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Psychiatry SB > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

what are the two systems in the brain broadly and what neurochemical is involved in them

A

approach (appetitive) system = dopamine

aversive (defensive) system = seratonin

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2
Q

what is involved in the approach system

A

ventral striatum

dorsal striatum (movement)

amygdala (conditioning/ learning)

anterior cingulate (attention/ conflict/response selection)

orbitofrontal cortex (relative reward preference/ rule learning)

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3
Q

what is involved in the aversive system

A

NA / CRF / peptide transmitters

central nucleus of amygdala
hippocampus

ventroanterior and medial hypothalamus

periaqueductal gray matter

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4
Q

how do MAO inhibitors work

A

prevent the breakdown of dopamine, norepinephrine and serotonin

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5
Q

how do TCAs work

A

block the re-uptake of serotonin and norepinephrine

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6
Q

how do SSRIs work

A

block the re-uptake of serotonin

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7
Q

what are SSRIs and examples of them

A

Selective Serotonin Re-uptake Inhibitors

e.g. fluoxetine, paroxetine, citalopram, escitalopram, sertraline, fluvoxamine

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8
Q

how long does it take for SSRIs to work

A

2-3 weeks

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9
Q

MOA of SSRIs

A

1 - at baseline, 5-HT re-uptake is unaffected and the firing rate is normal
2 - with AD re-uptake of 5-HT is inhibited
3 - increased extracellular conc of 5-HT stimulated the 5-HT1a auto receptors to inhibit firing
4 - Chronic occupancy of the 5-HT1A receptor causes it to desensitize. This leads to a return of normal firing.
5 - facilitates serotonergic transmission in the presence of reuptake blockade.

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10
Q

S.E. of SSRIs

A 
GI dysfunction (nausea, dyspepsia, constipation, diarrhoea, abdo pain)
Short-term anxiety, agitation
Insomnia
Headache
Dizziness
Sexual dysfunction

In young patients, there is an increased risk of self harm in first few weeks

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11
Q

when should the use of SSRIs be avoided

A

in patients using NSAIDs, aspirin or warfarin

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12
Q

why do patients using TCAs at a high dose need an ECG

A

side effects include arrhythmias, heart block, tachycardia, syncope

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13
Q

what are the common side effects of TCAs

A

Constipation
Dry mouth
Blurred vision
Postural hypotension

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14
Q

what is the MOA of MAOIs

A

inhibit monoamine oxidase A and B

Increased storage and availability for release of 5-HT and NA

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15
Q

examples of MAOIs

A

phenelzine, isocarboxazid, tranylcypromine

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16
Q

when are MAOIs commonly used

A

3rd line or 4th line

17
Q

S.E. of MAOI

A

Tyramine is normally inactivated in the gut by MAO

Hypertensive crises can occur with tyramine-containing foods and some drugs

Sx = flushing, headache, increased BP

Tx = alpha blockade

18
Q

what S.E. do all anti-depressant drugs have

A

hypotension
drowsiness
increased appetite
weight gain

Acetylcholine receptor (muscarinic) Sx = 
dry mouth, constipation, blurred vision and difficulty initiating micturition
19
Q

why do you sometimes get extra-pyramidal side effects in anti-depressant treatment

A

antagonism of dopamine [DA] receptors (primarily D2 receptors)

20
Q

what is the main inhibitory neurotransmitter and what does it do

A

GABA

allows flow of either Cl- ions into the cell or K+ ions out of the cell
» causing hyperpolatisation

21
Q

what are Sx of withdrawal of benzodiazepine

A

confusion
toxic psychosis
convulsions

insomnia
anxiety 
loss of appetite/wt
tremor 
perspiration 
tinnitus
22
Q

what does chronic benzodiazepine do to the brain

A

chronic treatment causes ↓ response to GABA.

Withdrawal results in anxiety/convulsions possibly due to ↓ density of BZ receptors

23
Q

what is the correct way to withdraw benzodiazepines

A

1 . Transfer patient to equivalent daily dose of diazepam/chlordiazepoxide (longer acting) preferably taken at night

  1. Reduce dose every 2–3 weeks in steps of 2 or 2.5mg; if withdrawal symptoms occur, maintain this dose until symptoms improve
  2. Reduce dose further, if necessary in smaller steps; it is better to reduce too slowly rather than too quickly
  3. Stop completely; time needed for withdrawal can vary from about 4 weeks to a year or more
24
Q

how do SSRIs help in anxiety

A

increase extracellular 5-HT and have anxiogenic properties

25
Q

what do patients being treated with SSRI need to be informed about

A

they will feel worse initially

cover this period with benzo

Psychiatry SB (23 decks)

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