Pharmacology Flashcards
give an example of an irriversible and reversible monoamine oxidase inhibitor
phenelzine and moclobemide respectively
what is the main side effect of MAO inhibitors
cheese reaction- hypertensive crisis
give and example of a tricyclic antidepressant
amitriptyline, imipramine, lofepramine
what is the mechanism of action of a tricyclic antidepressant
block the reuptake of monoamines such as noradrenaline and 5-HT/serotonin
under which conditions should imipramine be avoided
if the patient has cardiac conditions
giva an example of SSRI
fluoxitine, citalopram, sertraline
what is the mechanism of action of SSRI
block reuptake of serotonin
what are the side effects of SSRI
vivid dreams, nausea, sweating, sexual dysfunction and hyponatraemia (in the elderly)
give an example of SNRI
venlafaxine and duloxetine
what is the mechanism of mirtazapine
block of alpha 2, 5-HT2 and 3
give an example of a dopamine uptake inhibitor
bupropion
what special precautions are taken with lithium
12hr post dose blood levels due to narrow theraputic index
what is the mechanism of action of lithium
block second messenger system or inhibit glycogen synthase kinase 3beta or modulate NO signalling
what are the toxic effects of lithium
vomiting, diarrhoea, ataxia, altered consiousness
give and example of anticonvulsant (mood stabalisers)
carbamazepine, lamotrigine
side effects of valproate
teratogenicity
lamotrigine side effects
small risk of Stevens-Johnson syndrome
what are side effects shared by valproate and carbamazepine
ataxia, drowsiness, CV affects and induced liver enzymes
give examples of antipsychotics
aripiprazole, olanzipine
what is a risk of olanzipine use
higher risk of metabolic syndrome
what are the side effects of aripiprazole
extrapyramidal- motor
which classes of drugs can be used to treat anxiety
benzodiazepines, pregabalin, antidepressants, buspirone
what is the mechanism of action of benzodiazepines
enhance the activity of the neurotransmitter GABA, particuarly affecting the amygdala
give an example of a benzodiazepine used for rapid tranquilisation
lorazepam
what are the pharmacological effects of benzodiazepines
reduced anxiety and aggression
hypnosis and sedation
muscle relaxation
anticonvulsant effects
what are the 2 biggest side effects or problems with benzodiazepines
can cause anterograde amnesia
withdrawal and additction upon long term usage
what are the clinical uses of benzodiazepines
acute treatment of extreme anxiety and mania
rapid tranqulisation, status epilepticus
how do you withdraw a patient from benzodiazepines
transfer to equvalent dose of diazepam/chlordiazepoxide
reduce dose 2-3 weeks by 2-2.5mg
treatment pathway for anxiety (pharmacologically)
SSRI first then tricyclics (imipramine) then venalfaxine (also very useful in GAD)
what is the management pathway for GAD (generalised anxiety disorder)
1st- psychoeducation 2nd- self help and social groups 3rd- CBT or SSRI 4th- SNRI 5th- pregabalin
what are some of the clinical uses of SSRIs
panic disorder, PTSD, OCD and phobias
what is the management of panic disorder
1st- self help
2nd-CBT or SSRI if longstanding symptoms
3rd-tricyclics (clomipramine, imipramine)
continue treatment for 6 months
what is the management of OCD
1st- CBT or self help
2nd- more intense psychological intervention or SSRI (sertrline, citalopram)
3rd- consider increase in dose after 4-6 weeks
4th- SSRI plus CBT and ERP
5th- clomipramine
what is the management of PTSD
1st- watchful waiting for 4 weeks
2nd- within 3 months of trauma then CBT
after 3 months of trauma then forcused CBT or
EMRD
4th- mirtazepinewhat is the management of social anxiety
1st- CBT 2nd- SSRI reviewed at 12 weeks 3rd- SSRI plus CBT 4th- alternative SSRI (fluoxitine or paroxetine) 5th- MAOI (moclobemide)
