Pharmacology Flashcards
Explain the acute treatment of depression using biopsychosocial model
- Bio:
Mild - watchful waiting
Severe - ECT - Psycho:
Exercise, behavioural activation, self-help, computer CBT, psycho-education, CBT/IPT - Social:
Housing, finance, exercise, socialisation
What is the chronic treatment of depression using the biopsychosocial model?
1. Bio: Antidepressants, antipsychotics, mood stabilisers 2. Psycho: CBT/IPT Psychoanalysis 3. Social: daily activities, housing etc
Explain the specific drug regimen for treating depression
- SSRI
- Dose escalation
- switch or augmentation
What is the 1st line drug treatment for depression?
SSRIs - fluoxetine, citalopram, sertraline
explain how SSRIs work
reduces the reuptake of serotonin in the synpase therefore increasing the serotonin levels in the intrasynaptic space
What are the CIs of SSRIs
<18 (except fluoxetine) epilepsy DM Cardiac disease Pregnancy ECT
What are the features of serotonin syndrome
restless fever tremor myoclonus confusion fits arrhythmias
What are the SEs of SSRIs
GI: N&V, appetite/weight change
Eyes: blurred vision
Psychological: anxiety, agitation, insomnia
What are risks associated w SSRIs?
Increased suicide risk - check at two weeks
Serotonin syndrome
What are other categories of antidepressants that aren’t 1st line
MAOIs (phenelzine)
TCAs (amitriptyline)
SNRIs (venlafaxine)
What are MAOIs? How do they work?
monoamine oxidase inhibitors
serotonin is usually broken down by monoamine oxidase, so by inhibiting MAO, more serotonin is available
What is a hypertensive crisis and which drug is it associated w?
MAOI
When taking tyramine containing foods - cheese, red wine, bovril
What is the acute treatment of schizophrenia using biopsychosocial model
- Bio - antipsychotics
- Psycho - CBT, fam intervention
- Social - psychoeducation, care plan
What is the chronic treatment of schizophrenia using biopsychosocial model
1. Bio: antipsychotics antidepressants lithium 2. Psycho: CBT Art therapy, concordance therapy 3. Social: etc
What are the two main therapeutic effects of anti-psychotics?
- tranquillising (hrs)
2. anti-psychotic effects (days/weeks)
Give examples of the different generations of anti-psychotics
1st - chlorpromazine, haloperidol
2nd - clozapine, quetiapine, olanzapine, risperidone
Which SGA has the greatest efficacy?
Clozapine
Which generation of antipsychotics are typical;?
1st
How do 1st gen antipsychotics work?
- Blocks post-synaptic dopamine 2 receptors
- This results in the dopamine being re-uptaken and causing down regulation of it’s release
- This reduces the transmission at the post-synaptic receptors
- Reduction in mesolimbic and mesocortical dopamine levels reduces psychotic symptoms
How do 2nd gen antipsychotics work
- Blocks post-synaptic dopamine 2 receptors/5HT2A
- This results in the dopamine re-uptake and causing down regulation of its release
- This reduces the transmission as the post-synaptic receptors
Reduction in mesolimbic and mesocortical dopamine levels reduces psychotic symptoms
What are the extra-pyramidal SE of antipsychotics?
Acute: Parkinsonism Dystonia: spasms, torticollis Akathasia - restlessness Chronic: Tardive dyskinesia - choreoathetoid movements
What hormone do anti-psychotics have an effect on and what sx does this cause?
Prolactin:
amenorrhoea, galactorrhoea, gynaecomastia, impotence, weight gain, osteoporosis
What are anti-adrenergic SE of anti-psychotics?
postural hypotension
sexual dysfunction
What are anti-histamine SE of anti-psychotics?
sedation
anti-emetic
What investigations should be performed before starting antipsychotics?justify Cardiac ones
FBC, U&E, LFT, RBS/HbA1c, prolactin, lipids + cholesterol
Physical: weight, BP. pulse
ECG: risk of prolonged QTc/arrythmias
When should clozapine be prescribed
When two other diff treatments have failed (incl. one non-clozapine SGA)
What is a major SE of clozapine to be aware of? Give others
AGRANULOCYTOSIS (low wbc) myocarditis weight gain salivation seizures sedation
What is depot?When are they used?
IM slow release anti-psychotic prep
Used when poor compliance
What are the main 2 mood stabilisers?
lithium
sodium valproate
What is lithium indicated in?
mania/bipolar prophylaxis
recurrent depression
What is sodium valproate indicated in?
• Manic episodes in bipolar
• Migraine prophylaxis
All forms of epilepsy
What is dystonia?
sustained or repetitive muscle contractions result in twisting and repetitive movements or abnormal fixed postures.
What is torticollis?
abnormal, asymmetrical head or neck position
aka wry neck
What is tardive dyskinesia?
disorder that results in involuntary repetitive body movements including:
grimacing, sticking out the tongue, or smacking the lips
What is found in blood results in agranulocytosis
low wbc
How do SE of first generation and second generation antipsychotics compare?
first - mainly extrapyramidal sx + raised prolactin
second - weight gain, hyperglycaemia
What is the first line treatment for bipolar disorder?
lithium
Why does lithium require regular monitoring?
lithium toxicity can occur
What level of lithium usually indicates toxicity?
> 1.5
What is the therapeutic window of lithium,?
0.4-1
What are early SEs of lithium?
dry mouth metallic taste nausea fine tremor fatigue polyuria polydipsia
What are late SEs of lithium?
Diabetes insipidus hypothyroidism arrhythmias ataxia dysarthria weight gain teratogenic
What is the first line treatment for GAD?
sertraline
What other drugs can be used for GAD?
venlafaxine (SNRI)
What drugs can be used for short term relief of severe anxiety?
benzodiazepines - lorazepam, diazepam, midazolam
How do benzodiazepines work?
agonist of GABA, main inhibitory neurotransmitter in the brain,
What is neuroleptic malignant syndrome?
life threatening antipsychotic induced disorder requiring immediate treatmetn
What are the sx of NMS?
⎫ Fever
⎫ Muscle rigidity
⎫ Delirium
⎫ Autonomic instability ( BP, anxiety, diplopia, dizziness)
What Ix indicates NMS?
Raised creatine kinase
What is the management of NMS?
Stop causative factor
supportive measures
treat rhabdomyolysis
What is rhabdomyolysis?
Rapid breakdown of damaged skeletal muscle
What is rx of rhabdomyolysis?
aggressive rehydration to promote renal clearance of released intracellular muscular toxins)
What are sx of rhabdomyolysis?
muscle pains, weakness, vomiting, confusion
What Is associated w an oculogyric crisis?
acute dystonic reaction as a SE of anti-psychotics
What is this “Stopping of voluntary movement or staying still in an unusual position”
catatonia
What needs to be done if doses of clozapine is missed?
If clozapine doses are missed for more than 48 hours the dose will need to be restarted again slowly
What are the main anxiolytics?
Benzodiazepines - lorazapem, diazepam
Beta-blockers - propanolol
What is a short term anxiolytic drug?
lorazepam
What is a long term anxiolytic drug?
Diazepam
How do beta-blockers work for anxiety?
reduce autonomic symptoms
How is Parkinsonism treated w as a SE of antipsychotic?
procyclidine
How is tardive dyskinesia treated as a SE of antipsychotics?
tetrabenazine
What Benz is used in alcohol withdrawal?
chlordiazepoxide
What are examples of z drugs?
zopiclone, zolpidem
What are hypnotics?
benzos, z drugs, melatonin
What are withdrawal effects of hypnotics?
sleep disturbance irritability seiozures breakthrough anxiety resp depression
What are hypnotics NOT used in?
GAD
wHAT ARE EFFECTS OF RITALIN?
appetite suppression, psychosis, measure growth (may be stunted)
