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MB3 Psychiatry > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

clinical indication of antidepressants

A 
depresssion 
generalised anxiety disorder
panic disorder, OCD, PTSD
premenstrual dysphoric disorder
dysthymia 
bulimia 
neuropathic pain
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2
Q

types of antidepressant?

A

monoamine oxidase inhibitors
monoamine reuptake inhibitors - TCA, SSRI, SNRI
atypicals

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3
Q

what is the monoamine hypothesis

A

depression results from a functional deficit of monoamine neurotransmitters, especially NA and serotonin

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4
Q

name two monoamine oxidase inhibitors and whether they are reversible or irreversible

A

phenelzine - irreversible

moclobemide - reversible

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5
Q

side effects of monoamine oxidase inhibitors

A 
hypertensive crisis 
potentiated effects of other drugs 
postural hypotension 
insomnia 
peripheral oedema
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6
Q

describe how monoamine oxidase inhibitors can lead to hypertensive crisis and how it can be managed

A

inhibition of MAO-A in gut prevents breakdown of tyramine, which can act as a vasopressor to lead to significant HTN
avoid cheese, gravy, alcohol

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7
Q

mechanism of action of TCA

A

non-selective blocking of ACh, serotonin and NA reuptake in the synaptic cleft so remains to stimulate for longer

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8
Q

name 4 TCAs

A

imipramine
dosulepin
amitriptyline
lofepramine

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9
Q

side effects of TCA

A

sedation
weight gain
blurred vision, dry mouth, constipation and urine retention
postural hypotension, tachycardia and arrhythmia
can be CARDIOTOXIC in overdose

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10
Q

mechanism of action and names of 4 SSRI class antidepressants

A 
citalopram/escitalopram 
fluoxetine 
sertraline 
paroxetine 
blocks 5-HT (serotonin) uptake
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11
Q

side effects of SSRIs

A 
nausea 
headache 
sexual dysfunction 
worsened anxiety and transient increase in suicidal risk 
sweating 
vivid dreams
hyponatraemia in the elderly 
discontinuation effects
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12
Q

mechanism of action of venlafaxine and duloxetine

A

dual reuptake inhibition of serotonin/NA

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13
Q

action of mirtazepine

A

blocks alpha 2, 5-HT2, 5-HT3 so acts to prevent the side effect of nausea
can lead to weight gain and sedation

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14
Q

target range of lithum

A

0.4-1.0mmol/L

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15
Q

side effects of lithium

A 
dry mouth 
metallic taste 
hypothyroidism 
tremor 
reduction in renal function 
weight gain 
nephrogenic DI 
polydipsia/polyuria
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16
Q

toxic effects of lithium

A 
vomiting 
diarrhoea 
drowsiness 
convulsion 
coma 
ataxia/coarse tremor
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17
Q

what anticonvulsants can be used as mood stabilisers and how do they work

A

valproic acid
lamotrigine
carbamazepine
unclear

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18
Q

side effect to watch in lamotrigine

A

stephens-johnson syndrome

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19
Q

side effects to watch in valproate

A

teratogenic, cardiovascular defects, drowsiness and ataxia, induction of liver enzymes

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20
Q

side effects to watch in carbemazepine

A

cardiovascular defects, drowsiness and ataxia, induction of liver enzymes

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21
Q

name of 4 antipsychotics and how they act as mood stabilisers

A

quetiapine, arpiprazole, olanzapine, lurasidone

dopamine and 5-HT antagonist

22
Q

side effects of antipsychotics

A

sedation, weight gain, metabolic syndrome

extra-pyramidal side effects

23
Q

Drugs used to treat anxiety?

A 
BZD
Beta blockers 
ADs
buspirone 
pregabalin
24
Q

fearful aspects of anxiety symptoms are managed by the ____ circuit

A

amygdala central circuit

25
worryful aspects of anxiety symptoms are managed by the ____ circuit
cortico-striatal-thalamic-cortical circuit
26
function of amygdala
integration of sensory and cognitive info
27
where is the affect of fear generated
anterior cingulate cortex/orbitofrontal cortex
28
fight or flight and avoidance features are created by what part of the brain
periaqueductal grey matter
29
features of re-experiencing anxiety generating memories are from where?
hippocampus
30
describe the role of GABA In the amygdala centred circuit
inhibitory transmitter | reduction in activity of neurons in amygdala and CSTC
31
mechanism of action of BZD drugs
binds to BZD binding site on GABA receptor and enhances effect of GABA leads to hyperpolarisation of the neuron membrane due to Cl influx, less likely to carry AP hence inhibitory effect
32
other sites besides BZD site on GABA receptor?
Barbiturate site GABA site General anaesthetic site
33
antagonist for BZD in an overdose? mechanism of action
flumazenil | antagonist of GABA receptor
34
name 4 BZDs
lorazepam diazepam midalozam chlordiazepoxide
35
intended effects of BZD
``` anxiolytic hypnosis or sedation muscle relaxation anticonvulsant anterograde amnesia ```
36
clinical uses for BZDs
``` acute tx of extreme anxiety alcohol withdrawal hypnosis mania delirium rapid tranquilisation surgery status epilepticus ```
37
possible issues with BZD
respiratory depression combined with alcohol/opiates paradoxical aggression anterograde amnesia and impaired coordination tolerance/dependence
38
describe the mechanism of BZD tolerance
chronic adaptation, decreased response to GABA due to receptor downregulation and decreased density on synapse
39
features of rapid BZD withdrawal
``` tachycardia sweating psychosis convulsions confusion hypertension tremor ```
40
Features of non rapid/subactue/chronic BZD withdrawal
``` Abdominal cramps panic attacks blurred vision depression insomnia dizziness headache inability to concentrate N&V restless muscle tension chest pain sweating palpitations shaking ```
41
how to transfer a pt off BZD?
``` change dose to night transfer to diazepam reduce dose every 2-3 weeks in steps of 2-2.5mg if withdrawal occurs then maintain dose reduce dose further and eventually stop ```
42
indications of SSRI in anxiety
panic disorder, OCD, PTSD, phobia | GAD - citalopram/paroxetine
43
indications of TCA in anxiety
2nd line panic disorder | OCD
44
when to use beta blockers anxiety
physical symptoms
45
when to use pregabalin anxiety
if unresponsive to other tx
46
managing GAD
``` psychoeducation self help psychoeducation groups CBT SSRI BZD trial SNRI Pregabalin ```
47
managing panic disorder
``` self help CBT/SSRI avoid BZD, propranolol, sedating antihistamines Trial TCA 2nd line continue 6m ```
48
managing OCD
low intensity psycholifical intervention - CBT, ERP more intense or SSRI and continue 1yr consider SSRI +CBT clomipramine augment with antipsychotic or citalopram and clomipramine
49
managing social anxiety
``` individual CBT SSRI - sertraline/citalopram SSRI+CBT alternative SSRI/SNRI Moclobemide - MAOI ```
50
managing PTSD
if mild and <4wks then watchful wait within 3m - hypnotic for sleep and trauma focused CBT >3m - trauma focused CBT or EMDR paroxetine/mirtazapine may be of use phenylzine/amitriptyline may be of specialist use
51
when to stop ADs for GAD
18m

MB3 Psychiatry (16 decks)

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