Pharmacology Flashcards
What kind of drugs cross the BBB
Lipophilic/hydrophobic drugs
What are indications for anti depressants
Mod/severe depression Dysthymia Premenstrual dysphoric disorder Generalised anxiety disorder Panic disorder Bulimia nervosa Neuropathic pain
Which drugs act on the 5HT pathway
MAOI
SSRIs
Tricyclics
Dual reuptake inhibitors
Which drugs act on NA pathway
MAOI
Tricyclics
SNRIs
Give examples of MAOI
Phenelzine (irreversible)
Moclobemide (reversible)
What are side effects of MAOI
Cheese reaction/hypertensive crisis from increased unmetabolised tyramine Postural hypotension Insomnia Peripheral oedema Drug-drug interactions
Give types of reuptake inhibitors
SSRIs
SNRIs
Tricyclics
Others
Give examples of SSRIs
Fluoxetine Citalopram Escitalopram Sertraline Paroxetine
What are side effects of SSRIs
Nausea Headaches Sweating Vivid dreams Worsened anxiety sexual dysfunction hyponatraemia in elderly transient increase in suicidal ideation DISCONTINUATION SIDE EFFECTS
Give examples of tricyclics
Imipramine
Amitriptyline
Doselepin
Lofepramine
What are side effects of tricyclics
Anticholinergic: dry mouth, constipation, postural hypotension, urinary retention, blurred vision…
Weight gain
Sedation
Cardiotoxicity
Which group of people do you avoid giving tricyclics to
Those with heart disease: IHD, recent MI…
Give examples of dual reuptake inhibitors
Venlofaxine
Duloxetine
Give an example of an atypical antidepressant
Mirtazapine
Side effects of mirtazapine
Weight gain and sedation
How long to antidepressants take to work
Several weeks
Can see some improvement after 10-14 days
Give examples of mood stabilisers
Lithium
Antipsychotics
Anticonvulsants
Antidepressants
Lithium has a wide therapeutic index, TRUE or FALSE
FALSE
It has a very narrow TI
List side effects of lithium
Dry mouth / metallic taste Polydipsia Polyuria hypothyroidism hyperparathyroidism and hypercalcaemia long term renal damage nephrogenic diabetes insipidus weight gain exacerbation of skin conditions eg psoriasis teratogenic
List toxic effects of lithium
vomiting drowsiness ataxia diarrhoea convulsions coma
List tests required for lithium monitoring
Li levels FBC U+E LFTs TFTs Ca2+
Does lithium have hepatic metabolism
No, it is an element and so does not undergo hepatic metabolism
Lithium is indistinguishable from Na in the kidneys in terms of dehydration, true or false
True
Examples of anticonvulsants
Na valproate –> teratogenic
Carbamazepine –> CVS, ataxia, induce hepatic enzymes
Lamotrigine –> SJS, least teratogenic
Examples of antipsychotics
Quetiapine
Aripiprazole
olanzapine
lurasidone
What can Lithium NOT be prescribed with
NSAID or ACEI
What is Electroconvulsive Therapy ECT
Brief induction of seizure
ECT indications
Depression
Bipolar
Schizophrenia
Catatonia
examples of monoamines
dopamine
noradrenaline
serotonin
examples of amino acids
glutamate
GABA
How do MAOI work
inhibit monoamine oxidase and increase concentration of 5HT, NA and dopamine in the synaptic cleft
which antidepressant is cardiotoxic in overdose
tricyclic antidepressants
how can management of bipolar disorder be categorised
acute treatment of symptoms - mania/depression
long term treatment
how do you pick the best antidepressant for someone
if they have previously responded to a certain drug/class, stick to that one
which drug is considered to probably be the best all round SSRI
escitalopram
which SSRI has a good cardiac safety profile
sertraline
what should be checked if there is no response to treatment
concordance
right diagnosis
substance misuse
physical illness
what should be done to medication if there is no response to treatment
increase dose
swap
combine
augment
when should you review someone after starting antidepressants
1-2 weeks
timing for relapse prevention
1st episode of depression - continue antidepressant for 6 months post full recovery
>=2nd episode - continue antidepressant for at least 1-2 years post full recovery
if someone has had 3 or 4 episodes of depression, how long should they be on antidepressants after recovery
lifetime
management of mod/severe depression
risk assessment
sleep hygiene, diet, exercise
CBT
Drugs - 1st SSRI, 2nd SSRI, 3rd SNRI / TCA / MAOI
management of acute hypomania in bipolar disorder
antipsychotics
maximise antimanic dose
stop antidepressant
PO is always preferred over IM, true or false
true
what role do benzodiazepines have
symptomatic relief eg agitation, insomnia
in bipolar disorder, you can prescribe antidepressants alone, true or false
FALSE
never prescribe them alone, always prescribe antidepressants with antipsychotics
which drug is used for bipolar maintenance
lithium carbonate
in the elderly which drugs should you be cautious of prescribing
tricyclics - anticholinergics and sedation
SSRIs - hyponatraemia
how often do you get ECT
twice weekly
absolute contraindications for ECT
MI in last 3 months
recent CVA
^ICP
phaeochromocytoma
side effects of ECT
headache
memory problems
muscle aches
confusion
what are different kinds of psychological therapy
Cognitive behavioural therapy CBT
Interpersonal therapy IPT
Eye movement desensitisation and reprocessing EMDR
what are the 4P’s of formulation
Predisposing
Precipitant
Prolonging
Protective
tuberoinfundibular
PRL release
nigrostriatal
extrapyramidal system
mesolimbic
motivation and reward
what types of antipsychotic drugs are there
typical
atypical
list typical antipsychotics
chlorpromazine haloperidol thioridazine fluphenazine zuclopentixol
what is the main defining factor for typical antipsychotics
D2 inhibition/antagonism
features of atypical antipsychotics
less likely to cause extrapyramidal side effects
more serotonin antagonism than dopamine
list atypical antipsychotics
olanzapine risperidone quetiapine clozapine aripiprazole amisulpride
side effects of typical antipsychotics
EPSE - extrapyramidal side effects
side effects of antipsychotics
Acute dystonic reaction Parkinsonism Akathesia Tardive dyskinesia Hyperprolactinaemia
what is acute dystonic reaction and its management
acute involuntary distressing painful muscle spasms
stop antipsychotic and start anticholinergic
Features of drug induced parkinsonism and its management
bilateral symptoms
change antipsychotic or give anticholinergic
what is akathesia
what is the management
severe involuntary internal restlessness
stop/reduce antipsychotic
what is tardive dyskinesia
how long does it take to develop
what is the management
repetitive involuntary purposeless odd orofacial movements
takes years to develop
its hard to get rid of once you have got it, sometimes removing antipsychotic may make it worse
how is hyperprolactinaemia a side effect of antipsychotics
what are the features
antipsychotics antagonise dopamine which means there is no inhibitory control on PRL
amenorrhoea, infertility, galactorrhoea, sexual dysfunction, osteoporosis
side effects of atypical antipsychotics
metabolic syndrome
histamine blockade
alpha adrenergic blockade
muscarinic blockade
features of metabolic syndrome
5HT blockade results in weight gain, CVD, stroke, high cholesterol
features of histamine blockade
sedation
increased appetite
features of alpha adrenergic blockade
postural hypotension
dizziness
fainting
features of muscarinic blockade
dry mouth urinary retention constipation blurry vision sedation
indication for clozapine
3rd line treatment for resistant schizophrenia
clozapine side effects triad
sedation
weight gain
hypersalivation
rare side effect of clozapine and what should be done
agranulocytosis
routine FBC
other side effects of clozapine
myocarditis
paralytic ileus
what is neuroleptic malignant syndrome
rare condition caused by antipsychotic drugs or stopping anti-Parkinson medication
features of neuroleptic malignant syndrome
fever/hyperthermia
rigidity
autonomic dysfunction
altering consciousness
what is GABA and what is its effect
inhibitory neurotransmitter
calming tranquilising effect
mechanism of benzodiazepines
binding of BZD to its receptor increases affinity of GABA to the GABA receptor indirectly which causes Cl- influx and hyperpolarisation
benzodiazepines increase frequency/duration of GABA receptor opening
frequency
examples of BZDs
chlordiazepoxide
diazepam
lorazepam
side effects of BZDs
sedation
dizziness
decreased concentration
reduced motor coordination
indications for BZDs
convulsions
anxiety
agitation
mechanism of barbiturates
bind to GABAa receptor and enhance effect of GABA at GABA receptor directly
barbiturates increase the frequency/duration of opening of GABA receptors
duration
examples of barbiturates
phenobarbitol
pentobarbitol
mechanism of non-benzodiazepine hypnotics
bind to alpha subunit of GABAa receptor leading to Cl- influx
indication of B blocker
does it have an effect on anxiety
tremor
no
which atypical antipsychotic is most likely to cause metabolic syndrome
olanzapine
what should be monitored in someone taking vanlafaxine
BP
what should be monitored prior to starting citalopram/escitalopram
ECG for QT prolongation
what should be co prescribed with SSRIs and why
PPIs because of increased risk of GI bleeding
