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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
Q

worryful aspects of anxiety symptoms are managed by the ____ circuit

A

cortico-striatal-thalamic-cortical circuit

26
Q

function of amygdala

A

integration of sensory and cognitive info

27
Q

where is the affect of fear generated

A

anterior cingulate cortex/orbitofrontal cortex

28
Q

fight or flight and avoidance features are created by what part of the brain

A

periaqueductal grey matter

29
Q

features of re-experiencing anxiety generating memories are from where?

A

hippocampus

30
Q

describe the role of GABA In the amygdala centred circuit

A

inhibitory transmitter

reduction in activity of neurons in amygdala and CSTC

31
Q

mechanism of action of BZD drugs

A

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
Q

other sites besides BZD site on GABA receptor?

A

Barbiturate site
GABA site
General anaesthetic site

33
Q

antagonist for BZD in an overdose? mechanism of action

A

flumazenil

antagonist of GABA receptor

34
Q

name 4 BZDs

A

lorazepam
diazepam
midalozam
chlordiazepoxide

35
Q

intended effects of BZD

A 
anxiolytic 
hypnosis or sedation 
muscle relaxation 
anticonvulsant 
anterograde amnesia
36
Q

clinical uses for BZDs

A 
acute tx of extreme anxiety 
alcohol withdrawal 
hypnosis 
mania 
delirium
rapid tranquilisation 
surgery 
status epilepticus
37
Q

possible issues with BZD

A

respiratory depression combined with alcohol/opiates
paradoxical aggression
anterograde amnesia and impaired coordination
tolerance/dependence

38
Q

describe the mechanism of BZD tolerance

A

chronic adaptation, decreased response to GABA due to receptor downregulation and decreased density on synapse

39
Q

features of rapid BZD withdrawal

A 
tachycardia 
sweating 
psychosis 
convulsions 
confusion 
hypertension 
tremor
40
Q

Features of non rapid/subactue/chronic BZD withdrawal

A 
Abdominal cramps 
panic attacks 
blurred vision 
depression 
insomnia 
dizziness 
headache 
inability to concentrate 
N&V
restless 
muscle tension 
chest pain 
sweating 
palpitations 
shaking
41
Q

how to transfer a pt off BZD?

A 
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
Q

indications of SSRI in anxiety

A

panic disorder, OCD, PTSD, phobia

GAD - citalopram/paroxetine

43
Q

indications of TCA in anxiety

A

2nd line panic disorder

OCD

44
Q

when to use beta blockers anxiety

A

physical symptoms

45
Q

when to use pregabalin anxiety

A

if unresponsive to other tx

46
Q

managing GAD

A 
psychoeducation 
self help psychoeducation groups 
CBT
SSRI
BZD
trial SNRI 
Pregabalin
47
Q

managing panic disorder

A 
self help
CBT/SSRI
avoid BZD, propranolol, sedating antihistamines 
Trial TCA 2nd line 
continue 6m
48
Q

managing OCD

A

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
Q

managing social anxiety

A 
individual CBT 
SSRI - sertraline/citalopram 
SSRI+CBT 
alternative SSRI/SNRI
Moclobemide - MAOI
50
Q

managing PTSD

A

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
Q

when to stop ADs for GAD

A

18m

MB3 Psychiatry (16 decks)

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