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Psychiatry > Pharmacology > Flashcards

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
Q

What foods should be avoided in use with MAOIs?

A

Cheese, especially mature cheeses

Wines and beer

Smoked fish

Chicken liver

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26
Q

Which drugs should be avoided in use of MAOIs?

A

Anaesthetics

Certain components of cough medicine

Cocaine

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27
Q

What are the common side effects of MAOIs?

A

Weight gain

Dry mouth

Constipation

Headache

Low libido

Drowsiness

Insomnia

Seizures

28
Q

What are the contraindications of MAOIs?

A

Cerebrovascular disease

Severe liver disease

Mania

29
Q

What are the three main mood stabilisers?

A

Litium

Sodium valproate

Carbamazipine

30
Q

How long does it take for antidepressants to begin to work?

31
Q

What is the gold standard treatment for bipolar disorder?

32
Q

When is lithium used clinically?

A

Acute mania

Prophylaxis in bipolar disorder

Treatment resistant depression

Adjunct to antipsychotics

33
Q

What are some of the side effects associated with lithium?

A

Thirst

Polyuria

Weight gain

Oedema

Fine tremor

Skin problems

Concentration and memory problems

Hypothyroidism

34
Q

What drugs can cause increased lithium levels in the body?

A

NSAIDs

ACE inhibitors

Diuretics

35
Q

What are the symptoms of lithium toxicity?

A

Nausea

Vomiting

Course tremor

Ataxia

Muscle weakness

Nystagmus

Dysarthria

Drowsiness

Very toxic levels - confusion, seizures, coma

36
Q

When do lithium levels need monitored?

A

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
Q

When are antipsychotic drugs used clinically?

A

Psychotic disorders: schizophrenia, schizoaffective disorder, delusional disorder

Depression/mania with psychotic features

Delirium

38
Q

How do antipsychotic drugs work?

A

Blocking D2 dopamine receptors in the mesolimbic dopamine pathways

39
Q

Generally, how do typical antipsychotic drugs differ in their mechanism of action from atypical antipsychotic drugs?

A

Typical: block all D2 receptors

Atypical: less affinity for D2 receptors but also block 5-HT2a receptors

40
Q

Which causes more extrapyramidal side effects, typical or atypical antipsychotics?

A

Typical, as they block all D2 dopamine receptors

41
Q

What are examples of typical antipsychotics?

A

Haloperidol

Flupentixol

Sulpiride

42
Q

What are examples of atypical antipsychotics?

A

Clozapine

Olanzapine

Rispiridone

Quetapine

Amisulpride

43
Q

What are some of the extrapyramidal side effects associated with antipsychotic drugs?

A

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
Q

Other than extrapyramidal side effects, what other side effects are associated with antipsychotic drugs?

A

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
Q

What is neuroleptic malignant syndrome?

A

A life-threatening neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs

46
Q

When does neuroleptic malignant syndrome most frequently occur?

A

4-11 days after starting antipsychotic treatment or after a change in dose

47
Q

How does neuroleptic malignant syndrome present?

A

Motor signs: severe muscle rigidity

Mental signs: fluxuation in levels of consciousness

Autonomic disturbance: sweating, hyperthermia, unstable BP, rapid pulse

48
Q

What would blood tests show in neuroleptic malignant syndrome?

A

Abnormal LFTs

Raised creatine kinase levels

49
Q

How is neuroleptic malignant syndrome treated?

A

Immediately stop antipsychotics

A&E admittance

50
Q

Which antipsychotic tends to cause agranulocytosis?

51
Q

Which antipsychotic drugs tends to cause weight gain and increased prolactin?

A

Rispiridone

52
Q

Which antipsychotic drug has a particularly high risk of causing weight gain, diabetes and sedation?

A

Olanzapine

53
Q

What are some examples of benzodiazepines?

A

Lorazepam

Temazepam

Diazepam

Chlordiazepoxide

54
Q

Why are lorazepam and tempazepam known as hypnotics?

A

They are short acting

55
Q

Why are diazepam and chlordiazepoxide known as anxiolytics?

A

They have long half lives

56
Q

What is the main action of benzodiazepines?

A

They potentiate the action of GABA which is the main inhibitory neurotransmitter in the brain

57
Q

How can benzodiazepines be used clinically?

A

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
Q

How are benzodiazepines used in anxiety?

A

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
Q

Why are benzodiazepines only used in the short term?

A

Risk of dependance and withdrawl

60
Q

What are the side effects of benzodiazepines?

A

Drowsiness

Ataxia

Headaches

Confusion

Respiratory depression (in IV dose)

Dependence

61
Q

What is the antedote for a benzodiazepine overdose?

62
Q

Which drugs enhance the effect of benzodiazepines?

A

Alcohol

Opiates

Tricyclic antidepressants

Antihistamines

63
Q

Which antipsychotic drug can cause a characteristic blue-grey discolouration of the skin?

A

Chlorpromazine

64
Q

What drug is used for alcohol withdrawl in most medical units?

A

Chlordiazepoxide

65
Q

When is use of ECT indicated?

A

Catatonia

Severe depression

Prolonged or severe mania

66
Q

Which psychiatric drug is most likely to cause symptoms of hypothyroidism?

Psychiatry (10 decks)

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