Pharmacology of drugs used in psychiatry Flashcards
Types of antidepressants?
Tricyclic antidepressants (TCAs)
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin and noradrenaline reuptake inhibitors (SNRIs)
Examples of tricyclic antidepressants (TCAs)?
Amitriptyline
Lofepramine
How do TCAs work?
Inhibit 5-HT and NA uptake = produces therapeutic effect
How do TCAs produce side effects?
Block of M1, H1, alpha1 receptors produces side effects
Examples of selective serotonin reuptake inhibitors (SSRIs)?
Fluoxetine, sertraline, citalopram
How do SSRIs work?
Inhibit 5-HT uptake
Produces therapeutic benefit - depression, OCD, panic, anxiety
What side effects do SSRIs produce?
Nausea, early increased anxiety
What antidepressants are well tolerated and are good first line treatments?
SSRIs
Give an example of serotonin and noradrenaline reuptake inhibitors (SNRIs)
Venlafaxine
How do SNRIs work?
Inhibit 5-HT and NA (and DA) uptake
Produces therapeutic effect and side effects (similar to SSRIs)
Positives of SNRIs?
Better tolerated than TCAs
More effective than SSRIs for severe depression
Give examples of anxiolytics/hypnotics
Benzodiazepines e.g. diazepam and lorazepam
Z drugs - zopiclone = used as hypnotics due to shorted half lives
Types of antipsychotics - examples?
Typicals/1st generation antipsychotics = haloperidol
Atypicals/2nd generation = olanzapine and risperidone
How do typical antipsychotics work?
Block D2 receptors - therapeutic effects, EPSEs
How do typical antipsychotics cause side effects?
They antagonise histamine, NA and acetylcholine receptors
Mood stabilisers - features of lithium?
Lithium:
- Narrow therapeutic index
- Renal and thyroid dysfunction
- Teratogenic
- Interact with other drugs (NSAIDs)
Who should not take valproate (mood stabiliser)?
Women of child bearing potential due to teratogenicity
Principles of drugs in psychiatry?
Assess risks/benefits Consider cost Discussion with pt Informed choice by pt Repeated monitoring and re-assessment Integration with other tx
Non-pharmacological approaches for mental health?
ECT
Phototherapy
Psychological therapies -behavioural, cognitive, family, sex and relationship therapy
Social interventions: occupational therapy, finance, accommodation
Rehab - for chronic mentally ill
