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Pharmacology Flashcards

1
Q

What are the pharmalogical effects of benzodiazepines?

A
  • reduce anxiety and aggression
  • hypnosis/sedation
  • muscle relaxation
  • anticonvulsant effect
  • anterograde amnesia
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2
Q

What are the clinical uses of benzodiazepines?

A
  • Acute treatment of extreme anxiety
  • Hypnosis
  • Alcohol withdrawal
  • Mania
  • Delirium
  • Rapid tranquillisation
  • Premedication before surgery or during minor procedures
  • Status epilepticus
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3
Q

How do antidepressants work?

A

Increase monoamine neurotransmitters (5-HT/serotonin, dopamine and noradrenaline) in the synaptic cleft

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4
Q

What are the three main types of antidepressant?

A

SSRI

Tricyclics

MAOIs

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5
Q

What are examples of tricyclic antidepressant?

A

Amitriptilline and clomiprimine

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6
Q

How do tricyclic antidepressants work?

A

Act on the presynaptic terminal to block the re-uptake of noradrenaline and serotonin, increasing avaliability of these neurotransmitters

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7
Q

When are tricyclic antidepressants used?

A

Depression

Anxiety disorders

Chronic pain

Insomnia

Migraines

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8
Q

What are the side effects associated with tricyclic antidepressants?

A

Muscarinic: dry mouth, blurred vision, urinary retention, constipation

Alpha-adrenergic: postural hypotension, sexual dysfunction

Cardiotoxic: long QT, ST segment elevation, arrythmias

Antihistaminergic: weight gain, sedation

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9
Q

What are some of the contraindications for TCAs?

A

Recent MI

Arrythmias

Heart block

Liver disease

Mania

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10
Q

What are some examples of SSRIs?

A

Fluoxetine
Sertraline
Citalopram

Paroxetine

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11
Q

What is the mode of action of SSRIs?

A

Presynaptic blockade of 5-HT reuptake

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12
Q

When are SSRIs used?

A

Depression

Panic disorder

Social anxiety disorder

Stroke recovery

OCD

Chornic pain

Premature ejaculation

Bulimia (fluoxetine)

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13
Q

What are the first line antidepressants?

A

SSRIs

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14
Q

Which antidepressant is often used in bulimia nervosa?

A

Fluoxetine

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15
Q

What are the side effects associated with SSRIs?

A

GI: nausea, vomiting, diarrheoa

Initial rebound anxiety

Increased appetite

Weight changes

Sexual dysfunction

Insomnia

Hyponatremia

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16
Q

What is the main contraindication for SSRI use?

A

Mania

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17
Q

What is serotonin syndrome?

A

A rare but potentially fatal consequence of excess serotonin on the CNS

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18
Q

How does serotonin syndrome present?

A

Altered mental state

Agitation

Tremor

Shivering

Diarrheoa

Hyperreflexia

Rigidity

Myoclonus

Ataxia

Hyperthermia

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19
Q

What are the causes of serotonin syndrome?

A

Medication:

SSRIs

Amphetamines

Opiods

5-HT antagonists

Lithium

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20
Q

What investigations should be done if serotonin syndrome suspected?

A

Bloods

ECG

Drug screen

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21
Q

What are some examples of MAOIs?

A

Phenelzine

Tranylcypromine

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22
Q

What is the mode of action of MAOIs?

A

Non-selective irreversible inhibition of monoamine oxidase A and B, which act to break down monoamine neurotransmitters

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23
Q

Why is use of MAOIs avoided?

A

Serious risk of drug and food interactions causing tyramine crisis

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24
Q

What is tyramine crisis?

A

Tyramine is broken down by MAO-A, which is inhibited by use of MAOIs in depression

Increased levels of tyramine in the blood can cause a hypertensive crisis which can result in strokes and MIs

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25
What foods should be avoided in use with MAOIs?
Cheese, especially mature cheeses Wines and beer Smoked fish Chicken liver
26
Which drugs should be avoided in use of MAOIs?
Anaesthetics Certain components of cough medicine Cocaine
27
What are the common side effects of MAOIs?
Weight gain Dry mouth Constipation Headache Low libido Drowsiness Insomnia Seizures
28
What are the contraindications of MAOIs?
Cerebrovascular disease Severe liver disease Mania
29
What are the three main mood stabilisers?
Litium Sodium valproate Carbamazipine
30
How long does it take for antidepressants to begin to work?
2-3 weeks
31
What is the gold standard treatment for bipolar disorder?
Lithium
32
When is lithium used clinically?
Acute mania Prophylaxis in bipolar disorder Treatment resistant depression Adjunct to antipsychotics
33
What are some of the side effects associated with lithium?
Thirst Polyuria Weight gain Oedema Fine tremor Skin problems Concentration and memory problems Hypothyroidism
34
What drugs can cause increased lithium levels in the body?
NSAIDs ACE inhibitors Diuretics
35
What are the symptoms of lithium toxicity?
Nausea Vomiting Course tremor Ataxia Muscle weakness Nystagmus Dysarthria Drowsiness Very toxic levels - confusion, seizures, coma
36
When do lithium levels need monitored?
Weekly until theraputic level has been stable for 4 weeks Following this, lithium levels every 3 months Renal function and TFTs every 6 months
37
When are antipsychotic drugs used clinically?
Psychotic disorders: schizophrenia, schizoaffective disorder, delusional disorder Depression/mania with psychotic features Delirium
38
How do antipsychotic drugs work?
Blocking D2 dopamine receptors in the mesolimbic dopamine pathways
39
Generally, how do typical antipsychotic drugs differ in their mechanism of action from atypical antipsychotic drugs?
Typical: block all D2 receptors Atypical: less affinity for D2 receptors but also block 5-HT2a receptors
40
Which causes more extrapyramidal side effects, typical or atypical antipsychotics?
Typical, as they block all D2 dopamine receptors
41
What are examples of typical antipsychotics?
Haloperidol Flupentixol Sulpiride
42
What are examples of atypical antipsychotics?
Clozapine Olanzapine Rispiridone Quetapine Amisulpride
43
What are some of the extrapyramidal side effects associated with antipsychotic drugs?
Parkinsonian symptoms: muscle rigidity, bradykinesia, resting tremor Acute dystonia - involuntary sustained muscle contraction e.g. clenched jaw, eyes rolling up Akathisia - subjective feeling of restlessness Tardive dyskinesia - rhytmic involuntary movements e.g. chewing, protruding darting movements of the tongue
44
Other than extrapyramidal side effects, what other side effects are associated with antipsychotic drugs?
Anticholinergic: dry mouth, contsiptaion, urinary retention, blurred vision Alpha-adrenergic receptor blockade: postural hypotension Histaminergic receptor blockade: sedation, weight gain Cardiac effects: long QT syndrome, arrythmias Hyperprolactinaemia
45
What is neuroleptic malignant syndrome?
A life-threatening neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs
46
When does neuroleptic malignant syndrome most frequently occur?
4-11 days after starting antipsychotic treatment or after a change in dose
47
How does neuroleptic malignant syndrome present?
Motor signs: severe muscle rigidity Mental signs: fluxuation in levels of consciousness Autonomic disturbance: sweating, hyperthermia, unstable BP, rapid pulse
48
What would blood tests show in neuroleptic malignant syndrome?
Abnormal LFTs Raised creatine kinase levels
49
How is neuroleptic malignant syndrome treated?
Immediately stop antipsychotics A&E admittance
50
Which antipsychotic tends to cause agranulocytosis?
Clozapine
51
Which antipsychotic drugs tends to cause weight gain and increased prolactin?
Rispiridone
52
Which antipsychotic drug has a particularly high risk of causing weight gain, diabetes and sedation?
Olanzapine
53
What are some examples of benzodiazepines?
Lorazepam Temazepam Diazepam Chlordiazepoxide
54
Why are lorazepam and tempazepam known as hypnotics?
They are short acting
55
Why are diazepam and chlordiazepoxide known as anxiolytics?
They have long half lives
56
What is the main action of benzodiazepines?
They potentiate the action of GABA which is the main inhibitory neurotransmitter in the brain
57
How can benzodiazepines be used clinically?
Used in acute anxiety for rapid relief of symptoms Insomnia Siezures Anaesthetic Alcohol withdrawl Tranqulisation in psychosis Mania Can be used as: - hypnotics - anxiolytics - anticonvulsants - muscle relaxants
58
How are benzodiazepines used in anxiety?
For rapid relief of symptoms Start benzodiazepines and SSRIs at the same time to combat rebound SSRI anxiety Remove benzodiazepines - usually not used for more than 4 weeks
59
Why are benzodiazepines only used in the short term?
Risk of dependance and withdrawl
60
What are the side effects of benzodiazepines?
Drowsiness Ataxia Headaches Confusion Respiratory depression (in IV dose) Dependence
61
What is the antedote for a benzodiazepine overdose?
Temazenil
62
Which drugs enhance the effect of benzodiazepines?
Alcohol Opiates Tricyclic antidepressants Antihistamines
63
Which antipsychotic drug can cause a characteristic blue-grey discolouration of the skin?
Chlorpromazine
64
What drug is used for alcohol withdrawl in most medical units?
Chlordiazepoxide
65
When is use of ECT indicated?
Catatonia Severe depression Prolonged or severe mania
66
Which psychiatric drug is most likely to cause symptoms of hypothyroidism?
Lithium

Psychiatry (10 decks)

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