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Y3 Psychiatry > Pharmacological Therapies > Flashcards

Pharmacological Therapies Flashcards

1
Q

what are anti-depressants used for ?

A

unipolar and bipolar depression
mood disorders
schizophrenia
anxiety

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2
Q

what time period is there a delay of after starting anti-depressants ?

A

2-4weeks

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3
Q

what time period after no improvement of symptoms is an anti depressant changed ?

A

2 months

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4
Q

what is the response rate of anti-depressants ?

A

70%

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5
Q

what is the response rate for placebos for depression?

A

40%

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6
Q

how long after a depressive episode should someone treated?

A

6months to a year after the first episode

2 years after the second episode

life long after 3 episode

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7
Q

what % of patients relapse after 6 months of prophylaxis?

A

20%

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8
Q

what % of patients relapse after none of prophylaxis?

A

80%

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9
Q

state the 5 classifications of antidepressants ?

A

tricyclics (TCAs)
monoamine oxidase inhibitors (MAOIs)
selective serotonin repute inhibitors (SSRIs)
serotonin/noradrenaline repute inhibitors (SNRIs)
novel antidepressants

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10
Q

what changes to ECG can TCAs cause?

A

long QT

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11
Q

are TCAs easy or hard to overdose?

A

easy

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12
Q

what are some side effects of TCAs?

A

low BP, constipation, blurred vision

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13
Q

do secondary or tertiary TCAs have more side effects?

A

tertiary

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14
Q

state some examples of tertiary TCAs?

A

amitriptyline

clomipramine

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15
Q

what is the main function of secondary TCAs?

A

primarily block noradrenaline since they are a similar structure

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16
Q

state some examples of secondary TCAs?

A

despiramine

nortriptyline

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17
Q

what is the function of MAOIs?

A

they bind to monoamine oxidase thus preventing the breakdown of monoamine neurotransmitters and thereby increasing their availability

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18
Q

what conditions are MAOIs used for?

A

parkinsons

resistant depression

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19
Q

what are some side effects of MAOIs?

A 
orthostatic hypertension 
weight gain 
dry mouth 
sedation 
sexual dysfunction 
sleep disturbance
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20
Q

what diet change is required for use of MAOIs?

A

reduction of tyramine rich foods

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21
Q

why do patients on MAOIs need a reduction of tyramine rich foods?

A

causes hypertensive crisis

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22
Q

what is the cheese reaction

A

when patients on MAOIs take tyrosine rich foods

and since MAO is inhibited, the amines can enter the tissues and cause a hypertensive response

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23
Q

on what medication can serotonin syndrome occur?

A

MAOIs

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24
Q

give some symptom of serotonin syndrome?

A 
abdo pain
myoclonus 
irritability 
tachycardia 
HTN
delirium
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25
Q

how long is required to wait when switching from a SSRI to a MAOI?

A

2 weeks

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26
Q

what is the function of SSRIs?

A

block the presynaptic serotonin reuptake

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27
Q

what conditions are SSRIs used to treat?

A

anxiety and depression

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28
Q

state some side affects of SSRIs?

A 
GI upset
sexual dysfunction 
anxiety 
restlessness 
nervousness
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29
Q

what can occur if SSRIs are stopped suddenly?

A

discontinuation syndrome

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30
Q

what chemical is increased in the body by SSRIs?

A

serotonin

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31
Q

what medication should be started if discontinuation syndrome occurs?

A

fluoxetine

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32
Q

state some names of SSRIs

A

sertraline
fluoxetine
citalopram

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33
Q

what is the function of SNRIs?

A

Inhibit both serotonin and noradrenergic reuptake

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34
Q

give two names of SNRIs?

A

duloxetine

venlafaxine

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35
Q

give two names of novel antidepressants

A

mirtazapine

bupropion

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36
Q

are sertraline and citalopram sedating?

A

no

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37
Q

a patient with depression, hyperphagia, psychomotor retardation and hypersomnolence (sleeping too much) should be started on what type of medication?

A

SSRIs

38
Q

can TCAs help with pain

A

yes neuropathic pain

39
Q

what does IPT stand for?

A

interpersonal therapy

40
Q

what options are there for treatment resistance for depression?

A

combination of anti-depressants
adjunctive Tx of lithium
adjunctive Tx of atypical anti-psychotic
ECT

41
Q

what conditions is the medication mood stabilisers used for?

A

bipolar
schizoaffective
cyclothymia - mild, moods swing between short periods of mild depression and hypomania

42
Q

what are the three classes of mood stabilisers ?

A

lithium
anticonvulsants
antipsychotics

43
Q

what is the only medication to reduce the suicide rate?

A

lithium

44
Q

what condition is lithium used for?

A

bipolar

45
Q

what abnormality can be caused by lithium during pregnancy?

A

Ebsteins anomaly
- congenital heart defect, the septal and posterior leaflets of the tricuspid valve are displaced towards the apex of the right ventricle of the heart.

46
Q

what serum levels need to be checked after lithium has been started ?

A

TSH and creatinine

47
Q

what is the blood serum level goal for lithium ?

A

0.6 and 1.2

48
Q

what is the most common side effect of lithium ?

A

GI symptoms

  • appetite
  • nausea/vomiting
  • diarrhoea

hypothyroid

hair loss

49
Q

what is the treatment for a lithium overdose?

A

stop lithium and increase fluids

50
Q

what are the symptoms of severe lithium toxicity ?

A

generalised convulsions
oliguria
renal failure

51
Q

what are the symptoms of mild lithium toxicity ?

A 
vomiting 
diarrhoea 
ataxia 
dizziness
slurred speech
52
Q

what is valproic acid used for?

A

mania prophylaxis

53
Q

is lithium or valproic acid better tolerated

A

valproic acid

54
Q

what pregnancy defect can valproic acid cause?

A

neural tube defect

55
Q

what investigations need to be done before valproic acid is started ?

A

LFTs
Pregnancy test
FBC

56
Q

what are some side effects of valproic acid?

A

Thrombocytopenia and platelet dysfunction
Nausea, vomiting, weight gain
Sedation, tremor

57
Q

what is the first line agent for acute mania and mania prophylaxis ?

A

carbamazepine

58
Q

what investigations should be done before starting carbamazepine ?

A

ECG
LFTs
FBC

59
Q

what is the most common side effect of carbamazepine?

A

rash

60
Q

state some side effects of carbamazepine?

A 
GI effects - nausea, vomiting, diarrhoea 
sedation 
dizziness 
aplastic anaemia 
agranulocytosis
61
Q

what anti-convulsant be used for neuropathic pain?

A

lamotrigine

62
Q

state some side effects of lamotrigine?

A 
GI
sedation 
dizziness
ataxia 
confusion
63
Q

what two drugs increase the levels of lamotrigine?

A

sertraline

valproate

64
Q

what conditions should anti-psychotics be used for?

A

schizophrenia

bipolar for mood stabilisation

65
Q

what is the key pathway affecting in the brain in the Tx of schizophrenia?

A

dopamine

66
Q

what is first line for mania with no depression?

A

lithium

67
Q

what medication should be given for a rapid cycler of depression and mania with alcohol abuse?

A

depakote

68
Q

what part of the brain is responsible for negative symptoms ?

A

mesocortical

69
Q

what are the levels of dopamine like in the mesocortical part of the brain?

A

too little dopamine

70
Q

what part of the brain is responsible for positive symptoms ?

A

mesolimbic

71
Q

what are the levels of dopamine like in the mesolimbic part of the brain?

A

too much dopamine

72
Q

what part of the brain causes parkinsonian movements ?

A

nigrostriatal

73
Q

what levels of dopamine cause parkinsonian movements

A

dopamine hypoactivity

74
Q

what does dopamine do to the levels of prolactin?

A

inhibits release of prolactin

75
Q

if dopamine is blocked by medication, what happens to the levels of prolactin?

A

hyperprolactinaemia

76
Q

what are the symptoms of hyperprolatcineamia?

A

gynecomastia
galactorrhea
decreased libido
menstrual dysfunction

77
Q

what type of dopamine receptor antagonists are antipsychotics typicals ?

A

D2

78
Q

what type of antagonist are atypical antipsychotics ?

A

serotonin dopamine 2 antagonists

79
Q

what side effects does risperidone cause?

A

extrapyramidal side effects

hyperprolactineamia

80
Q

what is the most likely atypical antipsychotic to cause orthostatic hypotension

A

quetiapine

81
Q

what side effect is associated with aripiprazole ?

A

akathisia

82
Q

what is the most likely atypical antipsychotic to cause weight gain, sedation and abnormal LFTs?

A

clozapine

83
Q

are all atypical antipsychotics the same effectiveness?

A

yes

- they just have different side effects

84
Q

what is the commonest psychotic symptom?

A

lack of insight

85
Q

what is the most common cause of release in psychotic illness?

A

non compliance

86
Q

what should be considered for a third episode of schizophrenia?

A

long acting IM medication

87
Q

what is Tardive Dyskinesia (TD)?

A

involuntary muscle movements that may not resolve with drug discontinuation

88
Q

what is Neuroleptic Malignant Syndrome (NMS)?

A

Characterized by severe muscle rigidity, fever, altered mental status, autonomic instability, elevated WBC, CPK and lfts. Potentially fatal.

89
Q

what four tests should be done before prescribing anti-psychotics?

A

Fasting lipid profile
fasting blood sugar
LFTs
FBC

90
Q

what can akathisia increase the risk of ?

A

suicide

91
Q

what are anxiolytics used to treat?

A

panic disorder
generalised anxiety disorder
withdrawal

92
Q

give two examples of anxiolytics?

A

buspirone

benzodiazepines

Y3 Psychiatry (13 decks)

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