Psych drugs ANKI

Question 1

What are the drug classes for anxiety disorders? - […] - […] What are the drug classes for depression? - […] - […] What are the drug classes for psychoses? - […] - […]

Answer 1

What are the drug classes for anxiety disorders? - Benzodiazepines - SSRIs What are the drug classes for depression? - SSRIs - TCAs and other classes of antidepressants What are the drug classes for psychoses? - Typical antipsychotics - Atypical antipsychotics

Question 2

What are some symptoms of anxiety disorders? - […] - […] - […] - […] - […] - […] - […] - […]

Answer 2

What are some symptoms of anxiety disorders? - Apprehension and Fear - CVS: Palpitations and tremors - Resp: Chest pain and shortness of breath - GIT disturbance - Headaches and dizziness - Loss of libido - Muscular - Insomnia There are many clinical subtypes of anxiety disorders!!

Question 3

“Benzodiazepines are the most commonly used anti-anxiety and ““hypnotic”” agents (sleeping pills for insomnia) to treat the symptoms and behaviors caused by anxiety disorders. Name the different benzodiazepines. short acting: […] intermediate acting: […] longer acting: […] What is the MoA of Benzodiazepines? BZD binds to specific BZD sites in the CNS and potentiates GABA actions by increasin

Answer 3

“Benzodiazepines are the most commonly used anti-anxiety and ““hypnotic”” agents (sleeping pills for insomnia) to treat the symptoms and behaviors caused by anxiety disorders. Name the different benzodiazepines. short acting: midazolam intermediate acting: lorazepam, alprazolam longer acting: diazepam What is the MoA of Benzodiazepines? BZD binds to specific BZD sites in the CNS and potentiates GA

Question 4

Onset time of benzodiazepine (BZD): Oral: fast onset:0.5-1hr Parenteral: immediate Drugs that are given through IV: - […] - […] - […]

Answer 4

“Onset time of benzodiazepine (BZD): Oral: fast onset:0.5-1hr Parenteral: immediate Drugs that are given through IV: - Midazolam (short acting) - Lorazepam (intermediate acting) - Diazepam (long acting) just rmb these 3. Alprazolam just whatever HAHHAHA its a ““zolam”” anw”

Question 5

Name some adverse effects of benzodiazepine (Xanax) (vvvvvvvvvvvv IMPT!!!!) - […] (frequent) - […] (frequent) - […] (frequent) - […] - […] - […]

Answer 5

Name some adverse effects of benzodiazepine (Xanax) (vvvvvvvvvvvv IMPT!!!!) - CNS: increase drowsiness, decrease motor skills, increase reaction time, sedation (frequent) - CNS: Anterogade amnesia. Memory disturbances are particularly profound after intravenous sedation (frequent) - CVS: decreased BP, respiratory depression in predisposed patients. (frequent) - Paradoxical effects: excitement, gar

Question 6

Name some non-benzodiazepine hypnotics. What is their MoA? […] Short elimination T1/2 with hypnotic effects comparable to benzodiazepines. So these drugs are only used for […].

Answer 6

“Name some non-benzodiazepine hypnotics. What is their MoA? Zolpidem, Zopiclone. Act on BZD sites similar to BZD Short elimination T1/2 with hypnotic effects comparable to benzodiazepines. So these drugs are only used for insomnia. ““the zzzzzz drug”” Less side effects than benzodiazepines. Main side effect are withdrawl and abuse potential!”

Question 7

What are some non-pharmacological approach treatment for depression? - […] - […] - […] - […] - […]

Answer 7

What are some non-pharmacological approach treatment for depression? - Psychological: CBT, Interpersonal… - Social - Behavioural - Relaxation - Counselling CBT = Cognitive Behavior Therapy

Question 8

What is the biochemical basis behind antidepressants? […]

Answer 8

What is the biochemical basis behind antidepressants? Replenish deficiency of monoamines!!!

Question 9

Name the 4 classes of commonly used antidepressants. Which 2 are commonly used? 1. […] 2. […] 3. […] 4. […]

Answer 9

“Name the 4 classes of commonly used antidepressants. Which 2 are commonly used? 1. Selective Serotonin Re-uptake Inhibitors (SSRIs) (e.g fluoxetine, escitalopram, sertraline, paroxetine) 2. TriCyclic Antidepressants (TCAs) (amitriptyline, imipramine) 3. Serotonin norepinephrine reuptake inhibitors (SNRIs) 4. Noradrenergic selective serotonin antidepressant (NaSSa) depressed men go ““am I tripping

Question 10

MOA of SSRI? […] Examples of SSRI that are used? 1. […] 2. […] 3. […] 4. […]

Answer 10

MOA of SSRI? As the name suggest. Inhibit reuptake of serotonin at synapse. Creates excessive/ increased neurotransmitters in the synapse. Examples of SSRI that are used? 1. Fluoxetine (Prozac) 2. Escitalopram (Laxapo) 3. Sertraline 4. Paroxetine Increasing neurotrasmitters can increase BDNF –> neurogenesis

Question 11

What are the adverse effects of SSRIs? (vvvv IMPT!!!!) - […] - […] - […] - […] - […] - No fatality in overdose (similar to BZD) They are also very potent […]. Inhibition descends in the order Fluvoxamine > Fluoxetine > Paroxetine > Sertraline > Escitalopram

Answer 11

What are the adverse effects of SSRIs? (vvvv IMPT!!!!) - Anxiety - Weight gain - Headache, nausea (first few days) - Sexual dysfunction - Hyponatremia - No fatality in overdose (similar to BZD) They are also very potent CYP450 enzyme inhibitors. Inhibition descends in the order Fluvoxamine > Fluoxetine > Paroxetine > Sertraline > Escitalopram So SSRI anti-depressants can give u anxiety and weight

Question 12

TCA vs SSRI in terms of MOA? […] Which one causes fatality on overdose? (IMPT!!!!) […]

Answer 12

TCA vs SSRI in terms of MOA? SSRI blocks only serotonin transporter (SELECTIVE mah), TCA blocks BOTH serotonin transporter and and NA transporter. Which one causes fatality on overdose? (IMPT!!!!) TCA TCA is more value for money + is gold standard (for severe depression) but also have more adverse effects + fatality on overdose so SSRI is more commonly used. esp for chronic anxiety. gain tolerance

Question 13

What are the adverse effects of TCAs? (IMPT!!!) - […] - […] - […] - […] Most importantly: […].

Answer 13

What are the adverse effects of TCAs? (IMPT!!!) - CNS effects: sedation, fatigue - Cardiac rhythm: tachycardia, arrhythmias - Postural hypotension - Anticholinergic effects: glaucoma, blurred vision, urinary retention, constipation Most importantly: Fatality in overdose. FATALITY IN OVERDOSE! DEPRESSED PPL’S WAY OF SUICIDE - this is unlike the others like SSRIs BZDs also doesnt cause fatality in o

Question 14

“Psychosis is a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality. Schizophrenia is a subtype of psychosis. What is the hypothesis behind the pathophysiology of psychosis? […] What are the positive symptoms (““can”” symptoms) of schizophrenia? […] What are the negative symptoms (““cannot”” symptoms) of schizophrenia? […]”

Answer 14

“Psychosis is a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality. Schizophrenia is a subtype of psychosis. What is the hypothesis behind the pathophysiology of psychosis? Excessive dopamine transmission in mesocortico-limbic system. Its a hypothesis so antipsychotic drugs are used to treat symptoms, not cause. What are the positive sym

Question 15

Outline the classes of antipsychotic drugs and give examples of each (IMPT!!!) Typical (1st gen) - […] - […] Atypical (2nd gen) (less Extrapyramidal side effect) - […] - […] - […] - […] - […]

Answer 15

“Outline the classes of antipsychotic drugs and give examples of each (IMPT!!!) Typical (1st gen) - Chlorpromazine (low) - Haloperidol (high potency) (more extrapyramidal side effect) Atypical (2nd gen) (less Extrapyramidal side effect) - Risperidone (more extrapyramidal side effect) - Olanzapine (metabolic disorder) - Quetiapine - Clozapine(agranulocytosis, metabolic disorder) - Aripipazole ““Mn

Question 16

Difference between typical (1st gen) vs atypical (2nd gen) antipsychotic drugs PD? Typical blocks: […] - and also D1, cholinergic, histaminic, α adrenergic Atypical blocks: […] - and a number of other receptors

Answer 16

“Difference between typical (1st gen) vs atypical (2nd gen) antipsychotic drugs PD? Typical blocks: D2 > 5-HT2 receptors - and also D1, cholinergic, histaminic, α adrenergic Atypical blocks: 5-HT2 > D2 - and a number of other receptors blocking D2 = more EPSE = higher risks of parkinsonism 5HT2 antagonist is for anti-psychotics 5HT3 antagonist is for nausea and vomiting ““setron”” 5HT4 agonist is

Question 17

Name some of the effects of depression - […] - […] - […] - […] - […] - […] - […] - […]

Answer 17

Name some of the effects of depression - Poor mood - Loss of interest - Appetite changes - Reduced concentration and energy - Feelings of shame and guilt - Suicidal ideation - Less or more sleep - Psychomotor retardation Symptoms persist for >2 weeks + severity of symptoms interfere with normal functioning

Question 18

Adverse effects of typical and atypical antipsychotic drugs? Typical: Haloperidol hgher potency than chlorpromazine, more […] Atypical: Generally have fewer EPSE than typical Clozapine: […] Olanzapine: […] Quetiapine: […] Risperidone: […]

Answer 18

“Adverse effects of typical and atypical antipsychotic drugs? Typical: Haloperidol hgher potency than chlorpromazine, more EPSE Atypical: Generally have fewer EPSE than typical Clozapine: Agranulocytosis, weight gain and sedation Olanzapine: Weight gain and sedation Quetiapine: Weight gain Risperidone: EPS (dose dependant), weight gain Mn for the EPSE would be PAMAT The ““pine”” antipsychotics all

Question 19

Onset time of benzodiazepine (BZD): Oral: […] Parenteral: […] Drugs that are given through IV: - Midazolam (short acting) - Lorazepam (intermediate acting) - Diazepam (long acting)

Answer 19

“Onset time of benzodiazepine (BZD): Oral: fast onset:0.5-1hr Parenteral: immediate Drugs that are given through IV: - Midazolam (short acting) - Lorazepam (intermediate acting) - Diazepam (long acting) just rmb these 3. Alprazolam just whatever HAHHAHA its a ““zolam”” anw”

Question 20

“Benzodiazepines are the most commonly used anti-anxiety and ““hypnotic”” agents (sleeping pills for insomnia) to treat the symptoms and behaviors caused by anxiety disorders. Name the different benzodiazepines. short acting: midazolam intermediate acting: lorazepam, alprazolam longer acting: diazepam What is the MoA of Benzodiazepines? […]”

Answer 20

“Benzodiazepines are the most commonly used anti-anxiety and ““hypnotic”” agents (sleeping pills for insomnia) to treat the symptoms and behaviors caused by anxiety disorders. Name the different benzodiazepines. short acting: midazolam intermediate acting: lorazepam, alprazolam longer acting: diazepam What is the MoA of Benzodiazepines? BZD binds to specific BZD sites in the CNS and potentiates GA

Question 21

Benzodiazepines are also used in insomnia. What are some causes of insomnia? - […] - […] - […] - […] What are the characteristics of benzodiazepine induced sleep? - […]

Answer 21

Benzodiazepines are also used in insomnia. What are some causes of insomnia? - Anxiety - Depression - Drug induced (e.g caffeine) - Drugs withdrawal (after chronic use of sleeping pills/alcohol) What are the characteristics of benzodiazepine induced sleep? - Reduced REM and deep (stage 4) sleep Midazolam, lorazepam, diazepam. Elimination T1/2 can range from 2-24hrs

Question 22

Elderly patient walks in feeling giddy and faint. He has been maintained on anti-hypertensives. What question would you ask? […]

Answer 22

Elderly patient walks in feeling giddy and faint. He has been maintained on anti-hypertensives. What question would you ask? Has he been taking SSRIs for depression This means that you need to be constantly aware of SSRI being a potent CYP450 inhibitor when prescribing it. Always ask the patient what else he is taking!!!

Question 23

What is your choice of drugs for this patient and the reason? - […] - […] - […] Why would you choose SSRI over TCA when SSRIs are more expensive? […]

Answer 23

What is your choice of drugs for this patient and the reason? - SSRI - non fatal on overdose - TCA - gold standard for severe depression - Mirtazapine (NaSSA) - sedating, good for his insomnia Why would you choose SSRI over TCA when SSRIs are more expensive? SSRI overdose will not result in death of patient. If depressed patients with suicidal tendancies are given TCA, it worsens the suicide probl

Question 24

“Mrs A, 56 year-old complains that her neighbour upstairs can see her bathing and hear her having dinner. They ““purposely”” push their chair and make noise to disturb her. They even know her thoughts. Diagnosis? […] What antipsychotic drug will you prescribe? What are the considerations? - […] - […]”

Answer 24

“Mrs A, 56 year-old complains that her neighbour upstairs can see her bathing and hear her having dinner. They ““purposely”” push their chair and make noise to disturb her. They even know her thoughts. Diagnosis? Schizophrenia What antipsychotic drug will you prescribe? What are the considerations? - Typical - Haloperidol: Less sedation but more EPSE - Atypicals - Less EPSE but weight gain and agr