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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

reduces the reuptake of serotonin in the synpase therefore increasing the serotonin levels in the intrasynaptic space

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6
Q

What are the CIs of SSRIs

A 
<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
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
26
When should clozapine be prescribed
When two other diff treatments have failed (incl. one non-clozapine SGA)
27
What is a major SE of clozapine to be aware of? Give others
``` AGRANULOCYTOSIS (low wbc) myocarditis weight gain salivation seizures sedation ```
28
What is depot?When are they used?
IM slow release anti-psychotic prep | Used when poor compliance
29
What are the main 2 mood stabilisers?
lithium | sodium valproate
30
What is lithium indicated in?
mania/bipolar prophylaxis | recurrent depression
31
What is sodium valproate indicated in?
• Manic episodes in bipolar • Migraine prophylaxis All forms of epilepsy
32
What is dystonia?
sustained or repetitive muscle contractions result in twisting and repetitive movements or abnormal fixed postures.
33
What is torticollis?
abnormal, asymmetrical head or neck position | aka wry neck
34
What is tardive dyskinesia?
disorder that results in involuntary repetitive body movements including: grimacing, sticking out the tongue, or smacking the lips
35
What is found in blood results in agranulocytosis
low wbc
36
How do SE of first generation and second generation antipsychotics compare?
first - mainly extrapyramidal sx + raised prolactin | second - weight gain, hyperglycaemia
37
What is the first line treatment for bipolar disorder?
lithium
38
Why does lithium require regular monitoring?
lithium toxicity can occur
39
What level of lithium usually indicates toxicity?
>1.5
40
What is the therapeutic window of lithium,?
0.4-1
41
What are early SEs of lithium?
``` dry mouth metallic taste nausea fine tremor fatigue polyuria polydipsia ```
42
What are late SEs of lithium?
``` Diabetes insipidus hypothyroidism arrhythmias ataxia dysarthria weight gain teratogenic ```
43
What is the first line treatment for GAD?
sertraline
44
What other drugs can be used for GAD?
venlafaxine (SNRI)
45
What drugs can be used for short term relief of severe anxiety?
benzodiazepines - lorazepam, diazepam, midazolam
46
How do benzodiazepines work?
agonist of GABA, main inhibitory neurotransmitter in the brain,
47
What is neuroleptic malignant syndrome?
life threatening antipsychotic induced disorder requiring immediate treatmetn
48
What are the sx of NMS?
⎫ Fever ⎫ Muscle rigidity ⎫ Delirium ⎫ Autonomic instability ( BP, anxiety, diplopia, dizziness)
49
What Ix indicates NMS?
Raised creatine kinase
50
What is the management of NMS?
Stop causative factor supportive measures treat rhabdomyolysis
51
What is rhabdomyolysis?
Rapid breakdown of damaged skeletal muscle
52
What is rx of rhabdomyolysis?
aggressive rehydration to promote renal clearance of released intracellular muscular toxins)
53
What are sx of rhabdomyolysis?
muscle pains, weakness, vomiting, confusion
54
What Is associated w an oculogyric crisis?
acute dystonic reaction as a SE of anti-psychotics
55
What is this "Stopping of voluntary movement or staying still in an unusual position"
catatonia
56
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
57
What are the main anxiolytics?
Benzodiazepines - lorazapem, diazepam | Beta-blockers - propanolol
58
What is a short term anxiolytic drug?
lorazepam
59
What is a long term anxiolytic drug?
Diazepam
60
How do beta-blockers work for anxiety?
reduce autonomic symptoms
61
How is Parkinsonism treated w as a SE of antipsychotic?
procyclidine
62
How is tardive dyskinesia treated as a SE of antipsychotics?
tetrabenazine
63
What Benz is used in alcohol withdrawal?
chlordiazepoxide
64
What are examples of z drugs?
zopiclone, zolpidem
65
What are hypnotics?
benzos, z drugs, melatonin
66
What are withdrawal effects of hypnotics?
``` sleep disturbance irritability seiozures breakthrough anxiety resp depression ```
67
What are hypnotics NOT used in?
GAD
68
wHAT ARE EFFECTS OF RITALIN?
appetite suppression, psychosis, measure growth (may be stunted)

Psychiatry (21 decks)

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