Psych pharmacology

Question 1

Name 4 common SSRIs (Specific serotonin reuptake inhibitprs)

Answer 1

Fluoxetine
Sertraline
Paroxetine
Citalopram

Question 2

What drug class is Mirtazapine?

Answer 2

Noradrenergic and specific serotonergic antidepressant (NaSSA)

Question 3

What drug class are Amitriptyline and Clomipramine?

Answer 3

Tricyclic antidepressant (TCA)

inhibit noradrenaline and serotonin reuptake pumps

Question 4

What are the common side effects of the SSRIs?

Answer 4

GI disturbance
weight loss or weight gain
Insomnia
Sweating
Sexual dysfunction

Question 5

What are the common side effects of TCAs

Answer 5

Anticholinergic/muscarinic = dry mouth, constipation, urinary retention

Anti-adrenergic = post hypotension

Anti-histaminergic = weight gain, sedation

Cardiotoxic = QT prolongation, heart block, arrhythmias

Question 6

What conditions are SSRIs used for?

Answer 6

Depression
Anxiety disorders
OCD
Bulimia (fluoxetine)

Question 7

Name 4 mood stabilisers?

Answer 7

1. Lithium
2. Valproate (GABA system)
3. Carbamazepine (GABA system)
4. Lamotrigine (inhibits Na channels)

Question 8

What drugs can be used for acute mania?

Answer 8

Lithium or valproate

Question 9

What drug may be given alongside antipsychotics in schizophrenia?

Answer 9

Lithium

Question 10

What is the first line treatment for acute mania?

Answer 10

1. Oral antipsychotic eg. Olanzipine
2. add lithium or valproate
3. BDZs

Question 11

What is the long term maintenance drugs for bipolar?

Answer 11

1. Lithium
2. Lithium plys valproate

other = lamotrigine or carbamazepine

Question 12

What are the side effects of lithium?

Answer 12

Narrow therapeutic window 0.5-1.0mmol/L.

Toxic >1.5
Dangerously toxic >2

Question 13

What investigations are needed to start lithium therapy?

Answer 13

FBC
Renal function + electrolytes
Thyroid function
Pregnancy test
ECG

Question 14

Name 3 first generation antipsychotics?

Answer 14

Chlorpromazine
Haloperidol
Sulpiride

Question 15

Name 3 second generation antipsychotics?

Answer 15

Clozapine
Olanzapine
Respiridone

Question 16

What is the main mechanism of action for all antipsychotics except for clozapine?

Answer 16

Antagonism of dopamine D2 receptors in the mesolimbic dopamine pathway.

Most 2nd gens also block 5-HT2 receptors - especially clozapine.

Question 17

What are the side effects of antipsychotics in the mesocortical pathway?

Answer 17

Worsening of negative and cognitive symptoms of schizophrenia

Question 18

What are the side effects of antipsychotics in the nigrostriatal pathway?

Answer 18

Extra pyramidal side effects

• Parkinsonian syndrome
• Acute dystonia
• Akathisia
• Tardive dyskinesia
• Neuroepileptic malignant syndrome

Question 19

What are the side effects of antipsychotics in the tuberoinfundibular pathway?

Answer 19

Hyperprolactinaemia

• Galactorrhoea
• Amenorrhoea and infertility
• Sexual dysfunction

Question 20

What are the side effects of antipsychotics in the chemoreceptor trigger zone?

Answer 20

Anti-emetic

Question 21

What are the side effects associated with Clozapine?

Answer 21

Agranulocytosis/ neutropenia = major side effect, monitoring FBC is essential
Myocarditis
Cardiomyopathy

Clozapine only used in treatment resistant cases

Question 22

What is the mechanism of action for benzodiazepines?

Answer 22

Bind to receptors in the GABA receptor complex and increasing the affinity for GABA. This causes an increased flow of Cl- and reduces neuronal excitability.

Question 23

Give 3 examples of BDZs?

Answer 23

Zopiclone
Zolpidem
Zaleplon

Question 24

How can the effects fo BDZs be reversed and enhanced?

Answer 24

Flumazenil reverses effects

Alcohol, opiates, TCAs and sedatives enhance effect

Question 25

What drugs are used for alcohol dependence?

Answer 25

Acamprosate (cravings) Disulfiram (hangover) Naltrexone (pleasure)

Question 26

What drugs are used for opiate dependence?

Answer 26

Naloxone (OD) | Methadone

Question 27

What drugs are used for Dementia?

Answer 27

Cholinesterase inhibitors (donepezil, rivastigmine..), memantine

Question 28

What drug is prescribed to counter-act Extra-pyramidal side effects of antipsychotics?

Answer 28

Anticholinergic drugs (procyclidine)

Question 29

What is neuroleptic malignant syndrome?

Answer 29

A rare reaction to antipsychotic drugs which affects the nervous system. Triad of: 1. Muscle stiffness, slow reflexes 2. Autonomic dysfunction 3. Altered consciousness - Insidious onset 4-11 days after initiation/increase of dopamine antagonist

Question 30

What are the specific treatment options for NMS?

Answer 30

Bromocriptine (to reverse dopamine blockade) Dantrolene (to reduce muscle spasm) ECT 20% mortality if untreated

Question 31

What is serotonin syndrome?

Answer 31

Acute reaction to serotenergic medication (usually after 1-2 doses), most common cause is SSRI and MAOI together. Triad of: 1. Myoclonus, hyperreflexia, tremor, rigidity 2. Altered consciousness 3. Autonomic symptoms

Question 32

What are the specific treatment options for serotonin syndrome?

Answer 32

Cyproheptadine (5HT-2A antagonist) Low mortality rate

Question 33

What is the general treatment for serotonin syndrome and neuroleptic malignant syndrome?

Answer 33

1. Discontinue drugs 2. Cool patient 3. Fluid correction 4. Consider ITU 5. Monitor for complications (pneumonia, renal failure) 6. BDZs for sedation if agitation