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Psychiatry > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Indication for antidepressants

A

Unipolar or Bipolar depression
Organic mood disorder
Schizoaffective disorder
Anxiety disorders

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2
Q

How long is the delay for effect in antidepressant medication?

A

3-6 weeks

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3
Q

How long should a patient persist with an antidepressant medication before considering a switch or augmenting?

A

At least 2 months

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4
Q

Types of Antidepressants

A

Tricyclics (TCA)
Monoamine Oxidase Inhibitors (MAOI)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Serotonin/Noradrenaline Reuptake Inhibitors (SNRIs)
Novel antidepressants

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5
Q

What mechanism is used in Tricyclic Antidepressants?

A

Act mainly on serotonin receptors to inhibit serotonin and adrenaline

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6
Q

What side effects occur with TCAs?

A

Anticholinergic
Antiadrenergic
Antihistaminic

QT lengthening
Can be lethal in Overdose (OD)

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7
Q

Why are TCAs known to cause side effects?

A

Tertiary amine side chains prone to cross reaction with other receptors

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8
Q

Describe antihistaminic side effects seen in TCA use

A

Sedation

Weight gain

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9
Q

Describe anticholinergic side effects seen in TCA use

A 
Dry mouth
Dry eyes
Constipation
Memory deficits
Delirium
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10
Q

Describe antiadrenergic side effects seen in TCA use

A

Orthostatic hypotension
Sedation
Sexual dysfunction

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11
Q

Examples of TCAs

A

Amipramine
Amitriptyline
Clomipramine
Doxepin

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12
Q

What are secondary TCAs and what is their mechanism of action?

A

Metabolites of tertiary amines

Block Noradrenaline

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13
Q

Examples of secondary TCAs

A

Desipramine

Nortriptyline

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14
Q

What is the mechanism of action of MAOIs?

A

Irreversible monoamine oxidase binding

Blocks Noradrenaline, dopamine and serotonin

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15
Q

Side effects of MAOIs

A 
Orthostatic hypotension
Weight gain
Dry mouth 
Sedation
Sexual Dysfunction
Sleep disturbance

Hypertensive Crisis

Serotonin Sydrome

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16
Q

What can contribute to Hypertensive Crisis occuring with use of MAOIs?

A

Tyramine rich foods
Sympathomimetics

‘Cheese Reaction’ - red wine, processed meats, beans

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17
Q

What taken in addition to MAOIs can cause Serotonin Syndrome>

A

Medications increasing serotonin levels or sympathomimetics

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18
Q

Symptoms of Serotonin Syndrome

A 
Abdominal pain
Diarrhoea
Sweats
Tachycardia
Hypertension
Myoclonus
Irritability
Delirium
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19
Q

Cosequences of serotonin syndrome

A

Hyperpyrexia
Cardiovascular Shock
Death

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20
Q

Name a step to avoid Serotonin Syndrome

A

Wait period of 2 weeks before switching SSRI to MAOI

Except with fluoxetine- 5 week wait

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21
Q

SSRIs mechanism of action

A

Inhibit presynaptic serotonin reuptake

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22
Q

Side effects of SSRIs

A

GI upset
Sexual dysfunction

Anxiety
Restlessness
Insomnia
Fatigue
Sedation
Dizziness
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23
Q

Describe discontinuation syndrome

A

Agitation, nausea, disequilibrium and dysphoria
Experienced when medication stopped
Typical to SSRI use

24
Q

Compare the risks in overdose between TCAs and SSRIs

A

Risk of cardiotoxicity in SSRI overdose low

Lethality in TCA overdose

25
Q

Examples of SSRI

A

Fluoxetine, Sertraline, paroxetine, Citalopram, Escitalopram

Fluvoxamine- not used

26
Q

Mechanism of Action in SNRIs

A

Inhibit serotonin and NA reuptake

27
Q

Side effects of SNRIs

A

Anticholinergic in higher doses

28
Q

Examples of SNRIs

A

Duloxetine (less BP increase)

Venlaflaxine (fast renal clearance, good in geriatrics)

29
Q

Novel antidepressants

A

Mirtazepine- good to augment SSRIs

Bupropion

30
Q

Side effects of Mirtazepine

A

Increase serum cholesterol
Sedation
Weight gain (Appetite)

31
Q

Management of antidepressant treatment resistance

A

Combination of SSRI/SNRI with Mirtazepine
Adjunctive lithium
Adjunctive with atypical antipsychotic - olanzapine, aripiprazole

Electroconvulsive therapy

Typically SSRI - SNRI - Mirtazepine - Lithium

32
Q

Indication for mood stabilisers

A

Bipolar
Cycothymia
Schizoaffective

33
Q

Factors predicting positive response to Lithium

A

Prior long-term response
Family member with good response
Classic pure mania
Mania followed by depression

34
Q

Adverse effects of Lithium

A

Renal toxicity
Hypothyroidism
Teratogenic

GI distress
Thyroid abnormalities
Nonsignificant leukocytosis
Polyuria/Polydypsia
Interstitial renal fibrosis
Hairloss
Acne
Reduce seixure threshold
Cognitive slowing
Intention tremor
35
Q

Symptoms of Lithium toxicity

A

Mild- vomiting, diarrhoea, ataxia, dizziness, slurred speech, nystagmus

Moderate - anorexia, blurred vision, clonic limb movement, convulsions, delirium, syncope

Severe- Generalised convulsions, Oliguria, Renal failure

36
Q

Indication for anticonvulsants

A

Mania prophylaxis

37
Q

Factors predicting a positive response to valproic acid

A

Rapid cycling patients (females more than males)
Comorbid substance issues
Mixed patients
Comorbid anxiety disorders

38
Q

Which tests are needed to monitor lithium toxicity?

A

U&Es

Thyroid

39
Q

Which tests and supplements are required for valproic acid/anticonvulsant use?

A

Baseline liver function
Pregnancy test
Full Blood Count

Folic acid supplement

40
Q

Side effects of valproic acid

A 
Thrombocytopenia
Platelet dysfunction
Nausea, vomiting, 
Weight gain
Sedation
Tremor
Neural Tube defect
Hair Loss
41
Q

Carbamazepine is a first line agent for which conditions

A

Acute mania
Mania Prophylaxis

Rapid cyclers, mixed patients

42
Q

Side effects of carbamazepine

A 
RASH
Nausea, vomiting, diarrhoea
Sedation, dizziness, ataxia, confusion
AV conduction delays
Aplastic anaemia and agranulocytosis
Water retention
43
Q

Drugs that increase lamotrigine levels

A

VPA

Sertraline

44
Q

Indication for antipsychotic medication

A

Schizophrenia
Schizoaffective disorder
Bipolar disorder

45
Q

Mechanism of action of TYPICAL Antipsychotics

A

D2 dopamine receptor antagonists

46
Q

Risk of TYPICAL Antipsychotic use

A

Extrapyramidal effects

47
Q

Examples of typical antipsychotics

A

Fluphenazine
Haloperidol
Pimozide

48
Q

Mechanism of action of atypical antipsychotics

A

Serotonin Dopamine 2 Antagonists

49
Q

Examples of atypical antipsychotics

A 
Risperidone
Olanzapine
Queitapine
Aripiprazole
Clozapine
50
Q

Extrapyramidal side effects

A

Acute dystonia
Parkinson Syndrome
Akathisia

51
Q

Adverse side effects of antipsychotics

A

Tardive Dyskinesia
Neuroleptic Malignant Syndrome
Extrapyramidal SE

52
Q

What is tardive dyskinesia?

A

Involuntary muscle movements

May not cease on drug withdrawal

53
Q

Describe some features of Neuroleptic Malignant Syndrome

A 
Severe muscle rigidity
Fever
Altered mental status
Autonomic instability
Elevated WBC
Elevated CPK
Elevated LFTs
54
Q

How might you treat extrapyramidal side effects?

A

Anticholinergics - benzotropine
Dopamine facilitators - amantadine
Beta blockers - propanolol

55
Q

Indications for anxiolytics

A

Panic disorder
Generalised Anxiety Disorder
Substance related disorders and withdrawal
Insomnia

56
Q

Examples of anxiolytics

A

Buspirone

Benzodiazepines

57
Q

Side effects of benzodiazepines

A 
Somnolence
Cognitive defects
Amnesia
Disinhibition
Tolerance
Dependence

Psychiatry (6 decks)

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