Pharmacology Flashcards
Venlafaxine
- SNRI antidepressant
- Major depression; GAD
- SE’s: Constipation, nausea, vomiting, anorexia, hypertension, palpitations
What drugs are useful for impulse control?
- SSRIs, carbamazepine
- Lithium for aggression
Carbamazepine
- Anti-convulsant & mood-stabilizer
- Bipolar affective disorder unresponsive to lithium
- SE’s: headache, dry mouth, drowsiness, nausea, vomiting, blurring of vision, oedema, dermatitis, urticaria. Blood disorders inc. eospinophilia, leucopenia, thrombocytopenia, haemolyic anaemia.
Fluoxetine
- SSRI
- Indications: depression, OCD, GAD, panic disorder, social anxiety disorder.
- SEs: diarrhoea, dysphagia, hypo-tension, flushing, palpitation
Sertraline
-SSRI
Citalopram
-SSRI
Compare SSRIs to TCAs
SSRIs are less sedating and have fewer anti-muscarinic and cardiotoxic effects than TCAs.
Name some side effects of TCAs
- Common side effects are due to antimuscarinic properties of the TCAs, such as: dry mouth, blurred vision, constipation, urinary retention.
- CNS side effects include: anxiety, dizziness and confusion. -Other side effects include: arrhythmias, GI disturbances and hypersensitivity reactions.
Name three typical (1st generation) anti psychotics
Haloperidol, chlorpromazine, fluphenazine
Name 6 ATYPICAL antispychotics
- Clozapine
- Risperidone
- Aripiprazole
- Zotepine
- Olanzapine
- Quetiapine
What is the major action of most anti-psychotics?
They are dopamine anatagnists. They block post-synaptic D2 receptors.
What is the main problem with the typical antipsychotics?
They tend to cause distressing extra-pyramidal side effects at normal treatment doses.
What are the advantages of typical antipsychotics?
They are effective, cheap and provide depot options
What are the qualities of atypical antipsychotics that make them superior to typical antipsychotics?
They have fewer extra-pyramidal side effects and generally do not increase prolactin levels.
All atypical antipsychotics block dopamine receptors, but they also block another type of receptor. Name which receptor they also block.
Serotonin 5-HT2 receptors.
Which atypical antipsychotic is available as a depot injection?
Risperidone
Name four extrapyramidal side effects in order of their onset and describe what they are
1) Dystonia (early/within hours) - Involuntary, painful, sustained muscle spasms e.g. torticollis
2) Akathisia (Hours to weeks)- an unpleasant subjective feeling of restlessness and inability to remain still
3) Parkinsonism (Days to weeks) - The triad of rigidity, bradykinesia and resting tremor
4) Tardive dyskinesia (months to years) - Involuntary rhythmic, repetitive body movements which are very distressing e.g. chewing/sucking movements with mouth and tongue
What can hyper-pro-lactinaemia cause?
Galactorrhoea, amenorrhoea, gynecomastia, hypogonadism and sexual dysfunction. It also increases the risk of osteoporosis.
Which two atypical anti-psychotics notably cause weight gain as a side effect?
Clozapine and olanzapine
Other than extra-pyramidal side effects and increasing levels of prolactin, what other side effects occur with anti-psychotics?
- Weight gain
- Sedation
- Increased risk of diabetes
- Dyslipidaemia
- Anticholinergic side effects (e.g. dry mouth, blurred vision, constipation, urinary retention and tachycardia)
- Arrhythmias
- Seizures (greatest risk with clozapine)
- Neuroleptic malignant syndrome (rare but life threatening)
Regarding neuroleptic malignant syndrome (NMS), what are:
a) The symptoms
b) The blood results
a) Muscle stiffness and rigidity; altered consciousness and disturbance of the autonomic nervous system e.g. tachycardia, fever and labile BP
b) You would expect a raised creatinine kinase and a raised WCC
One atypical antipsychotic can cause hyper-prolactinaemia. Which one is it?
Risperidone
Which is the first line drug for treatment-resistant schizophrenia? Why should it only be tried when other anti-psychotics have failed, despite being more effective?
Clozapine; because it has the potentially fatal complication on agranulocytosis.
Finish this sentence: The use of clozapine requires weekly blood tests to detect early signs of …
Neutropenia
Clomipramine
TCA
Imipramine
TCA
