Pharmacology Flashcards
list some clinical indications for antidepressants
moderate to severe depression
neuropathic pain
OCD, panic disorder
generalised anxiety disorder
depression occurs as a result of which monoamine transmitter
serotonin
noradrenaline
what is the effect of monoamine oxidase A and B
when there is excess serotonin and noradrenaline produced they are fed into MAO which produces a by-product of the transmitters and it is excreted out of the cell
describe the mode of action of monoamine oxidase inhibitors
either reversibly or irreversibly inhibit MAO and allow more serotonin and noradrenaline to get to the synaptic cleft
phenelzine and moclobemide are examples of which drug
monoamine oxidase inhibitors
list the potential side effects of monoamine oxidase inhibitors
cheese reaction/hypertensive crisis
insomnia
postural hypotension
peripheral oedema
list some examples of tricyclic antidepressants
imipramine
amitriptyline
dosulepin
lofepramine
describe the mode of action of tricyclic antidepressants
blocks the re-uptake of noradrenaline and 5-HT into presynaptic terminals
list the side effects of tricyclic antidepressants
anti-cholinergic effects sedation weight gain postural hypotension arrhythmias cardiotoxic in overdose
describe anti-cholinergic side effects that may be present
constipation
urinary retention
dry mouth
blurred vision
describe the mode of action of SSRIs
selectively inhibit the reuptake of serotonin from the synaptic cleft
list some examples of SSRIs
citalopram escitalopram sertraline paroxetine fluoxetine
what are the side effects of SSRIs
think hangover symptoms –> headache, nausea, worsened anxiety, sweating and vivid dreams, reduced libido and erectile dysfunction
what side effects must be watched for in the young and the elderly on SSRIs
young - suicidal ideation
elderly - hyponatraemia
what is the only SSRI licensed for use in under 18s
fluoxetine
give some examples of SNRIs
venlafaxine
duloxetine
what is the mode of action of SNRIs
act in the same way as SSRIs but rather than just allowing reuptake of serotonin they also allow the reuptake of noradrenaline
list some side effects of mirtazapine
weight gain and sedation
describe the efficacy between antidepressants
most drugs efficacy is 40-70%
usually have a delayed onset of action and take several weeks before having any effect
what is the indication for lithium
used in the treatment of mania, hypomania and bipolar affective disorder
describe the monitoring required for lithium
weekly blood tests done to check the side effects have no become toxic
these are done 12 hours after taking a tablet
list the side effects of lithium
dry/metallic tasting mouth polydipsia and polyuria tremor hypothyroidism reduce renal function diabetes insipidus weight gain
list the toxic effects of lithium
vomiting diarrhoea ataxia and coarse tremor drowsiness convulsions coma
list some anticonvulsants that can be used as mood stabilisers
lamotrigine
carbemazepine
valproic acid
what are the side effects of anticonvulsants
teratogenic causing neural tube defects
CV risks
how long should an antidepressant be used for after recovery to prevent relapse
if first time on drug - 6 months
if been on drug before - 1 year
what is the first line treatment for depression
generic SSRI - commence on low dose and titrate up if needed, select SSRI based on patient wishes and side effect profile
outline the management of acute mania/hypomania
any second generation antipsychotic or valproate
discontinue use of antidepressant as that can worsen mania
hospital admission if suspected mania
list some examples of first generation antipsychotics
chlorpromazine
haloperidol
zuclopenthixol
list some examples of second generation antipsychotics
clozapine
olanzapine
quetiapine
risperidone
what type of drug is aripiprazole
third generation antipsychotic
what is the mode of action of antipsychotics
specifically target D2 receptors as dopamine antagonists as there is abhorrent firing of dopaminergic neurones in schizophrenia
list some of the groups of side effects in antipsychotics
extra-pyramidal side effects
neuroepileptic syndrome
hyperprolactinaemia
akathesia
describe extrapyramidal side effects in antipsychotics
acute dystonia - increasing muscle tone, presents within minutes
parkinsonism - gradual onset over weeks
tardive dyskinesia
what is the treatment for extra-pyramidal side effects from antipsychotics
treat with anticholinergics to get dopamine and ACh back into relative balance - procyclidine and trihexyphenidyl
what is neuroepileptic malignant syndrome
rare but potentially fatal condition with increasing muscle tone, pyrexia, fluctuating pulse and BP
eventually leads to rhabdomyolysis - acute renal failure and then death
what is the management of neuroepileptic malignant syndrome
stop antipsychotic
rapid cooling with renal support
dopamine agonists
what is akathesia
inability to sit still
presents with pacing, rocking from foot to foot
what is the treatment of akathesia
propanolol and long acting benzodiazepine such as clonazepam
list some additional side effects of antipsychotics
anticholinergic effects weight gain postural hypotension prolonged QTc interval photosensitivity
clozapine is particularly good for positive or negative symptoms of schizophrenia
negative symptoms and antisuicidal properties
list some of the side effects specific to clozapine
agranulocytosis myocarditis constipation which can lead to obstruction and perforation weight gain sedation sialorrhoea
what is the first line treatment for schizophrenia
second generation antipsychotic and titrate dose up and try for 6-8 weeks
what is the second line treatment for schizophrenia
try an alternative second generation or a first generation antipsychotic
what is the third line treatment for schizophrenia
clozapine
what drugs are used to treat anxiety
benzodiazepines
antidepressants
pregabalin
propanolol
what type of neurotransmitter is GABA
inhibitory neurotransmitter
what effect do benzodiazepines have on GABA
enhance the action of GABA, less likely that a neurone will fire an action potential
give some examples of benzodiazepines
midazolam
diazepam
loprazolam
chlordiazepam
what are the pharmacological effects of benzodiazepines
muscle relaxants reduce anxiety and depression hypnosis and sedation anticonvulsant effect anterograde amnesia
list some of the clinical uses of benzodiazepines
acute anxiety hypnosis alcohol withdrawal mania delirium status epilepticus rapid tranquillisation
what is the main issue with taking benzodiazepines especially for a long time
tolerance and dependence - the dose taken no longer has the desired effect
when immediately stopping benzodiazepines, list some of the effects of withdrawal
abdo cramps increased anxiety blurred vision depression insomnia dizziness headaches nausea and vomiting tingling in hands and feet restlessness sensory sensitivity
what causes the withdrawal symptoms associated with benzodiazepines
chronic treatment of benzos causes reduced GABA response, when someone immediately withdraws the anxiety and convulsions occur due to reduced density of benzodiazepines receptors
what is the correct way of withdrawing from benzodiazepines
convert dose to daily dose of diazepam at night
reduce dose but 2-2.5mg every 2-3 weeks
if s/e occur, reduce dose in smaller steps
