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Psychiatry > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

list some clinical indications for antidepressants

A

moderate to severe depression
neuropathic pain
OCD, panic disorder
generalised anxiety disorder

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2
Q

depression occurs as a result of which monoamine transmitter

A

serotonin

noradrenaline

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3
Q

what is the effect of monoamine oxidase A and B

A

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

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4
Q

describe the mode of action of monoamine oxidase inhibitors

A

either reversibly or irreversibly inhibit MAO and allow more serotonin and noradrenaline to get to the synaptic cleft

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5
Q

phenelzine and moclobemide are examples of which drug

A

monoamine oxidase inhibitors

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6
Q

list the potential side effects of monoamine oxidase inhibitors

A

cheese reaction/hypertensive crisis
insomnia
postural hypotension
peripheral oedema

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7
Q

list some examples of tricyclic antidepressants

A

imipramine
amitriptyline
dosulepin
lofepramine

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8
Q

describe the mode of action of tricyclic antidepressants

A

blocks the re-uptake of noradrenaline and 5-HT into presynaptic terminals

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9
Q

list the side effects of tricyclic antidepressants

A 
anti-cholinergic effects 
sedation 
weight gain 
postural hypotension 
arrhythmias 
cardiotoxic in overdose
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10
Q

describe anti-cholinergic side effects that may be present

A

constipation
urinary retention
dry mouth
blurred vision

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11
Q

describe the mode of action of SSRIs

A

selectively inhibit the reuptake of serotonin from the synaptic cleft

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12
Q

list some examples of SSRIs

A 
citalopram 
escitalopram 
sertraline 
paroxetine 
fluoxetine
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13
Q

what are the side effects of SSRIs

A

think hangover symptoms –> headache, nausea, worsened anxiety, sweating and vivid dreams, reduced libido and erectile dysfunction

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14
Q

what side effects must be watched for in the young and the elderly on SSRIs

A

young - suicidal ideation

elderly - hyponatraemia

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15
Q

what is the only SSRI licensed for use in under 18s

A

fluoxetine

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16
Q

give some examples of SNRIs

A

venlafaxine

duloxetine

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17
Q

what is the mode of action of SNRIs

A

act in the same way as SSRIs but rather than just allowing reuptake of serotonin they also allow the reuptake of noradrenaline

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18
Q

list some side effects of mirtazapine

A

weight gain and sedation

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19
Q

describe the efficacy between antidepressants

A

most drugs efficacy is 40-70%

usually have a delayed onset of action and take several weeks before having any effect

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20
Q

what is the indication for lithium

A

used in the treatment of mania, hypomania and bipolar affective disorder

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21
Q

describe the monitoring required for lithium

A

weekly blood tests done to check the side effects have no become toxic
these are done 12 hours after taking a tablet

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22
Q

list the side effects of lithium

A 
dry/metallic tasting mouth 
polydipsia and polyuria 
tremor 
hypothyroidism 
reduce renal function 
diabetes insipidus 
weight gain
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23
Q

list the toxic effects of lithium

A 
vomiting 
diarrhoea 
ataxia and coarse tremor 
drowsiness 
convulsions 
coma
24
Q

list some anticonvulsants that can be used as mood stabilisers

A

lamotrigine
carbemazepine
valproic acid

25
Q

what are the side effects of anticonvulsants

A

teratogenic causing neural tube defects

CV risks

26
Q

how long should an antidepressant be used for after recovery to prevent relapse

A

if first time on drug - 6 months

if been on drug before - 1 year

27
Q

what is the first line treatment for depression

A

generic SSRI - commence on low dose and titrate up if needed, select SSRI based on patient wishes and side effect profile

28
Q

outline the management of acute mania/hypomania

A

any second generation antipsychotic or valproate
discontinue use of antidepressant as that can worsen mania
hospital admission if suspected mania

29
Q

list some examples of first generation antipsychotics

A

chlorpromazine
haloperidol
zuclopenthixol

30
Q

list some examples of second generation antipsychotics

A

clozapine
olanzapine
quetiapine
risperidone

31
Q

what type of drug is aripiprazole

A

third generation antipsychotic

32
Q

what is the mode of action of antipsychotics

A

specifically target D2 receptors as dopamine antagonists as there is abhorrent firing of dopaminergic neurones in schizophrenia

33
Q

list some of the groups of side effects in antipsychotics

A

extra-pyramidal side effects
neuroepileptic syndrome
hyperprolactinaemia
akathesia

34
Q

describe extrapyramidal side effects in antipsychotics

A

acute dystonia - increasing muscle tone, presents within minutes
parkinsonism - gradual onset over weeks
tardive dyskinesia

35
Q

what is the treatment for extra-pyramidal side effects from antipsychotics

A

treat with anticholinergics to get dopamine and ACh back into relative balance - procyclidine and trihexyphenidyl

36
Q

what is neuroepileptic malignant syndrome

A

rare but potentially fatal condition with increasing muscle tone, pyrexia, fluctuating pulse and BP
eventually leads to rhabdomyolysis - acute renal failure and then death

37
Q

what is the management of neuroepileptic malignant syndrome

A

stop antipsychotic
rapid cooling with renal support
dopamine agonists

38
Q

what is akathesia

A

inability to sit still

presents with pacing, rocking from foot to foot

39
Q

what is the treatment of akathesia

A

propanolol and long acting benzodiazepine such as clonazepam

40
Q

list some additional side effects of antipsychotics

A 
anticholinergic effects 
weight gain 
postural hypotension 
prolonged QTc interval 
photosensitivity
41
Q

clozapine is particularly good for positive or negative symptoms of schizophrenia

A

negative symptoms and antisuicidal properties

42
Q

list some of the side effects specific to clozapine

A 
agranulocytosis 
myocarditis 
constipation which can lead to obstruction and perforation 
weight gain 
sedation 
sialorrhoea
43
Q

what is the first line treatment for schizophrenia

A

second generation antipsychotic and titrate dose up and try for 6-8 weeks

44
Q

what is the second line treatment for schizophrenia

A

try an alternative second generation or a first generation antipsychotic

45
Q

what is the third line treatment for schizophrenia

A

clozapine

46
Q

what drugs are used to treat anxiety

A

benzodiazepines
antidepressants
pregabalin
propanolol

47
Q

what type of neurotransmitter is GABA

A

inhibitory neurotransmitter

48
Q

what effect do benzodiazepines have on GABA

A

enhance the action of GABA, less likely that a neurone will fire an action potential

49
Q

give some examples of benzodiazepines

A

midazolam
diazepam
loprazolam
chlordiazepam

50
Q

what are the pharmacological effects of benzodiazepines

A 
muscle relaxants 
reduce anxiety and depression 
hypnosis and sedation 
anticonvulsant effect 
anterograde amnesia
51
Q

list some of the clinical uses of benzodiazepines

A 
acute anxiety 
hypnosis 
alcohol withdrawal 
mania 
delirium 
status epilepticus 
rapid tranquillisation
52
Q

what is the main issue with taking benzodiazepines especially for a long time

A

tolerance and dependence - the dose taken no longer has the desired effect

53
Q

when immediately stopping benzodiazepines, list some of the effects of withdrawal

A 
abdo cramps 
increased anxiety 
blurred vision 
depression 
insomnia 
dizziness 
headaches 
nausea and vomiting 
tingling in hands and feet 
restlessness 
sensory sensitivity
54
Q

what causes the withdrawal symptoms associated with benzodiazepines

A

chronic treatment of benzos causes reduced GABA response, when someone immediately withdraws the anxiety and convulsions occur due to reduced density of benzodiazepines receptors

55
Q

what is the correct way of withdrawing from benzodiazepines

A

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

Psychiatry (14 decks)

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