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Module 308 > Pharmacology for Psychiatry > Flashcards

Pharmacology for Psychiatry Flashcards

1
Q

Do antidepressants work?

A

Yes

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2
Q

If patient isnt responding to antidepressants…

  • review …
  • review …
  • consider …. strategies
  • address … …
A
  • review compliance
  • review diagnosis
  • consider alternative strategies
  • address perpetuating factors
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3
Q

If patient isnt responding to antidepressants…

  • review …
  • review …
  • consider …. strategies
  • address … …
A
  • review compliance
  • review diagnosis
  • consider alternative strategies
  • address perpetuating factors
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4
Q

Common SSRIS? (5)

A
  • Fluoxetine
  • Paroxetine
  • Sertraline
  • Citalopram
  • Escitalopram
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5
Q

Indications for SSRIs

A
  • Depression
  • Anxiety Disorders
  • Panic Disorder
  • OCD
  • PTSD
  • Other
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6
Q

SSRIS - similarities between them

  • Indications
  • Mechanism of …
  • Delayed peak action (..-.. days)
  • Efficacy
  • Relative safety in …
  • Advisability of … course (e.g. … months in major depression)
  • Interactions
A
  • Indications
  • Mechanism of action
  • Delayed peak action (10-14 days)
  • Efficacy
  • Relative safety in overdose
  • Advisability of prolonged course (e.g. 6 months in major depression)
  • Interactions
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7
Q

SSRIS - similarities between them

  • I…
  • Mechanism of action
  • … … action (10-14 days)
  • E…
  • Relative … in …
  • Advisability of prolonged course (e.g. 6 months in major depression)
  • I…
A
  • Indications
  • Mechanism of action
  • Delayed peak action (10-14 days)
  • Efficacy
  • Relative safety in overdose
  • Advisability of prolonged course (e.g. 6 months in major depression)
  • Interactions
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8
Q

SSRIS - differences between them

  • Half-life - … shortest (20 hours), … is longest (2-4 days - but active metabolite 14 day half-life)
  • Propensity to cause … syndrome if stopped
  • Side-effect profiles: fluoxetine causes … most commonly
  • Individual differences - people are different
A
  • Half-life - paroxetine shortest (20 hours), fluoxetine is longest (2-4 days - but active metabolite 14 day half-life)
  • Propensity to cause discontinuation syndrome if stopped
  • Side-effect profiles: fluoxetine causes agitation most commonly
  • Individual differences - people are different
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9
Q

SSRIS - differences between them

  • Half-life - paroxetine shortest (… hours), fluoxetine is longest (2-4 days - but active metabolite … day half-life)
  • Propensity to cause … … if stopped
  • Side-effect profiles: …. causes agitation most commonly
  • Individual differences - people are different
A
  • Half-life - paroxetine shortest (20 hours), fluoxetine is longest (2-4 days - but active metabolite 14 day half-life)
  • Propensity to cause discontinuation syndrome if stopped
  • Side-effect profiles: fluoxetine causes agitation most commonly
  • Individual differences - people are different
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10
Q

SSRI discontinuation syndrome

  • Occurs on … of SSRI especially when abrupt
  • Symptoms - agitation and …, dizziness, balance problems, nausea, diarrhoea, …-like symptoms
  • Commonest with …
  • Treat by - reassurance and …, reintroduction of drug + … withdrawal, consider alternative antidepressant or anxiolytic
A
  • Occurs on cessation of SSRI especially when abrupt
  • Symptoms - agitation and anxiety, dizziness, balance problems, nausea, diarrhoea, flu-like symptoms
  • Commonest with paroxetine
  • Treat by - reassurance and monitoring, reintroduction of drug + tapered withdrawal, consider alternative antidepressant or anxiolytic
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11
Q

Mirtazapine

  • What type of antidepressant?
  • Acts on what receptors?
A
  • NaSSA - Noradrenergic and Specific Serotonergic Antidepressant
  • Acts at alpha 2 receptors (antagonist) “cuts the brake cable” on serotonin and nordrenaline release
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12
Q

Tricylic Antidepressants

  • Many compounds since 1950s
  • Main ones in current use:
    • A…
    • Imipramine
    • L…
    • Dothiepin
  • Indications similar to SSRIs although not as widely used outside of depression
    • Efficacy in major depression … to SSRIs
    • Rarely used first-line nowadays due to … effects and … risk
A
  • Many compounds since 1950s
  • Main ones in current use:
    • Amitriptyline
    • Imipramine
    • Lofepramine
    • Dothiepin
  • Indications similar to SSRIs although not as widely used outside of depression
    • Efficacy in major depression similar to SSRIs
    • Rarely used first-line nowadays due to adverse effects and overdose risk
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13
Q

Tricylic Antidepressants

  • Many compounds since 1950s
  • Main ones in current use:
    • Amitriptyline
    • …
    • Lofepramine
    • …
  • Indications similar to SSRIs although not as widely used outside of …
    • Efficacy in major depression similar to SSRIs
    • Rarely used first-line nowadays due to adverse effects and overdose risk
A
  • Many compounds since 1950s
  • Main ones in current use:
    • Amitriptyline
    • Imipramine
    • Lofepramine
    • Dothiepin
  • Indications similar to SSRIs although not as widely used outside of depression
    • Efficacy in major depression similar to SSRIs
    • Rarely used first-line nowadays due to adverse effects and overdose risk
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14
Q

Tricyclic Antidepressants

  • Mechanism of action:
    • Bind to … and … reuptake inhibitors
      • Increase monoamine levels in synaptic cleft
    • Pronounced … (antimuscarinic) effects
    • Specific affinities vary widely between different compounds
      • This means that TCA properties are variable
      • This may be clinically relevant e.g. if … effects are desirable (e.g. amitriptyline, dothiepin)
A
  • Mechanism of action:
    • Bind to NA and 5HT reuptake inhibitors
      • Increase monoamine levels in synaptic cleft
    • Pronounced anticholinergic (antimuscarinic) effects
    • Specific affinities vary widely between different compounds
      • This means that TCA properties are variable
      • This may be clinically relevant e.g. if sedative effects are desirable (e.g. amitriptyline, dothiepin)
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15
Q

Tricylic Antidepressants - Adverse Effects

  • Anticholinergic effects:
    • … mouth, c…, u… retention, c… effects
  • Other adverse effects - … effects (agitation, nightmares), Sexual dysfunction (e.g. erectile dysfunction), akathisia, muscle twitches, cardiac arrhythmias
A
  • Anticholinergic effects:
    • Dry mouth, constipation, urinary retention, cognitive effects
  • Other adverse effects - psychotropic effects (agitation, nightmares), Sexual dysfunction (e.g. erectile dysfunction), akathisia, muscle twitches, cardiac arrhythmias
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16
Q

Tricylic Antidepressants - Adverse Effects

  • … effects:
    • Dry mouth, constipation, urinary retention, cognitive effects
  • Other adverse effects - psychotropic effects (…, nightmares), Sexual dysfunction (e.g. … …), akathisia, … twitches, cardiac …
A
  • Anticholinergic effects:
    • Dry mouth, constipation, urinary retention, cognitive effects
  • Other adverse effects - psychotropic effects (agitation, nightmares), Sexual dysfunction (e.g. erectile dysfunction), akathisia, muscle twitches, cardiac arrhythmias
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17
Q

Tricylic Antidepressants - Overdose

  • Neurological and cardiovascular effects:
    • …, tachycardia and other …, hypotension, mydriasis - seizures, coma, … arrest
    • Studies in 1000s suggested … deaths per 100,000 prescriptions, and that TCAs involved in around a third of all fatal overdoses
A
  • Neurological and cardiovascular effects:
    • Confusion, tachycardia and other arrythmias, hypotension, mydriasis - seizures, coma, cardiorespiratory arrest
    • Studies in 1000s suggested 5 deaths per 100,000 prescriptions, and that TCAs involved in around a third of all fatal overdoses
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18
Q

Tricylic Antidepressants - Overdose

  • Neurological and cardiovascular effects:
    • Confusion, t.. and other arrythmias, …, mydriasis - seizures, c…, cardiorespiratory arrest
    • Studies in 1000s suggested 5 deaths per 100,000 prescriptions, and that TCAs involved in around a … of all fatal overdoses
A
  • Neurological and cardiovascular effects:
    • Confusion, tachycardia and other arrythmias, hypotension, mydriasis - seizures, coma, cardiorespiratory arrest
    • Studies in 1000s suggested 5 deaths per 100,000 prescriptions, and that TCAs involved in around a third of all fatal overdoses
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19
Q

TCA overdose deaths …./10^6 scripts

A

TCA overdose deaths 34.14/10^6 scripts

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20
Q

SSRIS overdose deaths …./10^6 scripts

A

SSRIS overdose deaths 2.02/10^6 scripts

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21
Q

Consistent finding that … are much more dangerous in overdose

A

Consistent finding that TCAs are much more dangerous in overdose

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22
Q

Venlafaxine

  • S…RI (serotonin and … reuptake inhibitor)
  • Not a TCA or SSRI- chemically distinct
  • Appears to have … pronounced dose-response effect than other antidepressants
  • Some evidence that it is particularly effective for mixed anxiety and depression
  • Side effects: headache, nausea, hypertension, discontinuation syndrome
A
  • SNRI (serotonin and noradrenaline reuptake inhibitor)
  • Not a TCA or SSRI- chemically distinct
  • Appears to have more pronounced dose-response effect than other antidepressants
  • Some evidence that it is particularly effective for mixed anxiety and depression
  • Side effects: headache, nausea, hypertension, discontinuation syndrome
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23
Q

Venlafaxine

  • S…RI (serotonin and … reuptake inhibitor)
  • Not a TCA or SSRI- chemically distinct
  • Appears to have … pronounced dose-response effect than other antidepressants
  • Some evidence that it is particularly effective for … … and depression
  • Side effects: headache, nausea, hypertension, …. syndrome
A
  • SNRI (serotonin and noradrenaline reuptake inhibitor)
  • Not a TCA or SSRI- chemically distinct
  • Appears to have more pronounced dose-response effect than other antidepressants
  • Some evidence that it is particularly effective for mixed anxiety and depression
  • Side effects: headache, nausea, hypertension, discontinuation syndrome
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24
Q

Duloxetine – also an SNRI – without concerns re …

A

Duloxetine – also an SNRI – without concerns re hypertension

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25
Q

MAOIs

  • Prevents action of … …
  • Thereby preventing 5-HT, DA and NA being broken down
A
  • Prevents action of Monoamine Oxidase
  • Thereby preventing 5-HT, DA and NA being broken down
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26
Q

MAOIs

  • Prevents action of Monoamine Oxidase
  • Thereby preventing 5-HT, DA and NA being broken down
A
  • Prevents action of Monoamine Oxidase
  • Thereby preventing 5-HT, DA and NA being broken down
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27
Q

MAOIs interactions

  • Foods
  • Which ones?
    • Most …, red wine, … production liver, broad bean pods, fermented sausages – salami etc.
  • T…
  • Hypertensive effect -> HYPERTENSIVE CRISIS
  • Moclebamide is much lower risk
A
  • Foods
  • Which ones?
    • Most cheeses, red wine, yeast production liver, broad bean pods, fermented sausages – salami etc.
  • TYRAMINE
  • Hypertensive effect -> HYPERTENSIVE CRISIS
  • Moclebamide is much lower risk
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28
Q

MAOI interactions cont

  • Drugs
  • … syndrome
    • DO NOT COMBINE WITH SSRIs
  • Autonomic hyperactivity
  • Neuromuscular abnormality
  • Mental status changes
  • Adrenaline and noradrenaline
  • L-Dopa
A
  • Drugs
  • Serotonin syndrome
    • DO NOT COMBINE WITH SSRIs
  • Autonomic hyperactivity
  • Neuromuscular abnormality
  • Mental status changes
  • Adrenaline and noradrenaline
  • L-Dopa
29
Q

Summary of actions - Antidepressants

A
30
Q

Summary of actions - Antidepressants

A
31
Q

Depression - flow chart

A
32
Q

Antipsychotics

  • Licenced uses:
    • Psychotic illnesses
    • … … disorder
    • … therapy for depressive episodes
  • Off-licence uses:
    • Anxiety disorders
    • … disturbance in dementia and learning disability
    • … disorder
    • … disorder
    • PTSD
  • And many more…
A
  • Licenced uses:
    • Psychotic illnesses
    • Bipolar affective disorder
    • Adjunctive therapy for depressive episodes
  • Off-licence uses:
    • Anxiety disorders
    • Behavioural disturbance in dementia and learning disability
    • Conduct disorder
    • Personality disorder
    • PTSD
  • And many more…
33
Q

Dopamine

  • What is it?
    • Monoamine neurotransmitter
    • Metabotropic, G-protein coupled receptors
    • Precursor = …
  • What does dopamine do?
    • … functions
    • Motor control
    • M..
    • Reward
    • L…
    • Nausea
A
  • What is it?
    • Monoamine neurotransmitter
    • Metabotropic, G-protein coupled receptors
    • Precursor = Tyrosine
  • What does dopamine do?
    • Executive functions
    • Motor control
    • Motivation
    • Reward
    • Lactation
    • Nausea
34
Q

Dopamine

  • What is it?
    • … neurotransmitter
    • …, G-protein coupled receptors
    • Precursor = Tyrosine
  • What does dopamine do?
    • Executive functions
    • Motor control
    • Motivation
    • R..
    • Lactation
    • N…
A
  • What is it?
    • Monoamine neurotransmitter
    • Metabotropic, G-protein coupled receptors
    • Precursor = Tyrosine
  • What does dopamine do?
    • Executive functions
    • Motor control
    • Motivation
    • Reward
    • Lactation
    • Nausea
35
Q

Dopamine pathways

A
36
Q

So what goes wrong in schizophrenia?

A

We know that “too much dopamine” can cause psychotic symptoms

37
Q

Typical Antipsychotics

A
38
Q

Typical Antipsychotic Side Effects

  • Dopamine has inhibitory effect on … release - reduced dopamine by D2 antipsychotics therefore cause …
  • Too little dopamine effect in nigrostriatum causes …
A

Dopamine has inhibitory effect on prolactin release - reduced dopamine by D2 antipsychotics therefore cause hyperprolactinaemia

Too little dopamine effect in nigrostriatum causes EPSE

39
Q

Neuroleptics or “typical antipsychotics” were introduced when? What is efficacy like? What side effects?

A

1950s various different classes of drug, all have roughly similar efficacy - neurological side effects include EPSEs - parkinsonism, akathisia, dystonia and tardive dyskinesia which develops in approx 5% of patients on long-term antipsychotic medication per year

40
Q

Other neurotransmitter systems and psychosis

Serotonin hypothesis: some …. drugs (e.g. LSD) have structural resemblance to serotonin, some newer antipsychotic drugs (especially …) act at serotonin receptors

Glutamate hypothesis: … - glutamate agonist that can produce schizophrenia like symptoms, some evidence of abnormal glutamate activity in schizophrenia

A

Serotonin hypothesis: some hallucinogenic drugs (e.g. LSD) have structural resemblance to serotonin, some newer antipsychotic drugs (especially clozapine) act at serotonin receptors

Glutamate hypothesis: PCP - glutamate agonist that can produce schizophrenia like symptome, some evidence of abnormal glutamate activity in schizophrenia

41
Q

…. …. develops in approx 5% of patients on long-term antipsychotic medication per year (typical antipsychotics)

A

tardive dyskinesia which develops in approx 5% of patients on long-term antipsychotic medication per year

42
Q

Examples of typical antipsychotics:

  • Butyrophenones: H…
  • Phenothiazines: C…, Trifluoperazine, Fluphenazine
  • Thioxanthines: Flupenthixol
  • Differ mainly in terms of side effect profiled, degree of sedation and preparations available (e.g. depot forms)
A
  • Butyrophenones: Haloperidol
  • Phenothiazines: Chlorpromazine, Trifluoperazine, Fluphenazine
  • Thioxanthines: Flupenthixol
  • Differ mainly in terms of side effect profiled, degree of sedation and preparations available (e.g. depot forms)
43
Q

Atypical antipsychotics

  • Newer drugs with less propensity to cause … - they still can and do cause them
  • Different mechanism of action - generally not as specific for …. receptors, also act on serotonin (…) system
  • Not neccessarily any more effective than older “typicals”
  • Examples: R…, olanzapine, Q…, aripiprazole
  • Neurological side effects less common/severe than with typicals
  • Problems with weight gain and ‘metabolic syndrome’ (new-onset diabetes), particularly with olanzapine
A
  • Newer drugs with less propensity to cause EPS - they still can and do cause them
  • Different mechanism of action - generally not as specific for D2 receptors, also act on serotonin (5HT) system
  • Not neccessarily any more effective than older “typicals”
  • Examples: risperidone, olanzapine, quetiapine, aripiprazole
  • Neurological side effects less common/severe than with typicals
  • Problems with weight gain and ‘metabolic syndrome’ (new-onset diabetes), particularly with olanzapine
44
Q

Atypical antipsychotics

  • … drugs with less propensity to cause EPS - they still can and do cause them
  • Different mechanism of action - generally not as specific for D2 receptors, also act on serotonin (5HT) system
  • Not neccessarily any more effective than older “typicals”
  • Examples: risperidone, …, quetiapine, …
  • Neurological side effects … common/severe than with typicals
  • Problems with … … and ‘… syndrome’ (new-onset diabetes), particularly with …
A
  • Newer drugs with less propensity to cause EPS - they still can and do cause them
  • Different mechanism of action - generally not as specific for D2 receptors, also act on serotonin (5HT) system
  • Not neccessarily any more effective than older “typicals”
  • Examples: risperidone, olanzapine, quetiapine, aripiprazole
  • Neurological side effects less common/severe than with typicals
  • Problems with weight gain and ‘metabolic syndrome’ (new-onset diabetes), particularly with olanzapine
45
Q

Thinking about side effects - down to receptors

  • Occur because - side effect of the direct action of the drug (antipsychotics and …)
  • but also happen due to other receptors affected by the drug (antipsychotics and …, muscarinic, alpha 1 & 2 receptors)
A
  • Occur because - side effect of the direct action of the drug (antipsychotics and dopamine)
  • but also happen due to other receptors affected by the drug (antipsychotics and histamine, muscarinic, alpha 1 & 2 receptors)
46
Q

Dopamine receptor blockade side effects

  • …. side effects
    • Parkinsonism
    • Dystonias
    • Tardive ….
    • ….
A
  • Extrapyramidal side effects
    • Parkinsonism
    • Dystonias
    • Tardive Dyskinesia
    • Hyperprolactinaemia
47
Q

Muscarinic (cholinergic) receptor side effects

  • C…, dyspepsia, …. vission, dry eyes, T…, somnolence, impaired memory and cognition, D…
A

Constipation, dyspepsia, blurred vission, dry eyes, tachycardia, somnolence, impaired memory and cognition, dizziness

48
Q

Alpha adrenergic receptor side effects

  • Orthostatic …, vertigo, p…, …. dysfunction
A
  • Orthostatic hypotension, vertigo, palpitations, sexual dysfunction
49
Q

Clozapine

  • Reserved for …-resistant cases
  • … effective antipsychotic
  • Problems with … side-effects (in 1-3%) necessitate blood test monitoring
  • Acts on range of neurotransmitter systems (including D4 receptors and serotonin system)
  • … propensity to cause EPS
  • Hypersalivation and hypotension may occur
A
  • Reserved for treatment-resistant cases
  • Most effective antipsychotic
  • Problems with haematological side-effects (in 1-3%) necessitate blood test monitoring
  • Acts on range of neurotransmitter systems (including D4 receptors and serotonin system)
  • Low propensity to cause EPS
  • Hypersalivation and hypotension may occur
50
Q

Clozapine

  • Reserved for treatment-resistant cases
  • Most effective antipsychotic
  • Problems with haematological side-effects (in …-…%) necessitate blood test monitoring
  • Acts on range of neurotransmitter systems (including D4 receptors and serotonin system)
  • Low propensity to cause …
  • … and … may occur
A
  • Reserved for treatment-resistant cases
  • Most effective antipsychotic
  • Problems with haematological side-effects (in 1-3%) necessitate blood test monitoring
  • Acts on range of neurotransmitter systems (including D4 receptors and serotonin system)
  • Low propensity to cause EPS
  • Hypersalivation and hypotension may occur
51
Q

Clozapine - can’t forget …

A

constipation! can be fatal - toxic megacolon

52
Q

Rapid transquillisation

  • For acute agitation/aggression where risk of harm to self or others
  • oral first
  • IM
  • Antipsychotics - … or olanzapine
  • Benzodiazepines - … or midazolam
  • Check local protocols - treat underlying cause
A
  • For acute agitation/aggression where risk of harm to self or others
  • oral first
  • IM
  • Antipsychotics - haloperidol or olanzapine
  • Benzodiazepines - lorazepam or midazolam
  • Check local protocols - treat underlying cause
53
Q

Rapid transquillisation

  • For acute …/… where risk of harm to … or …
  • oral first
  • IM
  • Antipsychotics - haloperidol or olanzapine
  • Benzodiazepines - lorazepam or midazolam
  • Check local protocols - treat underlying cause
A
  • For acute agitation/aggression where risk of harm to self or others
  • oral first
  • IM
  • Antipsychotics - haloperidol or olanzapine
  • Benzodiazepines - lorazepam or midazolam
  • Check local protocols - treat underlying cause
54
Q

Mood stabilisers

A
  • Lithium
  • Valproate
  • Carbamazepine
  • Lamotrigine
  • Other anticonvulsants e.g. gabapentin
55
Q

Lithium

  • Certain mode of action
  • Second messenger - inhibition of …
  • Regulation of gene expression - protein … C
A
  • Certain mode of action
  • Second messenger - inhibition of inositol
  • Regulation of gene expression - protein kinase C
    *
56
Q

Lithium - short term side effects

A

polydipsia and polyuria, nausea, fine tremor, loose stools

57
Q

Lithium - long term side effects

A

renal impairment, hypothyroidism, weight gain, acne

58
Q

Lithium toxicity

  • … … index - 0.4-1.2mmol/L
  • Coarse …, nausea and …., ataxia and …. signs, confusion
  • Precipitants: - dehydration (e.g. in …), drug interactions-thiazides, NSAIDs, deteriorating renal function
A
  • Narrow therapeutic index - 0.4-1.2mmol/L
  • Coarse tremor, nausea and vomiting, ataxia and cerebellar signs, confusion
  • Precipitants: - dehydration (e.g. in diarrhoea), drug interactions-thiazides, NSAIDs, deteriorating renal function
59
Q

Lithium toxicity

  • Narrow therapeutic index - 0.4-1.2mmol/L
  • Coarse tremor, nausea and vomiting, …. and cerebellar signs, ….
  • Precipitants: - …. (e.g. in diarrhoea), drug interactions-thiazides, NSAIDs, …. renal function
A
  • Narrow therapeutic index - 0.4-1.2mmol/L
  • Coarse tremor, nausea and vomiting, ataxia and cerebellar signs, confusion
  • Precipitants: - dehydration (e.g. in diarrhoea), drug interactions-thiazides, NSAIDs, deteriorating renal function
60
Q

Valproate

  • Effect on … of Ca and Na channels
  • … inhibitory GABA
  • … excitatory glutamate
  • Effective in … mania, not effective in … phase
  • ease of use
  • improved tolerability
  • weight gain
  • teratogenic - plus developmental disorders
A
  • Effect on inhibition of Ca and Na channels
  • Enhances inhibitory GABA
  • Reduces excitatory glutamate
  • Effective in acute mania, not effective in depressive phase
  • ease of use
  • improved tolerability
  • weight gain
  • teratogenic - plus developmental disorders
61
Q

Valproate

  • Effect on inhibition of Ca and Na channels
  • Enhances inhibitory GABA
  • Reduces excitatory glutamate
  • Effective in acute mania, not effective in depressive phase
  • ease of use
  • improved …
  • … gain
  • … - plus developmental disorders
A
  • Effect on inhibition of Ca and Na channels
  • Enhances inhibitory GABA
  • Reduces excitatory glutamate
  • Effective in acute mania, not effective in depressive phase
  • ease of use
  • improved tolerability
  • weight gain
  • teratogenic - plus developmental disorders
62
Q

Carbamazepine

  • Antimanic but … effective than lithium
  • major problems with drug …
  • … liver enzymes so … levels of other agents
  • other agents in turn alter CBZ metabolism
A
  • Antimanic but less effective than lithium
  • major problems with drug interactions
  • reduces liver enzymes so reducing levels of other agents
  • other agents in turn alter CBZ metabolism
63
Q

Benzodiazepines

  • Commonly used ones - diazepam, lorazepam, clonazepam, temazepam, clobazam (benzo derivative)
  • Differ mainly in potency, half-life duration of action (lorazepam …-acting, clonazepam …-acting)
A
  • Commonly used ones - diazepam, lorazepam, clonazepam, temazepam, clobazam (benzo derivative)
  • Differ mainly in potency, half-life duration of action (lorazepam short-acting, clonazepam longer-acting)
64
Q

Benzodiazepines - uses in psychiatry

  • …, anxiolytics, “… tranquillisers” - role in acute transquillisation, management of … withdrawal, also … (esp. clobazam) and muscle relaxant, bind to BZP site on GABA-A receptor, … is main inhibitory neurotransmitter in CNS
A
  • hypnotics, anxiolytics, “minor tranquillisers” - role in acute transquillisation, management of alcohol withdrawal, also anticonvulsant (esp. clobazam) and muscle relaxant, bind to BZP site on GABA-A receptor, GABA is main inhibitory neurotransmitter in CNS
65
Q

Dependency - benzos

  • …, withdrawal - abrupt withdrawal can precipitate acute …, rarely psychosis, …
  • other withdrawal symptoms include …, hyperacusis, dizziness and imbalance, tinnitus, …
  • … lengthy prescriptions
  • tapered withdrawal using ‘diazepam equivalents’
  • but - there will be a very small subgroup of patients for whom long term treatment is …
A
  • Tolerance, withdrawal - abrupt withdrawal can precipitate acute delirium, rarely psychosis, convulsions
  • other withdrawal symptoms include nausea, hyperacusis, dizziness and imbalance, tinnitus, depersonalization
  • avoid lengthy prescriptions
  • tapered withdrawal using ‘diazepam equivalents’
  • but - there will be a very small subgroup of patients for whom long term treatment is indicated
66
Q

Management of alcohol withdrawal

  • Reducing regimen of …
  • … supplementation - oral, IM/IV
  • Additional aids to maintain abstinence - … reduces cravings, … reduces cravings/enjoyment via opiod receptors, … (antabuse) induces severe reaction if alcohol consumed
A
  • Reducing regimen of benzodiazepines
  • Vitamin supplementation - oral, IM/IV
  • Additional aids to maintain abstinence - acamprosate reduces cravings, naltrexone reduces cravings/enjoyment via opiod receptors, disulfiram (antabuse) induces severe reaction if alcohol consumed
67
Q

Other anxiolytics

  • … - binds to and modulates voltage-gated calcium channels in CNS, originally developed for use in neuropathic pain but has a growing use in anxiety and panic disorder, also in partial seizures, concerns re misuse
  • …. - partial agonist at 5HT-1a receptors, licensed for use in generalised anxiety disorder - doubts over efficacy
A
  • Pregablin - binds to and modulates voltage-gated calcium channels in CNS, originally developed for use in neuropathic pain but has a growing use in anxiety and panic disorder, also in partial seizures, concerns re misuse
  • Buspirone - partial agonist at 5HT-1a receptors, licensed for use in generalised anxiety disorder - doubts over efficacy
68
Q

Dont forget psychological and social interventions!

A

also effective, patient choice, side effects too!

Module 308 (17 decks)

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