Pharmacology Flashcards
What are the pharmalogical effects of benzodiazepines?
- reduce anxiety and aggression
- hypnosis/sedation
- muscle relaxation
- anticonvulsant effect
- anterograde amnesia
What are the clinical uses of benzodiazepines?
- Acute treatment of extreme anxiety
- Hypnosis
- Alcohol withdrawal
- Mania
- Delirium
- Rapid tranquillisation
- Premedication before surgery or during minor procedures
- Status epilepticus
How do antidepressants work?
Increase monoamine neurotransmitters (5-HT/serotonin, dopamine and noradrenaline) in the synaptic cleft
What are the three main types of antidepressant?
SSRI
Tricyclics
MAOIs
What are examples of tricyclic antidepressant?
Amitriptilline and clomiprimine
How do tricyclic antidepressants work?
Act on the presynaptic terminal to block the re-uptake of noradrenaline and serotonin, increasing avaliability of these neurotransmitters
When are tricyclic antidepressants used?
Depression
Anxiety disorders
Chronic pain
Insomnia
Migraines
What are the side effects associated with tricyclic antidepressants?
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
What are some of the contraindications for TCAs?
Recent MI
Arrythmias
Heart block
Liver disease
Mania
What are some examples of SSRIs?
Fluoxetine
Sertraline
Citalopram
Paroxetine
What is the mode of action of SSRIs?
Presynaptic blockade of 5-HT reuptake
When are SSRIs used?
Depression
Panic disorder
Social anxiety disorder
Stroke recovery
OCD
Chornic pain
Premature ejaculation
Bulimia (fluoxetine)
What are the first line antidepressants?
SSRIs
Which antidepressant is often used in bulimia nervosa?
Fluoxetine
What are the side effects associated with SSRIs?
GI: nausea, vomiting, diarrheoa
Initial rebound anxiety
Increased appetite
Weight changes
Sexual dysfunction
Insomnia
Hyponatremia
What is the main contraindication for SSRI use?
Mania
What is serotonin syndrome?
A rare but potentially fatal consequence of excess serotonin on the CNS
How does serotonin syndrome present?
Altered mental state
Agitation
Tremor
Shivering
Diarrheoa
Hyperreflexia
Rigidity
Myoclonus
Ataxia
Hyperthermia
What are the causes of serotonin syndrome?
Medication:
SSRIs
Amphetamines
Opiods
5-HT antagonists
Lithium
What investigations should be done if serotonin syndrome suspected?
Bloods
ECG
Drug screen
What are some examples of MAOIs?
Phenelzine
Tranylcypromine
What is the mode of action of MAOIs?
Non-selective irreversible inhibition of monoamine oxidase A and B, which act to break down monoamine neurotransmitters
Why is use of MAOIs avoided?
Serious risk of drug and food interactions causing tyramine crisis
What is tyramine crisis?
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
What foods should be avoided in use with MAOIs?
Cheese, especially mature cheeses
Wines and beer
Smoked fish
Chicken liver
Which drugs should be avoided in use of MAOIs?
Anaesthetics
Certain components of cough medicine
Cocaine