Pharmacological Therapies Flashcards
what are anti-depressants used for ?
unipolar and bipolar depression
mood disorders
schizophrenia
anxiety
what time period is there a delay of after starting anti-depressants ?
2-4weeks
what time period after no improvement of symptoms is an anti depressant changed ?
2 months
what is the response rate of anti-depressants ?
70%
what is the response rate for placebos for depression?
40%
how long after a depressive episode should someone treated?
6months to a year after the first episode
2 years after the second episode
life long after 3 episode
what % of patients relapse after 6 months of prophylaxis?
20%
what % of patients relapse after none of prophylaxis?
80%
state the 5 classifications of antidepressants ?
tricyclics (TCAs)
monoamine oxidase inhibitors (MAOIs)
selective serotonin repute inhibitors (SSRIs)
serotonin/noradrenaline repute inhibitors (SNRIs)
novel antidepressants
what changes to ECG can TCAs cause?
long QT
are TCAs easy or hard to overdose?
easy
what are some side effects of TCAs?
low BP, constipation, blurred vision
do secondary or tertiary TCAs have more side effects?
tertiary
state some examples of tertiary TCAs?
amitriptyline
clomipramine
what is the main function of secondary TCAs?
primarily block noradrenaline since they are a similar structure
state some examples of secondary TCAs?
despiramine
nortriptyline
what is the function of MAOIs?
they bind to monoamine oxidase thus preventing the breakdown of monoamine neurotransmitters and thereby increasing their availability
what conditions are MAOIs used for?
parkinsons
resistant depression
what are some side effects of MAOIs?
orthostatic hypertension weight gain dry mouth sedation sexual dysfunction sleep disturbance
what diet change is required for use of MAOIs?
reduction of tyramine rich foods
why do patients on MAOIs need a reduction of tyramine rich foods?
causes hypertensive crisis
what is the cheese reaction
when patients on MAOIs take tyrosine rich foods
and since MAO is inhibited, the amines can enter the tissues and cause a hypertensive response
on what medication can serotonin syndrome occur?
MAOIs
give some symptom of serotonin syndrome?
abdo pain myoclonus irritability tachycardia HTN delirium
how long is required to wait when switching from a SSRI to a MAOI?
2 weeks
what is the function of SSRIs?
block the presynaptic serotonin reuptake
what conditions are SSRIs used to treat?
anxiety and depression
state some side affects of SSRIs?
GI upset sexual dysfunction anxiety restlessness nervousness
what can occur if SSRIs are stopped suddenly?
discontinuation syndrome
what chemical is increased in the body by SSRIs?
serotonin
what medication should be started if discontinuation syndrome occurs?
fluoxetine
state some names of SSRIs
sertraline
fluoxetine
citalopram
what is the function of SNRIs?
Inhibit both serotonin and noradrenergic reuptake
give two names of SNRIs?
duloxetine
venlafaxine
give two names of novel antidepressants
mirtazapine
bupropion
are sertraline and citalopram sedating?
no
a patient with depression, hyperphagia, psychomotor retardation and hypersomnolence (sleeping too much) should be started on what type of medication?
SSRIs
can TCAs help with pain
yes neuropathic pain
what does IPT stand for?
interpersonal therapy
what options are there for treatment resistance for depression?
combination of anti-depressants
adjunctive Tx of lithium
adjunctive Tx of atypical anti-psychotic
ECT
what conditions is the medication mood stabilisers used for?
bipolar
schizoaffective
cyclothymia - mild, moods swing between short periods of mild depression and hypomania
what are the three classes of mood stabilisers ?
lithium
anticonvulsants
antipsychotics
what is the only medication to reduce the suicide rate?
lithium
what condition is lithium used for?
bipolar
what abnormality can be caused by lithium during pregnancy?
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.
what serum levels need to be checked after lithium has been started ?
TSH and creatinine
what is the blood serum level goal for lithium ?
0.6 and 1.2
what is the most common side effect of lithium ?
GI symptoms
- appetite
- nausea/vomiting
- diarrhoea
hypothyroid
hair loss
what is the treatment for a lithium overdose?
stop lithium and increase fluids
what are the symptoms of severe lithium toxicity ?
generalised convulsions
oliguria
renal failure
what are the symptoms of mild lithium toxicity ?
vomiting diarrhoea ataxia dizziness slurred speech
what is valproic acid used for?
mania prophylaxis
is lithium or valproic acid better tolerated
valproic acid
what pregnancy defect can valproic acid cause?
neural tube defect
what investigations need to be done before valproic acid is started ?
LFTs
Pregnancy test
FBC
what are some side effects of valproic acid?
Thrombocytopenia and platelet dysfunction
Nausea, vomiting, weight gain
Sedation, tremor
what is the first line agent for acute mania and mania prophylaxis ?
carbamazepine
what investigations should be done before starting carbamazepine ?
ECG
LFTs
FBC
what is the most common side effect of carbamazepine?
rash
state some side effects of carbamazepine?
GI effects - nausea, vomiting, diarrhoea sedation dizziness aplastic anaemia agranulocytosis
what anti-convulsant be used for neuropathic pain?
lamotrigine
state some side effects of lamotrigine?
GI sedation dizziness ataxia confusion
what two drugs increase the levels of lamotrigine?
sertraline
valproate
what conditions should anti-psychotics be used for?
schizophrenia
bipolar for mood stabilisation
what is the key pathway affecting in the brain in the Tx of schizophrenia?
dopamine
what is first line for mania with no depression?
lithium
what medication should be given for a rapid cycler of depression and mania with alcohol abuse?
depakote
what part of the brain is responsible for negative symptoms ?
mesocortical
what are the levels of dopamine like in the mesocortical part of the brain?
too little dopamine
what part of the brain is responsible for positive symptoms ?
mesolimbic
what are the levels of dopamine like in the mesolimbic part of the brain?
too much dopamine
what part of the brain causes parkinsonian movements ?
nigrostriatal
what levels of dopamine cause parkinsonian movements
dopamine hypoactivity
what does dopamine do to the levels of prolactin?
inhibits release of prolactin
if dopamine is blocked by medication, what happens to the levels of prolactin?
hyperprolactinaemia
what are the symptoms of hyperprolatcineamia?
gynecomastia
galactorrhea
decreased libido
menstrual dysfunction
what type of dopamine receptor antagonists are antipsychotics typicals ?
D2
what type of antagonist are atypical antipsychotics ?
serotonin dopamine 2 antagonists
what side effects does risperidone cause?
extrapyramidal side effects
hyperprolactineamia
what is the most likely atypical antipsychotic to cause orthostatic hypotension
quetiapine
what side effect is associated with aripiprazole ?
akathisia
what is the most likely atypical antipsychotic to cause weight gain, sedation and abnormal LFTs?
clozapine
are all atypical antipsychotics the same effectiveness?
yes
- they just have different side effects
what is the commonest psychotic symptom?
lack of insight
what is the most common cause of release in psychotic illness?
non compliance
what should be considered for a third episode of schizophrenia?
long acting IM medication
what is Tardive Dyskinesia (TD)?
involuntary muscle movements that may not resolve with drug discontinuation
what is Neuroleptic Malignant Syndrome (NMS)?
Characterized by severe muscle rigidity, fever, altered mental status, autonomic instability, elevated WBC, CPK and lfts. Potentially fatal.
what four tests should be done before prescribing anti-psychotics?
Fasting lipid profile
fasting blood sugar
LFTs
FBC
what can akathisia increase the risk of ?
suicide
what are anxiolytics used to treat?
panic disorder
generalised anxiety disorder
withdrawal
give two examples of anxiolytics?
buspirone
benzodiazepines
