Pharmacology Flashcards
What class do the neurotransmitters NA and seritonin 5-HT belong to?
monoamines
Noradrenaline pathways in the brain are widely distributed. T or F
true
Where do the NA pathways of the brain originate?
brainstem
What primitive features does NA have a role in?
arousal and emotion
Serotonin pathways are widely distributed through the cortexes and subcortical areas. T or F
true
Where do the serotonin 5-HT pathways of the brain originate?
brainstem
Serotonin 5-HT has a role in mood, sleep, feed, behaviour, sensory perception and analgesia. T or F
true
What non psychiatric disorder can antidepressants be prescribed for?
neuropathic pain
migraine
What is the 1st line antidepressant?
there isn’t one. match to patient’s needs - but generally its a SSRI
Give examples of MAOIs monoamine oxidase inhibitors?
phenelzine, moclobemide
Typical antidepressants act at the _____ and include the classes _____, ______, _____ and ______. Atypical antidepressants act at the ______.
Typical antidepressants act at the synapse and include the classes MAOIs, SSRIs, SNRIs and tricyclics. Atypical antidepressants act post-synaptically.
What must you be mindful of when prescribing MAOIs and why?
PTx cannot eat foods containing tyramine (cheese, venison, red wine etc.) since can cause hypertensive crisis
How would a hypertensive crisis due to eating tyramine when taking MAOIs present?
headache
SOB
nosebleed
Give examples of MAOI SEs
insomnia
postural hypotension
peripheral edema
What is the mechanism of tricyclics?
non-selectively inhibit monoamine reuptake
Give examples of tricyclic antidepressants
amitriptyline
dosulepin
imipramine
lofepramine
What are the contraindications to tricyclics?
elderly / cognitive impairment
suicidal intent - is this true?
Can you overdose on tricyclics?
yes - OD is cardiotoxic
What are some side effects of tricyclic antidepressants
anticholinergic SEs sedation weight gain arrhythmia postural hypotension
Give examples of anticholinergic side effects
blurred vision constipation dry mouth urinary retention sweating
What is the mechanism of SSRIs?
inhibit serotonin 5-HT reuptake at synaptic cleft to increase extracellular 5-HT conc
Can you OD on SSRIs?
SSRIs have no OD risk
Give examples of SSRIs
fluoxetine citalopram paroxetine escitalopram sertraline
What are the side effects of SSRIs
nausea HA sweat vivid dream anxiety/agitation sex
Give examples of SNRIs
venlafaxine, duloxetine
What is the mechanism of SNRIs
non-selectively block reuptake to presynaptic terminal
What are the side effects of SNRIs
Same as SSRIs but more likely
What drug class are reboxetine and maprotiline in?
antidepressants - NA reuptake inhibitor
What receptor does agomelatine act on?
melatonin receptors
What is the mechanism of mirtazapine?
blocks alpha-2 & 5-HT receptors post-synaptically
What are the side effects of mirtazapine?
weight gain
sedation (hence good for insomnia)
Buproprion is an atypical antidepressant. Its mechanism is a ____ uptake inhibitor
dopamine uptake inhibitor
Which mood stabiliser blocks the phosphatidylinositol pathway or inhibits glycogen synthase kinase 3β?
lithium
Lithium has a ____ therapeutic index
narrow
Does lithium cause weight gain or weight loss?
weight gain
What should you monitor when prescribing lithium?
U+E, TFT, ECG
Side effects of lithium?
dry mouth strange taste polydipsia/uria tremor hypothyroid renal nephrogenic DI
How does lithium toxicity present?
V, diarrhea, coarse ataxic tremor, drowsy, convulsion, coma
What is the general mechanism of typical antipsychotics?
block D2 receptors in nigrostriatum
Give examples of typical antipsychotics
Haloperidol, chlorpromazine, thioridazine, fluphenazine
What side effect of typical antipsychotics can take years to present?
tardrive dyskinesia (orofacial)
What hormone disturbance can occur as a side effect of typical antipsychotics and how would this present?
> PRL
gynaecomastia, galactorrhea, ED,
What side effect of typical antipsychotic occurs soon after beginning the drug, and is managed with anticholinergics?
acute dystonic reaction
What side effect of typical antipsychotics is managed by decreasing the dose or adding an anti-acetylcholinesterase?
Parkinsonism extra-pyramidal
Typical antipsychotics cause sedation. T or F
true
Are typical or atypical antipsychotics better for the negative symptoms of schizophrenia?
atypical
Give examples of atypical antipsychotics
quetiapine, clozapine, olanzapine, risperidone, aripiprazole, olanzapine
Atypical antipsychotics block histamine that leads to which side effects?
sedation
increased appetite/wt
Atypical antipsychotics block Na that leads to which side effects?
postural hypotension
What is one of the main side effects from atypical antipsychotics?
metabolic synd
What is the most effective antipsychotic drug?
clozapine
What are the side effects of clozapine?
agranulocytosis
>saliva
myocarditis
weight gain
How do you monitor clozapine to prevent agranulocytosis
FBC once a week for 6 months. then every 2 weeks
Which anticonvulsants can be used as antipsychotics?
valproate
lamotrigine
carbamazepine
What are the side effects of lamotrigine?
SJS stevent johnson synd
diarrhoea/vomiting
What are the side effects of carbamazepine?
drowsy, ataxic, CVD, induces liver enzymes
What is the mechanism of valproate?
> GABA
What are contraindications to valproate?
female of child-bearing age since neural tube defect teratogen
Name 5 types of anxiolytics
benzos pregabalin beta-blockers buspirone barbituates
What is the general mechanism of benzos?
> GABA inhibition at GABA-A receptor
Do benzos have a rapid or slow onset?
rapid onset
Can you overdose on benzos?
no
What effect do benzos have on muscle?
relaxation
Name 3 examples of benzos?
lorazepam
diazepam (valium)
chlordiazepoxide
Do benzos increase or decrease aggression?
decrease
Are benzos sedative?
yes
What effect do benzos have on depression?
worsen it
Benzos can cause psychosis, >HR, tremor, convulsion, sweat, confuse and agitation by what mechanism?
rapid withdrawal
What is the mechanism of pregabalin?
Ca2+ channel blocker, >GABA
Propanolol can be prescribed for ____ anxiety symptoms such as _____ and ____, in the _____ age range.
Propanolol can be prescribed for somatic anxiety symptoms such as palpitation and tremor, in the adult age range.
If a PTx taking an SSRI and experiences a loss of libido, what medication can you co-administer to prevent this?
buspirone