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pharmacology Flashcards

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1
Q

clinical uses of antidepressants

A 
moderate to severe depression 
dysthymia 
generalised anxiety disorder 
panic disorder, OCD, PTSD
premenstrual dysphoric disorder 
bulimia nervosa 
neuropathic pain
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2
Q

classes of antidepressants

A 
monoamine oxidase inhibitors 
tricylics 
non-selective reuptake inhibitors 
selective serotonin repute inhibitors 
noradrenaline reuptake inhibitors 
atypical drugs
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3
Q

which neurotransmitters are targeted by antidepressants

A

noradrenaline
serotonin
dopamine

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4
Q

describe the monoamine hypothesis

A

depression results from a functional deficit of monoamine transmitters, in particular serotonin and noradrenaline, therefore most drugs that treat depression act to increase monoaminergic transmission

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5
Q

examples of monoamine oxidase inhibitors

A

phenelzine

moclobemide

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6
Q

how do MAO-Is work

A

inhibit the action of MOA
serotonin/noradrenaline is not broken down
more serotonin/noradrenaline available for transport

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7
Q

side effects of MOA-Is

A 
hypertensive crisis 
potentiates actions of some other drugs 
insomnia 
postural hypotension 
peripheral oedema
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8
Q

what causes hypertensive crisis in MAO-Is and how can it be avoided

A

caused by inhibition of MAO-A in the gut by irreversible inhibitors preventing breakdown of dietary tyramine
avoid food like cheese, red wine, cured meats

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9
Q

examples of TCAs

A

imipramine
dosulepin
amitriptyline
lofepramine

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10
Q

mode of action of TCAs

A

block the reuptake of monoamines into presynaptic terminals

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11
Q

side effects of TCAs

A 
anti-cholinergic S/Es 
sedation 
weight gain
postural hypotension 
tachycardia 
arrhythmias 
cardiotoxic in OD
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12
Q

what are anti-cholinergic S/Es

A

blurred vision
dry mouth
constipation
urinary retention

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13
Q

examples of SSRIs

A

fluoxetine
citalopram/escitalopram
sertraline
paroxetine

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14
Q

mode of action of SSRIs

A

selectively inhibit reuptake of serotonin from the synaptic cleft

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15
Q

S/Es of SSRIs

A 
nausea
headache 
sweating
vivd dreams 
worsened anxiety 
sexual dysfunction 
transient increase in self-harm/suicidal ideation in <25 years
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16
Q

mode of action of SNRIs

A

block reuptake of monoamines (noradrenaline and serotonin) into presynaptic terminals

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17
Q

examples of SNRIs

A

venlafaxine

duloxetine

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18
Q

SE of SNRIs

A

similar to SSRIs

more limited SEs than TCAs

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19
Q

examples of atypical antidepressant

A

mirtazapine

bupropion

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20
Q

mode of action of atypical antidepressant

A

mixed receptor effects

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21
Q

why can it be beneficial to give mirtazapine alongside an SSRI

A

can block serotenergic side effects

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22
Q

acute aims of bipolar treatment

A

reduce mood in episodes of mania

raise mood in episodes of depression

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23
Q

long term aims of bipolar treatment

A

stabilise mood and prevent recurrence of both mania and depression

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24
Q

SEs of lithium

A 
dry mouth/strange taste 
polydipsia/polyuria 
tremor 
hypothyroidism 
reduced renal function 
nephrogenic DI
weight gain
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25
Q

symptoms of lithium toxicity

A 
vomiting 
diarrhoea 
ataxia/coarse tremor 
drowsiness
convulsions 
coma
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26
Q

which anticonvulsants can be used as mood stabilisers

A

valproic acid
lamotrigine
carbamazepine

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27
Q

which antipsychotics can be used as mood stabilisers

A

quetiapine
aripiprazole
olanzapine
lurasidone

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28
Q

what is the usual first line treatment of depression

A

SSRIs

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29
Q

what factors should be considered when choosing an anti-depressant

A 
previous response 
comorbidities and risk factors
patient preference 
safety in pregnancy/breastfeeding 
treatment of specific symptoms 
risk of overdose 
patient's willingness to adhere to monitoring
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30
Q

how long do antidepressants typically take to work

A

2-6 weeks

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31
Q

what combination of drugs can be used to treat psychotic depression

A

antidepressant and antipsychotic

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32
Q

define nonresponse to an antidepressant

A

no response or inadequate response after 6 weeks at the maximum BNF dose or highest tolerated dose

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33
Q

how long should antidepressants be continued for after full resolution of symptoms

A

6-12 months after a first episode
12-24 months for a recurrence
indefinitely if after a third episode

34
Q

what is the mainstay of treatment of bipolar disorder

A

mood stabilisers

eg lithium, anticonvulsants and antipsychotics

35
Q

lamotrigine is good for which bipolar symptoms

A

bipolar depression

36
Q

valproate is good for which bipolar symptoms

A

mania/hypomania

37
Q

which class of drugs should be avoided in bipolar

A

antidepressants, unless short term in severe depressive episode and always with a mood stabiliser

38
Q

why are antidepressant less effective in treating bipolar depression

A

they can cause switching to mania/hypomania or mood instability

39
Q

why should SSRIs be taken in the morning

A

to reduce insomnia

40
Q

which SSRI is safest to use in cardiac conditions

A

sertraline

41
Q

which SSRI is safest in epilepsy

A

citalopram

42
Q

which SSRI is associated with long QTc

A

citalopram

43
Q

why should TCAs be taken at night

A

due to sedation

44
Q

why should TCAs be avoided in patients with suicidal intent

A

cardiac toxicity in OD

45
Q

what other uses are there for TCAs

A 
neuropathic pain
OCD
anxiety disorders 
migraine prophylaxis 
nocturnal enuresis (bedwetting) 
cataplexy
46
Q

what class of drug is mirtazapine

A

noradrenergic and specific serotenrgic antidepressant

47
Q

when might mirtazapine be prescribed

A

insomnia
poor appetite
poor response to SSRI

48
Q

which drugs can be used in combination with mirtazapine

A

SSRIs

venlafaxine

49
Q

why should mirtazapine be taken at night

A

sedative effect

50
Q

why should mirtazapine not be mixed with alcohol

A

causes GI upset

51
Q

when should SNRIs be taken

A

in the morning to avoid insomnia

52
Q

examples of irreversible MAOIs

A

phenelzine

isocarboxazid

53
Q

examples of reversible MAOIs

A

moclobemide

54
Q

what is the difference between reversible and irreversible MAOIs

A

irreversible ones permanently block the action of MAO to prevent break down of monoamines
therefore cause more side effects
reversible MAOIs cause less side effects but are less effective

55
Q

why might there be difficulty with adherence in treatment with MOAIs

A

three times daily dosing

56
Q

why can MAOIs cause hypertensive crisis

A

tyramine is a potent releaser of noradrenaline leading to elevated BP
if MAO-A is inhibited and a high-tyramine meal is taken, noradrenaline can accumulate and cause hypertensive crisis

57
Q

symptoms of MAOI hypertensive crisis

A

headache
SOB
nosebleed
anxiety

58
Q

examples of high tyramine foods

A 
cheese
red wine 
dried/smoked/fermented meats 
stock cubes 
pate 
black pudding 
caffeine 
soy/tofu
59
Q

how is hypertensive crisis treated

A

phentolamine infusion

60
Q

what is the most effective treatment for bipolar disorder

A

litium carbonate

61
Q

when should lithium be taken

A

at night due to sedation

62
Q

which drugs does lithium interact with

A

NSAIDs
ACEIs/ARBs
diuretics

63
Q

which tests must be done before initiating lithium treatment

A

U+Es
TFTs
ECG

64
Q

which tests should be done when stabilising lithium levels

A 
lithium level (12 hours last dose)
U+E every 5 days until lithium level stable within therapeutic range
65
Q

how often should lithium levels and U+Es be monitored during treatment

A

every 3 months

66
Q

how often should TFTs be monitored during treatment

A

every 6 months

67
Q

should lithium be stopped if there is evidence of hypothyroidism

A

hypothyroidism is usually treated with levothyroxine rather than stopping lithium

68
Q

warning signs of lithium toxicity

A 
GI upset 
blurred vision 
coarse tremor 
ataxia 
drowsiness
69
Q

signs of severe lithium toxicity

A 
confusion 
LOC
seizures
coma
death
70
Q

causes of lithium toxicity

A

increased dose
dehydration (physical illness, lack of fluid intake, hot weather, alcohol, exercise)
drug interactions
reduction in salt intake

71
Q

treatment of lithium toxicity

A

stop lithium
IV fluids
monitor renal function
may need dialysis in severe cases

72
Q

when is semisodium valproate used

A

bipolar mania/hypomania

73
Q

what type of drug is semisodium valproate

A

anticonvulsant

74
Q

what is the mechanism of action of semisoidum valproate

A

blocks voltage sensitive sodium channels to increase levels of GABA

75
Q

why should valproate be avoided in women of childbearing age

A

highly teratogenic (neural tube defects)

76
Q

which tests should be done prior to starting valproate treatment

A

platelet count

LFTs

77
Q

what type of drug is lamotrigine

A

anticonvulsant

78
Q

when is lamotrigine used

A

treatment and prophylaxis of bipolar depression

antimanic ??

79
Q

which serious side effect is associated with lamotrigine

A

stevens johnson syndrome

80
Q

which atypical antipsychotics are available as depot IM preparations

A

risperidone

olanzapine

81
Q

which tests should be done prior to starting atypical antipsychotics

A 
BP
weight 
lipids 
blood glucose 
ECG
FBC, U+Es, LFTs
82
Q

how often should monitoring be done on patients being treated with atypical antipsychotics

A

at one month
yearly thereafter
more often depending on results and risk factors

3 PSYCH (4 decks)

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