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Psychiatry > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What kind of drugs cross the BBB

A

Lipophilic/hydrophobic drugs

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2
Q

What are indications for anti depressants

A 
Mod/severe depression 
Dysthymia 
Premenstrual dysphoric disorder 
Generalised anxiety disorder 
Panic disorder 
Bulimia nervosa 
Neuropathic pain
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3
Q

Which drugs act on the 5HT pathway

A

MAOI
SSRIs
Tricyclics
Dual reuptake inhibitors

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4
Q

Which drugs act on NA pathway

A

MAOI
Tricyclics
SNRIs

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5
Q

Give examples of MAOI

A

Phenelzine (irreversible)

Moclobemide (reversible)

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6
Q

What are side effects of MAOI

A 
Cheese reaction/hypertensive crisis from increased unmetabolised tyramine 
Postural hypotension 
Insomnia 
Peripheral oedema 
Drug-drug interactions
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7
Q

Give types of reuptake inhibitors

A

SSRIs
SNRIs
Tricyclics
Others

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8
Q

Give examples of SSRIs

A 
Fluoxetine 
Citalopram 
Escitalopram 
Sertraline 
Paroxetine
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9
Q

What are side effects of SSRIs

A 
Nausea 
Headaches 
Sweating
Vivid dreams 
Worsened anxiety 
sexual dysfunction 
hyponatraemia in elderly 
transient increase in suicidal ideation 
DISCONTINUATION SIDE EFFECTS
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10
Q

Give examples of tricyclics

A

Imipramine
Amitriptyline
Doselepin
Lofepramine

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11
Q

What are side effects of tricyclics

A

Anticholinergic: dry mouth, constipation, postural hypotension, urinary retention, blurred vision…
Weight gain
Sedation
Cardiotoxicity

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12
Q

Which group of people do you avoid giving tricyclics to

A

Those with heart disease: IHD, recent MI…

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13
Q

Give examples of dual reuptake inhibitors

A

Venlofaxine

Duloxetine

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14
Q

Give an example of an atypical antidepressant

A

Mirtazapine

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15
Q

Side effects of mirtazapine

A

Weight gain and sedation

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16
Q

How long to antidepressants take to work

A

Several weeks

Can see some improvement after 10-14 days

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17
Q

Give examples of mood stabilisers

A

Lithium
Antipsychotics
Anticonvulsants
Antidepressants

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18
Q

Lithium has a wide therapeutic index, TRUE or FALSE

A

FALSE

It has a very narrow TI

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19
Q

List side effects of lithium

A 
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
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20
Q

List toxic effects of lithium

A 
vomiting 
drowsiness 
ataxia 
diarrhoea 
convulsions 
coma
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21
Q

List tests required for lithium monitoring

A 
Li levels
FBC 
U+E
LFTs
TFTs
Ca2+
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22
Q

Does lithium have hepatic metabolism

A

No, it is an element and so does not undergo hepatic metabolism

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23
Q

Lithium is indistinguishable from Na in the kidneys in terms of dehydration, true or false

A

True

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24
Q

Examples of anticonvulsants

A

Na valproate –> teratogenic
Carbamazepine –> CVS, ataxia, induce hepatic enzymes
Lamotrigine –> SJS, least teratogenic

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25
Q

Examples of antipsychotics

A

Quetiapine
Aripiprazole
olanzapine
lurasidone

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26
Q

What can Lithium NOT be prescribed with

A

NSAID or ACEI

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27
Q

What is Electroconvulsive Therapy ECT

A

Brief induction of seizure

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28
Q

ECT indications

A

Depression
Bipolar
Schizophrenia
Catatonia

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29
Q

examples of monoamines

A

dopamine
noradrenaline
serotonin

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30
Q

examples of amino acids

A

glutamate

GABA

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31
Q

How do MAOI work

A

inhibit monoamine oxidase and increase concentration of 5HT, NA and dopamine in the synaptic cleft

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32
Q

which antidepressant is cardiotoxic in overdose

A

tricyclic antidepressants

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33
Q

how can management of bipolar disorder be categorised

A

acute treatment of symptoms - mania/depression

long term treatment

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34
Q

how do you pick the best antidepressant for someone

A

if they have previously responded to a certain drug/class, stick to that one

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35
Q

which drug is considered to probably be the best all round SSRI

A

escitalopram

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36
Q

which SSRI has a good cardiac safety profile

A

sertraline

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37
Q

what should be checked if there is no response to treatment

A

concordance
right diagnosis
substance misuse
physical illness

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38
Q

what should be done to medication if there is no response to treatment

A

increase dose
swap
combine
augment

39
Q

when should you review someone after starting antidepressants

A

1-2 weeks

40
Q

timing for relapse prevention

A

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

41
Q

if someone has had 3 or 4 episodes of depression, how long should they be on antidepressants after recovery

A

lifetime

42
Q

management of mod/severe depression

A

risk assessment
sleep hygiene, diet, exercise
CBT
Drugs - 1st SSRI, 2nd SSRI, 3rd SNRI / TCA / MAOI

43
Q

management of acute hypomania in bipolar disorder

A

antipsychotics
maximise antimanic dose
stop antidepressant

44
Q

PO is always preferred over IM, true or false

A

true

45
Q

what role do benzodiazepines have

A

symptomatic relief eg agitation, insomnia

46
Q

in bipolar disorder, you can prescribe antidepressants alone, true or false

A

FALSE

never prescribe them alone, always prescribe antidepressants with antipsychotics

47
Q

which drug is used for bipolar maintenance

A

lithium carbonate

48
Q

in the elderly which drugs should you be cautious of prescribing

A

tricyclics - anticholinergics and sedation

SSRIs - hyponatraemia

49
Q

how often do you get ECT

A

twice weekly

50
Q

absolute contraindications for ECT

A

MI in last 3 months
recent CVA
^ICP
phaeochromocytoma

51
Q

side effects of ECT

A

headache
memory problems
muscle aches
confusion

52
Q

what are different kinds of psychological therapy

A

Cognitive behavioural therapy CBT
Interpersonal therapy IPT
Eye movement desensitisation and reprocessing EMDR

53
Q

what are the 4P’s of formulation

A

Predisposing
Precipitant
Prolonging
Protective

54
Q

tuberoinfundibular

A

PRL release

55
Q

nigrostriatal

A

extrapyramidal system

56
Q

mesolimbic

A

motivation and reward

57
Q

what types of antipsychotic drugs are there

A

typical

atypical

58
Q

list typical antipsychotics

A 
chlorpromazine 
haloperidol 
thioridazine
fluphenazine
zuclopentixol
59
Q

what is the main defining factor for typical antipsychotics

A

D2 inhibition/antagonism

60
Q

features of atypical antipsychotics

A

less likely to cause extrapyramidal side effects

more serotonin antagonism than dopamine

61
Q

list atypical antipsychotics

A 
olanzapine 
risperidone 
quetiapine
clozapine
aripiprazole
amisulpride
62
Q

side effects of typical antipsychotics

A

EPSE - extrapyramidal side effects

63
Q

side effects of antipsychotics

A 
Acute dystonic reaction 
Parkinsonism 
Akathesia 
Tardive dyskinesia 
Hyperprolactinaemia
64
Q

what is acute dystonic reaction and its management

A

acute involuntary distressing painful muscle spasms

stop antipsychotic and start anticholinergic

65
Q

Features of drug induced parkinsonism and its management

A

bilateral symptoms

change antipsychotic or give anticholinergic

66
Q

what is akathesia

what is the management

A

severe involuntary internal restlessness

stop/reduce antipsychotic

67
Q

what is tardive dyskinesia
how long does it take to develop
what is the management

A

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

68
Q

how is hyperprolactinaemia a side effect of antipsychotics

what are the features

A

antipsychotics antagonise dopamine which means there is no inhibitory control on PRL
amenorrhoea, infertility, galactorrhoea, sexual dysfunction, osteoporosis

69
Q

side effects of atypical antipsychotics

A

metabolic syndrome
histamine blockade
alpha adrenergic blockade
muscarinic blockade

70
Q

features of metabolic syndrome

A

5HT blockade results in weight gain, CVD, stroke, high cholesterol

71
Q

features of histamine blockade

A

sedation

increased appetite

72
Q

features of alpha adrenergic blockade

A

postural hypotension
dizziness
fainting

73
Q

features of muscarinic blockade

A 
dry mouth
urinary retention 
constipation 
blurry vision 
sedation
74
Q

indication for clozapine

A

3rd line treatment for resistant schizophrenia

75
Q

clozapine side effects triad

A

sedation
weight gain
hypersalivation

76
Q

rare side effect of clozapine and what should be done

A

agranulocytosis

routine FBC

77
Q

other side effects of clozapine

A

myocarditis

paralytic ileus

78
Q

what is neuroleptic malignant syndrome

A

rare condition caused by antipsychotic drugs or stopping anti-Parkinson medication

79
Q

features of neuroleptic malignant syndrome

A

fever/hyperthermia
rigidity
autonomic dysfunction
altering consciousness

80
Q

what is GABA and what is its effect

A

inhibitory neurotransmitter

calming tranquilising effect

81
Q

mechanism of benzodiazepines

A

binding of BZD to its receptor increases affinity of GABA to the GABA receptor indirectly which causes Cl- influx and hyperpolarisation

82
Q

benzodiazepines increase frequency/duration of GABA receptor opening

A

frequency

83
Q

examples of BZDs

A

chlordiazepoxide
diazepam
lorazepam

84
Q

side effects of BZDs

A

sedation
dizziness
decreased concentration
reduced motor coordination

85
Q

indications for BZDs

A

convulsions
anxiety
agitation

86
Q

mechanism of barbiturates

A

bind to GABAa receptor and enhance effect of GABA at GABA receptor directly

87
Q

barbiturates increase the frequency/duration of opening of GABA receptors

A

duration

88
Q

examples of barbiturates

A

phenobarbitol

pentobarbitol

89
Q

mechanism of non-benzodiazepine hypnotics

A

bind to alpha subunit of GABAa receptor leading to Cl- influx

90
Q

indication of B blocker

does it have an effect on anxiety

A

tremor

no

91
Q

which atypical antipsychotic is most likely to cause metabolic syndrome

A

olanzapine

92
Q

what should be monitored in someone taking vanlafaxine

A

BP

93
Q

what should be monitored prior to starting citalopram/escitalopram

A

ECG for QT prolongation

94
Q

what should be co prescribed with SSRIs and why

A

PPIs because of increased risk of GI bleeding

Psychiatry (27 decks)

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