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Psychiatry > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Name the SSRIs.

A 
Fluoxetine
Setraline
Citalopram
Escitalopram
Paroxetine
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2
Q

What is the mechanism of action of the SSRIs?

A

Specifically inhibit serotonin reuptake at the pre-synaptic membrane, increasing the serotonin concentration in the synaptic cleft.

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3
Q

What are some advantages of using an SSRI over other types of anti-depressants?

A

Less sedating
Fewer anti-muscarinic effects
Lower risk of cardiotoxicity
Safer in overdose

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4
Q

What are some ADRs of SSRIs?

A

GI disturbances (nausea, vomiting, dyspepsia, diarrhoea, constipation, abdominal pain)
Altered appetite
Drowsiness OR insomnia
Sexual dysfunction

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5
Q

Name the TCAs.

A

Amitryptilline
Imipramine
Lofepramine
Nortryptilline

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6
Q

What is the mechanism of action of the TCAs?

A

Inhibit reuptake of serotonin and NA at the pre-synaptic membrane, increasing their concentrations in the synaptic cleft.

Also block serotonergic, alpha-adrenergicm histaminic and muscarinic receptors.

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7
Q

What are some ADRs of TCAs?

A

Sedation, weight gain, dry mouth, constipation, urinary retention, blurred vision, tachycardia, arrythmias, nausea, drowsiness.

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8
Q

What are the PK of TCAs? (absorption/metabolism)

A

Absorbed by the gut
Lipid soluble
Metabolised by the liver

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9
Q

What are the PK of SSRIs? (absorption/metabolism)

A

Almost completely absorbed from gut and metabolised by liver

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10
Q

Give an example of a NaSSA.

A

Mirtazapine

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11
Q

What is the mechanism of action of mirtazapine?

A

Enhances serotonin and NA neurotranmission.

Also classed as a TCA as well as a NaSSA

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12
Q

What are the indications for mirtazapine?

A

Severe depression, PTSD

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13
Q

What are some contra-indications for mirtazapine?

A

Renal impairment
Pregnancy
Hepatic impairment
Jaundice

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14
Q

What are the ADRs of mirtazapine?

A 
Weight gain
Sedation
Hallucinations 
Confusion
Mania
Postural hypotension
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15
Q

Name the SNRIs.

A

Venlafaxine

Duloxetine

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16
Q

What is the mechanism of action of SNRIs?

A

Inhibit the re-uptake of serotonin and noradrenaline at the pre-synaptic membrane, increasing their concentration at the synaptic cleft.

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17
Q

What are the ADRs of SNRIs?

A

Same as SSRIs (GI disturbances, appetite changes, sleep disturbances)
PLUS increased BP, dry mouth, hyponatraemia

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18
Q

Name the MAOIs.

A

Isocarboxacid

Phenelzine

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19
Q

What is the mechanism of action of the MAOIs?

A

Inhibit the enzyme monoamine oxidase.
Prevents inactivation of monoamines (serotonin, NA, dopamine) within the neurone, causing excess neurotransmitter to diffuse into the synaptic cleft.

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20
Q

Why are MAOIs not often used?

A

Drug-food interactions -
MAOIs also inhibit the breakdown of tyramine, a chemical found in cheese. In excess, tyramine causes the release of large amounts of catecholamines, resulting in a hypertensive crisis.

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21
Q

What are the signs/symptoms of a hypertensive crisis?

A 
HYPERTENSION
Occipital headache
Stiff neck
Tachycardia
Nausea
Cardiac arrythmias
Seizures
Stroke
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22
Q

Name the typical antipsychotics.

A

Haloperidol

Chlorpromazine

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23
Q

Name the atypical antipsychotics.

A 
Olanzapine
Risperidone
Clozapine
Quetiapine
Aripiprazole
Paliperidone
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24
Q

What is the mechanism of action of antipsychotics?

A

Inhibition of the dopamine D2 receptors in the CNS (some have actions at other receptors as well)

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25
Q

What is the difference between the atypical and typical antipsychotics?

A

Atypical antipsychotics produce fewer EP signs and are more effective at treating the negative symptoms of schizophrenia.

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26
Q

What are the indications for clozapine?

A

Treatment resistant schizophrenia

  • Failure of 2 antipsychotics
  • One of which should be an atypical antipsychotic
  • Over 6-8 weeks each
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27
Q

What are the side effects of clozapine?

A

AGRANULOCYTOSIS
(Requires regular haemotological monitoring)
Myocarditis

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28
Q

What are the side effects of typical antipsychotics?

A

Extrapyramidal signs:

dystonia, akathisia, Parkinson like symptoms (tremor, muscular rigidity, bradykinesia), tardive dyskinesia

29
Q

What are the side effects of atypical antipsychotics?

A

Excessive weight gain (esp. olanzapine)
Increased prolactin secretion (risperidone)
EPSE (less common)
Postural hypotension
Cardiac toxicity (long QT syndrome and therefore increased risk of Torsades de Pointes)

30
Q

What is the mechanism of action of the benzodiazepines?

A

Agonist at GABA-A receptors

GABA is the major inhibitory neurotransmitter in the CNS

31
Q

What are the indications of benzos?

A

SHORT TERM use for anxiety disorders

Alcohol detoxification

32
Q

What are the ADRs of benzos?

A 
Drowsiness
Light headedness
Ataxia
Confusion
Amnesia
33
Q

What are the indications for beta-blockers (in a psychiatric setting)?

A

Patients who have predominantly the somatic, autonomic symptoms of an anxiety disorder, e.g. tachycardia, tremor.

34
Q

What is buspirone and what is it indicated for?

A

5-HT 1A agonist

Generalsed anxiety disorder (short term use only)

35
Q

What are the contraindications of buspirone?

A

Epilepsy

Acute porphyria

36
Q

What are the side effects of buspirone?

A

Light headedness
Dizziness
Nausea

37
Q

What is the mechanism of the barbiturates?

A

Agonist of the GABA-A receptors (distinct binding site from the benzos)

38
Q

What is the mechanism of action of pregabalin?

A

Inhibits glutamate, noradrenaline and substance P

39
Q

What is pregabalin indicated in?

A

Generalised anxiety disorder

Neuropathic pain

40
Q

What are some side effects of pregabalin?

A

Dizziness, drowsiness, blurred vision, diplopia, confusion, vivid dreams

41
Q

Name the benzodiazepine antagonist.

A

Flumazenil

IV only

42
Q

Name the hypnotic agents.

A

Zopiclone
Zolpidem
Zalepon

43
Q

What is the mechanism of action of the hypnotic agents?

A

Act on the GABA-A complex

44
Q

Name the acetylcholinesterase inhibitors.

A

Donepezil
Galantamine
Rivastigmine

45
Q

What are the indications for acetylcholinesterase inhibitors?

A

Mild to moderate dementia related to Alzheimer’s disease

46
Q

What are the side effects of acetylcholinesterase inhibitors?

A

Nausea, vomiting
Gastric and duodenal ulcers
Syncope
Bradycardia, AV block, MI

47
Q

What are the contra-indications for acetylcholinesterase inhibitors?

A

Renal impairment (galantamine)
Cardiac disease
Peptic ulcer disease

48
Q

Name the NMDA antagonist.

A

Memantine

49
Q

What are the indications for memantine?

A

Moderate to severe dementia related to Alzheimer’s disease

50
Q

What are the side effects of memantine?

A 
Constipation
Hypertension
Seizures
Dizziness
Depression
51
Q

What are the contra-indications of memantine?

A

Renal impairment

Seizure history

52
Q

What is the mechanism of action of disulfiram?

A

Inhibition of acetaldehyde dehydrogenase.

If taken with alcohol, causes facial flushing, headache, palpitations, nausea and vomiting, etc.

53
Q

What are the side effects of disulfiram?

A

Fatigue

Reduced libido

54
Q

What are the contra-indications of disulfiram?

A

CVS disease
Hypertension
Previous CVA
Psychosis

55
Q

What is the mechanism of acamprosate?

A

Reduces the conditioned aspects of drinking

Prevents craving induced relapses

56
Q

What are the side effects of acamprosate?

A

GI disturbance

Rash

57
Q

What are the contra-indications of acamprosate?

A

Severe hepatic/renal failure

58
Q

Name the mood stabilisers.

A

Lithium, sodium valproate, lamotrigine, carbamazepine

59
Q

What monitoring is required with sodium valproate?

A

Serum levels when indicated
Annual TFT
6 monthly LFT and FBC

60
Q

What are some side effects of sodium valproate?

A

Tremor, sedation, GI disturbances, headache, thrombocytopenia, hair loss

61
Q

What monitoring is required with carbamazepine?

A

6 monthly serum levels

LFTs, U&Es, FBCs and annual TFTs

62
Q

What are some side effects of carbamazepine?

A

Dizziness, visual disturbances, hyponatremia, oedema, GI disturbances, rashes

63
Q

What are some contra-indications of carbamazepine?

A

AV node abnormalities
History of bone marrow suppression
Acute porphyria

64
Q

What monitoring is required with lithium?

A

Serum concentration after one week, then one week after every change in dose

(Serum level is aimed at 0.4-0.8 mmol/L)

6 monthly TFT and U&E

65
Q

What are the indications for lithium?

A

Prophylaxis and treatment of mania, hypomania and depression in bipolar disorder
Prophylaxis and treatment of recurrent unipolar depression

66
Q

What are the side effects of lithium?

A

Diabetes insipidus like syndrome, nausea/GI disturbances, weight gain, FINE tremor, leukocytosis, ECG changes, metallic taste in mouth.

67
Q

What ECG changes may be seen with lithium?

A

Flattened T waves

Wide QRS complexes

68
Q

What are some contra-indications for lithium?

A

Low sodium diet
Addison’s disease
Untreated hypothyroidism
Cardiac rhythm disorder

69
Q

What are some signs of lithium toxicity?

A 
COARSE tremor
Ataxia
Dysarthria
Reduced level of consciousness
Convulsions
Coma

Psychiatry (2 decks)

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