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Psychiatry - Y3* > Pharmacological Treatments of Affective and Anxiety Disorders > Flashcards

Pharmacological Treatments of Affective and Anxiety Disorders Flashcards

1
Q

What are the classes of anti-depressants?

A 
Tricyclics 
MAOIs
SSRIs
SNRIs
Novel antidepressants
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2
Q

What are the side effects of tricyclics?

A
  • Antihistaminic
  • Anticholinergic: dry mouth, increased heart rate, light sensitivity
  • Antiadrenergic
  • QT prolongation
  • Lethal in overdose
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3
Q

Do tertiary tricyclics have more or less side effects than normal tricyclics?

A

More side effects

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4
Q

What are examples of tertiary tricyclics?

A

Imipramine
Amitriptyline
Doxepin
Clomipramine

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5
Q

What is the action of secondary tricyclics?

A

Block noradrenaline

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6
Q

Do secondary tricyclics have more or less side effects than tertiary tricyclics?

A

Same but less severe

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7
Q

What are examples of secondary tricyclics?

A

Desipramine

Nortriptyline

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8
Q

What class of antidepressant is good for resistant depression?

A

MAOIs. Occasionally for treatment resistant depression and sleep disturbance.

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9
Q

What is the action of MAOIs?

A

Bind irreversibly to MAO, preventing inactivation of amines such as norepinephrine, dopamine and serotonin, leading to increased synaptic levels.

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10
Q

Main side effects of MAOIs?

A

Weight gain, dry mouth, sexual dysfunction, sedation, postural hypotension and sleep disturbance.

Cheese reaction: foods rich in tyramine or sympathomimetics

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11
Q

What class of antidepressant can treat both depression and anxiety?

A

SSRIs

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12
Q

What are the benefits of SSRIs?

A

Very little risk in overdose

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13
Q

What is the action of SSRIs?

A

Block presynaptic serotonin reuptake

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14
Q

Main side effects of SSRIs?

A

Anxiety, restlessness, nervousness, insomnia, fatigue, sedation, sexual dysfunction

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15
Q

What are examples of SSRIs?

A

Sertraline

Fluoxetine

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16
Q

Pros and cons of Sertraline?

A

Pros: Less sedating when compared to paroxetine, short half-life with a build-up of metabolites

Cons: Full stomach for max absorption, increased number of GI adverse reactions

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17
Q

Pros and cons of fluoxetine?

A

Pros: Long half-life so decreased incidence of discontinuation syndromes (non-compliant patients)

Cons: Long half-life so build-up active metabolite (hepatic illness), significant P450 interactions (polypharmacy), activation syndrome, mania.

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18
Q

What treats depression, anxiety and possibly neuropathic pain?

A

SNRIs

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19
Q

What is the action of SNRIs?

A

Inhibit serotonin and noradrenergic reuptake like TCAs, but without bad side effects

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20
Q

What are examples of SNRIs?

A

Venlafaxine

Duloxetine

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21
Q

Pros and cons of Venlafaxine?

A

Pros: Minimal drug interactions, a short half-life, fast renal clearance.

Cons: Increase diastolic BP, nausea, continuation syndrome and QT prolongation.

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22
Q

Pros and cons of Duloxetine?

A

Pros: physical symptoms of depression, less increase in BP.

Cons: Active ingredient not stable in stomach.

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23
Q

What is an example of novel antidepressants?

A

Mirtrazapine

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24
Q

Pros and cons of Mirtrazapine?

A

Pros: Good augmentation strategy to SSRIs, hypnotic at lower doses secondary to antihistaminic effects.

Cons: 20% increased serum cholesterol, sedation and weight gain at low doses.

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25
Q

Management of treatment resistant depression?

A

Antidepressant with

  • Mirtazapine
  • Atypical antipsychotic (quetiapine, olanzapine, aripiprazole)
  • Lithium
  • ECT
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26
Q

What class of drug do you use for bipolar, cyclothymia, schizoaffective disorder?

A

Mood stabiliser

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27
Q

First line for bipolar?

28
Q

Factors predicting positive response to lithium?

A
  • Prior long term response or family member with good response
  • Classic pure mania
  • Mania follower by depression
29
Q

What to check before starting patients on lithium?

A

U&E, TSH, pregnancy

30
Q

Side effects of lithium

A
  • Thyroid
  • Interstitial renal fibrosis
  • Polyuria/polydipsia
  • Hair loss
  • CNS symptoms (seizure, tremor)
  • Acne
  • GI distress
  • Nonsignificant leukocytosis
31
Q

What is mild lithium toxicity?

A

1.5-2, vomiting, diarrhoea, ataxia, dizziness, slurred speech, nystagmus

32
Q

What is moderate lithium toxicity?

A

2-2.5 vomiting, diarrhoea, ataxia, dizziness, slurred speech, nystagmus
nausea.

33
Q

What is severe lithium toxicity?

A

> 2.5 generalised convulsions, oliguria and renal failure

34
Q

What are examples of anticonvulsants?

A

Valproic acid
Carbamazepine
Lamotrigine

35
Q

Valproic acid: what to check and main side effects?

A

LFT, pregnancy

Side effects include thrombocytopaenia and platelet dysfunction, nausea, vomiting, weight gain, sedation, tremor, hair loss.

36
Q

Carbamazepine: what to check and main side effects?

A

FBC, ECG

Rash, nausea, vomiting, diarrhoea, sedation, ataxia, confusion, AV conduction delays, aplastic anaemia and
agranulocytosis

37
Q

Lamotrigine: what to check and main side effects?

A

LFT

Nausea, vomiting, sedation, dizziness, ataxia and confusion. Toxic epidermal necrosis (if rash stop immediately), blood dyscrasias

38
Q

What are rapid cycler and mixed patients?

A

Rapid cycler: many bipolar episodes in a year

Mixed patients: Depression and mania at the same time

39
Q

What is the first line agent for acute mania and mania prophylaxis in rapid cycler and mixed patients?

A

Carbamazepine

40
Q

What class of drug do you use for schizophrenia, schizoaffective disorder, bipolar disorder, psychotic depression?

A

Antipsychotics

41
Q

What are the different dopamine pathways?

A

Mesocortical
Mesolimbic
Nigrostriatal
Tuberoinfundibular

42
Q

What symptoms does the mesocortical pathway give rise to?

A

Negative symptoms and

cognitive disorders arise. Problem here for a psychotic patient is too little dopamine

43
Q

What symptoms does the mesoclimbic pathway give rise to?

A

Positive symptoms come from here. Too much dopamine

44
Q

What symptoms does the nigrostriatal pathway give rise to?

A

Involved in movement

regulation. Dopamine hypoactivity –> Parkinsonian movements

45
Q

What symptoms does the tuberoinfundibular pathway give rise to?

A

Blocking dopamine in this pathway will predispose to hyperprolactinaemia

46
Q

What is the action of typical antipsychotics?

A

D2 receptor antagonists

47
Q

What are the main side effects of typical antipsychotics?

A

Higher risk extrapyramidal side effects. Cardiotoxic and anticholinergic adverse effects including sedation and hypotension.

48
Q

What are the examples of typical antipsychotics?

A

Fluphenazine, haloperidol, pimozide, chlorpromazine, thioridazine.

49
Q

What is the action of atypical antipsychotics?

A

Serotonin-dopamine 2 agonists.

50
Q

What is the difference between atypical and typical antipsychotics?

A

Atypicals affect dopamine and serotonin in the four key dopamine pathways in the brain, so they differ in side effect profiles.

51
Q

What are the examples of atypical antipsychotics?

A

Risperidone, Olanzapine, Quetiapine, Aripiprazole, Clozapine

52
Q

What are the main side effects of risperidone?

A

Extrapyramidal side effects
Prolactinaemia
Weight gain
Sedation.

53
Q

What are the main side effects of olanzapine?

A

Prolactinaemia

Abnormal LFTs

54
Q

What are the main side effects of quetiapine?

A 
Abnormal LFTs
Weight gain
Cholesterolaemia
Glycaemia
Triglyceridaemia
Orthostatic hypotension
55
Q

What are the main side effects of aripiprazole?

A

Extrapyramidal side effects No QT prolongation
Akathisia/activation
Not really sedation or weight gain.

56
Q

What are the main side effects of clozapine?

A 
Used for treatment resistant patients 
Agranulocytosis
Lowers seizure threshold, Most sedation + weight gain Abnormal LFTs Triglyceridaemia
Cholesterolaemia
Glycaemia
Coma
57
Q

What is an important principle of schizophrenia prophylaxis?

A

Keep the patient on treatment as far as possible, to prevent relapse and cognitive decline.

58
Q

What are the main antipsychotic adverse effects?

A

Tardive dyskinesia
Neuroleptic malignant syndrome
Elevated WBC, CPK, LFTs
Extrapyramidal side effects

59
Q

What are extrapyramidal side effects?

A

Acute dystonia, Parkinson syndrome, akathisia

60
Q

If a patient comes in showing signs of extrapyramidal side effects, what can you use to treat?

A

Benztropine
Trihexyphenidyl Diphenhydramine
Amantidine
Propranolol Diazepam

61
Q

What are anxiolytics used to treat?

A

Panic disorder, GAD, substance misuse, withdrawal, insomnia, parasomnias

62
Q

What are examples of anxiolytics?

A

Busiprone

Benzodiazepines

63
Q

What are the pros of busiprone?

A

Good augmentation strategy. Independent of endogenous release of serotonin. No sedation

64
Q

What are the cons of busiprone?

A

Effect takes around 2 weeks. Less efficacious in patients used to BZDs

65
Q

What are the pros of benzodiazepines ?

A

Very effective, used as acute short-term treatment.

66
Q

What are the cons of benzodiazepines ?

A
  • Somnolence
  • Cognitive defects
  • Amnesia
  • Disinhibition
  • Tolerance
  • Dependence (potential for misuse)

Psychiatry - Y3* (16 decks)

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