine?

A

NA reuptake inhibitor

Not used. Much

32
Q

What is vortioxetine?

A

5HT reuptake inhibitor
5HT1A agonist
5HT3 antagonist actions

33
Q

Indications for anxiolytics?4 things

A

Generalized anxiety disorder
Phobias
Sleep disturbance
Anxiety from med disorder

34
Q

4 classes of anxiolytics

A

Benzos
Buspirone
Antidepressants
Beta blockers

35
Q

Main use of benzos? Chloride ion

A

Sleep disturbance
Panic attacks
Phobias

36
Q

Main SFx prob with benzos?

A

bad Withdrawal

Addictive

37
Q

Benzos NOT used in 3 things:

A

Simple phobias
PTSD
OCD

38
Q

Most important benzos SFx?

A
  1. Behavioural disinhibition (rage, hostility, aggressiveness)
  2. Psychomotor impairment
  3. Cognitive impairment
  4. Abrupt Withdrawal phenomena (seizures)
  5. Rebound insomnia
39
Q

Suffix for benzos?

A
  • pam

- lam

40
Q

Most used benzo hypnotic?

A

Temazepam

41
Q

Flunitrazepam important how?

A

‘Date rape’ drug
Long half life
Short duration of action

42
Q

What are zopiclone and zolpidem? How long to use?

A

Hypnotic agents for sedation

Short term use (Max 10 days)

43
Q

Benzos work on what receptor?

A

GABA-A

44
Q

Buspirone works on what?

Takes how long?

A

5HT-1A partial agonist

Take weeks to work

45
Q

When is Busiprone used for?

A

PTSD

Social phobia

46
Q

Important SFx with Buspirone?

A

Dysphoria on initiation

Not useful for benzo withdrawal

47
Q

Indications for antipsychotics?

A 
Schizophrenia (Psychotic symptoms only)
Bipolar disorder manic psychotic
Brief psychosis
Depression (psychotic)
Delirium

Methamphetamine overdose

48
Q

When use haloperidol?

A

Delirium in ICU

49
Q

Haloperidol risk?

A

Extrapyramidal symptoms

50
Q

When use intramuscular injection for antipsychotics?

A

Non-compliance

51
Q

When use atypical antipsychotics?

A 
First line
Positive
Negative
Relapse
Restablisation
Maintenance
52
Q

3 most important drugs of atypical antipsychotics

A

Olanzipine
Risperidone

Then clozapine if failed

53
Q

Clozapine serious SFX?

A

Agranular cytosis

Cardiomyopathy, myocarditis

54
Q

Quetiapine in low dose used for what

A

Hypnotic agent.

55
Q

Quetiapine indicated for

A 
Bipolar
Depression
Schizo
PTSD
Generalized anxiety disorder
Sleep disturbances
56
Q

Notable SFx of atypical antipsychotics?

A

Weight gain (Olanzapine and clozapine)

T2DM

57
Q

main Risperodone side effects?

A

Extrapyramidal SFx
Increase prolactin
QTc

58
Q

2 classes for mood stabilizing for bipolar?

A

Lithium

Anticonvulsants

59
Q

Name 4 anticonvulsants

A

Sodium valproate
Carbamazepine
Lamotrigine
Topiramate

60
Q

Lithium needs two things before starting:

A

Need
thyroid/FBE, ECG, renal function

Baseline
Checked every 6 months

61
Q

Why is renal function important in lithium?

A

Lithium not metabolized, only removed by kidneys

62
Q

When take bloods for lithium?

A

12 hours after dose to get trough 0.4-0.8

63
Q

Optimal dose in psychiatry?

A

Titration to dose response

Dose that gets them better

Jason's MD3 Psychiatry Rot (23 decks)

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