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Phase 3a > Psych pharmacology > Flashcards

Psych pharmacology Flashcards

1
Q

Name 4 common SSRIs (Specific serotonin reuptake inhibitprs)

A

Fluoxetine
Sertraline
Paroxetine
Citalopram

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2
Q

What drug class is Mirtazapine?

A

Noradrenergic and specific serotonergic antidepressant (NaSSA)

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3
Q

What drug class are Amitriptyline and Clomipramine?

A

Tricyclic antidepressant (TCA)

inhibit noradrenaline and serotonin reuptake pumps

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4
Q

What are the common side effects of the SSRIs?

A 
GI disturbance
weight loss or weight gain
Insomnia
Sweating
Sexual dysfunction
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5
Q

What are the common side effects of TCAs

A

Anticholinergic/muscarinic = dry mouth, constipation, urinary retention

Anti-adrenergic = post hypotension

Anti-histaminergic = weight gain, sedation

Cardiotoxic = QT prolongation, heart block, arrhythmias

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6
Q

What conditions are SSRIs used for?

A

Depression
Anxiety disorders
OCD
Bulimia (fluoxetine)

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7
Q

Name 4 mood stabilisers?

A
  1. Lithium
  2. Valproate (GABA system)
  3. Carbamazepine (GABA system)
  4. Lamotrigine (inhibits Na channels)
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8
Q

What drugs can be used for acute mania?

A

Lithium or valproate

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9
Q

What drug may be given alongside antipsychotics in schizophrenia?

A

Lithium

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10
Q

What is the first line treatment for acute mania?

A
  1. Oral antipsychotic eg. Olanzipine
  2. add lithium or valproate
  3. BDZs
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11
Q

What is the long term maintenance drugs for bipolar?

A
  1. Lithium
  2. Lithium plys valproate

other = lamotrigine or carbamazepine

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12
Q

What are the side effects of lithium?

A

Narrow therapeutic window 0.5-1.0mmol/L.

Toxic >1.5
Dangerously toxic >2

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13
Q

What investigations are needed to start lithium therapy?

A 
FBC
Renal function + electrolytes
Thyroid function
Pregnancy test
ECG
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14
Q

Name 3 first generation antipsychotics?

A

Chlorpromazine
Haloperidol
Sulpiride

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15
Q

Name 3 second generation antipsychotics?

A

Clozapine
Olanzapine
Respiridone

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16
Q

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

A

Antagonism of dopamine D2 receptors in the mesolimbic dopamine pathway.

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

17
Q

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

A

Worsening of negative and cognitive symptoms of schizophrenia

18
Q

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

A

Extra pyramidal side effects

  • Parkinsonian syndrome
  • Acute dystonia
  • Akathisia
  • Tardive dyskinesia
  • Neuroepileptic malignant syndrome
19
Q

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

A

Hyperprolactinaemia

  • Galactorrhoea
  • Amenorrhoea and infertility
  • Sexual dysfunction
20
Q

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

A

Anti-emetic

21
Q

What are the side effects associated with Clozapine?

A

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

Clozapine only used in treatment resistant cases

22
Q

What is the mechanism of action for benzodiazepines?

A

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.

23
Q

Give 3 examples of BDZs?

A

Zopiclone
Zolpidem
Zaleplon

24
Q

How can the effects fo BDZs be reversed and enhanced?

A

Flumazenil reverses effects

Alcohol, opiates, TCAs and sedatives enhance effect

25
Q

What drugs are used for alcohol dependence?

A

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

26
Q

What drugs are used for opiate dependence?

A

Naloxone (OD)

Methadone

27
Q

What drugs are used for Dementia?

A

Cholinesterase inhibitors (donepezil, rivastigmine..), memantine

28
Q

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

A

Anticholinergic drugs (procyclidine)

29
Q

What is neuroleptic malignant syndrome?

A

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
30
Q

What are the specific treatment options for NMS?

A

Bromocriptine (to reverse dopamine blockade)
Dantrolene (to reduce muscle spasm)
ECT

20% mortality if untreated

31
Q

What is serotonin syndrome?

A

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

32
Q

What are the specific treatment options for serotonin syndrome?

A

Cyproheptadine (5HT-2A antagonist)

Low mortality rate

33
Q

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

A
  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

Phase 3a (13 decks)

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