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Psychiatry > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Explain the acute treatment of depression using biopsychosocial model

A
  1. Bio:
    Mild - watchful waiting
    Severe - ECT
  2. Psycho:
    Exercise, behavioural activation, self-help, computer CBT, psycho-education, CBT/IPT
  3. Social:
    Housing, finance, exercise, socialisation
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2
Q

What is the chronic treatment of depression using the biopsychosocial model?

A 
1. Bio:
Antidepressants, antipsychotics, mood stabilisers
2. Psycho:
CBT/IPT
Psychoanalysis
3. Social:
daily activities, housing etc
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3
Q

Explain the specific drug regimen for treating depression

A
  1. SSRI
  2. Dose escalation
    • switch or augmentation
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4
Q

What is the 1st line drug treatment for depression?

A

SSRIs - fluoxetine, citalopram, sertraline

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5
Q

explain how SSRIs work

A

increase serotonin levels in the brain

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6
Q

What are the CIs of SSRIs

A 
not in <18 (except fluoxetine)
epilepsy
DM
Cardiac disease 
Pregnancy 
ECT
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7
Q

What are the features of serotonin syndrome

A 
restless
fever
tremor
myoclonus
confusion
fits
arrhythmias
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8
Q

What are the SEs of SSRIs

A

GI: N&V, appetite/weight change
Eyes: blurred vision
Psychological: anxiety, agitation, insomnia

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9
Q

What are risks associated w SSRIs?

A

Increased suicide risk - check at two weeks

Serotonin syndrome

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10
Q

What are other categories of antidepressants that aren’t 1st line

A

MAOIs (phenelzine)
TCAs (amitriptyline)
SNRIs (venlafaxine)

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11
Q

What are MAOIs? How do they work?

A

monoamine oxidase inhibitors

serotonin is usually broken down by monoamine oxidase, so by inhibiting MAO, more serotonin is available

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12
Q

What is a hypertensive crisis and which drug is it associated w?

A

MAOI

When taking tyramine containing foods - cheese, red wine, bovril

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13
Q

What is the acute treatment of schizophrenia using biopsychosocial model

A
  1. Bio - antipsychotics
  2. Psycho - CBT, fam intervention
  3. Social - psychoeducation, care plan
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14
Q

What is the chronic treatment of schizophrenia using biopsychosocial model

A 
1. Bio:
antipsychotics
antidepressants
lithium
2. Psycho:
CBT
Art therapy, concordance therapy
3. Social:
etc
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15
Q

What are the two main therapeutic effects of anti-psychotics?

A
  1. tranquillising (hrs)

2. anti-psychotic effects (days/weeks)

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16
Q

Give examples of the different generations of anti-psychotics

A

1st - chlorpromazine, haloperidol

2nd - clozapine, quetiapine, olanzapine, risperidone

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17
Q

Which SGA has the greatest efficacy?

A

Clozapine

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18
Q

Which generation of antipsychotics are typical;?

A

1st

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19
Q

How do 1st gen antipsychotics work?

A
  1. Blocks post-synaptic dopamine 2 receptors
  2. This results in the dopamine being re-uptaken and causing down regulation of it’s release
  3. This reduces the transmission at the post-synaptic receptors
  4. Reduction in mesolimbic and mesocortical dopamine levels reduces psychotic symptoms
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20
Q

How do 2nd gen antipsychotics work

A
  1. Blocks post-synaptic dopamine 2 receptors/5HT2A
  2. This results in the dopamine re-uptake and causing down regulation of its release
  3. This reduces the transmission as the post-synaptic receptors
    Reduction in mesolimbic and mesocortical dopamine levels reduces psychotic symptoms
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21
Q

What are the extra-pyramidal SE of antipsychotics?

A 
Acute: Parkinsonism
Dystonia: spasms, torticollis
Akathasia - restlessness
Chronic:
Tardive dyskinesia - choreoathetoid movements
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22
Q

What hormone do anti-psychotics have an effect on and what sx does this cause?

A

Prolactin:

amenorrhoea, galactorrhoea, gynaecomastia, impotence, weight gain, osteoporosis

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23
Q

What are anti-adrenergic SE of anti-psychotics?

A

postural hypotension

sexual dysfunction

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24
Q

What are anti-histamine SE of anti-psychotics?

A

sedation

anti-emetic

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25
Q

What investigations should be performed before starting antipsychotics?justify Cardiac ones

A

FBC, U&E, LFT, RBS/HbA1c, prolactin, lipids + cholesterol
Physical: weight, BP. pulse
ECG: risk of prolonged QTc/arrythmias

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26
Q

When should clozapine be prescribed

A

When two other diff treatments have failed (incl. one non-clozapine SGA)

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27
Q

What is a major SE of clozapine to be aware of? Give others

A 
AGRANULOCYTOSIS (low wbc)
myocarditis
weight gain
salivation
seizures
sedation
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28
Q

What is depot?When are they used?

A

IM slow release anti-psychotic prep

Used when poor compliance

29
Q

What are the main 2 mood stabilisers?

A

lithium

sodium valproate

30
Q

What is lithium indicated in?

A

mania/bipolar prophylaxis

recurrent depression

31
Q

What is sodium valproate indicated in?

A

• Manic episodes in bipolar
• Migraine prophylaxis
All forms of epilepsy

32
Q

What is dystonia?

A

sustained or repetitive muscle contractions result in twisting and repetitive movements or abnormal fixed postures.

33
Q

What is torticollis?

A

abnormal, asymmetrical head or neck position

aka wry neck

34
Q

What is tardive dyskinesia?

A

disorder that results in involuntary repetitive body movements including:
grimacing, sticking out the tongue, or smacking the lips

35
Q

What is found in blood results in agranulocytosis

A

low wbc

36
Q

How do SE of first generation and second generation antipsychotics compare?

A

first - mainly extrapyramidal sx + raised prolactin

second - weight gain, hyperglycaemia

37
Q

What is the first line treatment for bipolar disorder?

A

lithium

38
Q

Why does lithium require regular monitoring?

A

lithium toxicity can occur

39
Q

What level of lithium usually indicates toxicity?

A

> 1.5

40
Q

What is the therapeutic window of lithium,?

A

0.4-1

41
Q

What are early SEs of lithium?

A 
dry mouth 
metallic taste
nausea
fine tremor
fatigue
polyuria
polydipsia
42
Q

What are late SEs of lithium?

A 
Diabetes insipidus
hypothyroidism
arrhythmias
ataxia
dysarthria
weight gain 
teratogenic
43
Q

What is the first line treatment for GAD?

A

sertraline

44
Q

What other drugs can be used for GAD?

A

venlafaxine (SNRI)

45
Q

What drugs can be used for short term relief of severe anxiety?

A

benzodiazepines - lorazepam, diazepam, midazolam

46
Q

How do benzodiazepines work?

A

agonist of GABA, main inhibitory neurotransmitter in the brain,

47
Q

What is neuroleptic malignant syndrome?

A

life threatening antipsychotic induced disorder requiring immediate treatmetn

48
Q

What are the sx of NMS?

A

⎫ Fever
⎫ Muscle rigidity
⎫ Delirium
⎫ Autonomic instability ( BP, anxiety, diplopia, dizziness)

49
Q

What Ix indicates NMS?

A

Raised creatine kinase

50
Q

What is the management of NMS?

A

Stop causative factor
supportive measures
treat rhabdomyolysis

51
Q

What is rhabdomyolysis?

A

Rapid breakdown of damaged skeletal muscle

52
Q

What is rx of rhabdomyolysis?

A

aggressive rehydration to promote renal clearance of released intracellular muscular toxins)

53
Q

What are sx of rhabdomyolysis?

A

muscle pains, weakness, vomiting, confusion

54
Q

What Is associated w an oculogyric crisis?

A

acute dystonic reaction as a SE of anti-psychotics

55
Q

What is this “Stopping of voluntary movement or staying still in an unusual position”

A

catatonia

56
Q

What needs to be done if doses of clozapine is missed?

A

If clozapine doses are missed for more than 48 hours the dose will need to be restarted again slowly

57
Q

What are the main anxiolytics?

A

Benzodiazepines - lorazapem, diazepam

Beta-blockers - propanolol

58
Q

What is a short term anxiolytic drug?

A

lorazepam

59
Q

What is a long term anxiolytic drug?

A

Diazepam

60
Q

How do beta-blockers work for anxiety?

A

reduce autonomic symptoms

61
Q

How is Parkinsonism treated w as a SE of antipsychotic?

A

procyclidine

62
Q

How is tardive dyskinesia treated as a SE of antipsychotics?

A

tetrabenazine

63
Q

What Benz is used in alcohol withdrawal?

A

chlordiazepoxide

64
Q

What are examples of z drugs?

A

zopiclone, zolpidem

65
Q

What are hypnotics?

A

benzos, z drugs, melatonin

66
Q

What are withdrawal effects of hypnotics?

A 
sleep disturbance
irritability
seiozures
breakthrough anxiety 
resp depression
67
Q

What are hypnotics NOT used in?

A

GAD

68
Q

wHAT ARE EFFECTS OF RITALIN?

A

appetite suppression, psychosis, measure growth (may be stunted)

Psychiatry (21 decks)

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