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Year 5 > Psychcopharmacology > Flashcards

Psychcopharmacology Flashcards

1
Q

Dopamine functions mnemonic

A 
Drive (motivation and reward)
psychOsis
Parkinsonism
Attention
Motor function
Inhibits prolactin
Narcotics (DA release in substance misuse)
Extrapyramidal
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2
Q

Where is the dopamine reward pathway?

A

Ventral Tegmental Area

Most important part is nucleus accumbens

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3
Q

Serotonin functions

A

“Head, Red and Fed”

Head - satisfaction, sociability

Red - platelet binding and bleeding

Fed - GI motility and nausea

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4
Q

Serotonin syndrome mnemonic

A

Head, Red and Dead

Head - confusion and agitation

Red - Flushing, hyperthermia, sweating, tachycardia

Dead - mortality :(

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5
Q

Noradrenaline functions

A
  • Fight or flight responses
  • Concentration, attention and energy
  • Tachycardia, HTN
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6
Q

Glutamate functions

A
  • Main on switch of the brain

- Excitatory

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7
Q

GABA functions

A
  • Main off switch of the brain

- Relaxation, euphoria, muscle relaxation

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8
Q

Acetylcholine functions

A 
"ACH"
A - Autonomic
- Rest and digest function
- Bradycardia
- GI motility

C - Contraction
- of muscle

H - Hippocampus
- Learning, memory, attention

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9
Q

SSRIs - MOA

A
  • Inhibit the serotonin reuptake transporter on the presynaptic membrane
  • More serotonin available in the synapse
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10
Q

Which SSRI has the longest half life?

A

Fluoxetine
This means it works better for people who are less compliant

However be careful when switching to another SSRI, as the levels may be too high (serotonin syndrome)

Best avoided in patients with epilepsy

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11
Q

Sertraline

A

First line for people with underlying cardiac disease

Take with a meal to help absorption
As it can have GI side-effects

Safe in breastfeeding

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12
Q

Paroxetine

A
  • Rapidly absorbed
  • Can have worse side-effects when starting taking the drug
  • Will have a worse withdrawal on suddenly stopping

DO NOT USE IN PREGNANCY because it can cause withdrawal in the baby

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13
Q

Citalopram

A

Effective SSRI

Can prolong the QTc interval at higher doses >40mg

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14
Q

Which neurotransmitters can be used in depression?

A
  • Serotonin

- Noradrenaline

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15
Q

Venlafaxine

A
  • Serotonin and NA reuptake inhibitor

- Can cause HTN but this is short lived

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16
Q

Duloxetine

A
  • Serotonin and NA reuptake inhibitor

- Also used in Stress urinary incontinence !

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17
Q

Mirtazapine

A
  • Alpha-2 adrenergic receptor inhibitor, increases levels of serotonin and NA
  • Can exacerbate the effects of warfarin
  • Causes increased appetite and drowsiness - useful!
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18
Q

Tricyclic antidepressants

A
  • Serotonin and NA reuptake inhibitors
    e. g. Imipramine, Clomipramine, Amitryptiline

Anticholinergic side effects

  • Dry mouth
  • Blurred vision
  • Urinary retention
  • Confusion, memory problems

UNSAFE IN OVERDOSE! :O
These can widen the QRS complex in overdose!

Tx for overdose = sodium bicarbonate

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19
Q

Monoamine oxidase inhibitors (MAOIs)

A
  • Block monoamine oxidase, - This blocks Serotonin, Dopamine and Noradrenaline
  • e.g. Phenelzine - for depression
  • Associated with hypertensive crisis!
  • CHEESE EFFECT - eating tyramine-rich foods results in INCREASED BP

Hypertensive crisis:

  • Severe throbbing headache
  • Severe HTN
  • Flushing
  • Tachycardia
  • Pallor
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20
Q

SSRI side-effects and caution

A
  • All SSRIs can cause hyponatraemia and reduced libido
  • Increased risk of GI bleed, so prescribe a PPI if the patient is on NSAIDs

Patients on warfarin/heparin - avoid SSRIs and use mirtazapine instead

  • Avoid SSRIs if the patient is on triptans
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21
Q

When to review a patient who has started on anti-depressants?

A
  • In 2 weeks

or

  • In 1 week if aged <30, or increased suicide risk
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22
Q

Citalopram dosing

A
  • Max adult dose is 40mg

- In adults with hepatic impairment and patients >65, max 20mg

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23
Q

Refractory depression

A
  • Depression with failure to respond, despite 2 adequate trials of different classes of antidepressants at adequate doses for periods of 6-8 weeks

Mx

  • Re-examine diagnosis
  • Check compliance
  • Offer buspirone (synergistic effect with SSRIs)
24
Q

Typical anti-psychotics

Overview

A

Mostly block DOPAMINE

Leads to ESPEs

  • Haloperidol
  • Chlopromazine
25
Q

Atypical antipsychotics

Overview

A

Block DA and SE

Less EPSEs

Causes metabolic issues!

  • Olanzapine
  • Clozapine
  • Risperidone
26
Q

Side-effects of anti-psychotics

A
  • Inattention
  • Slowing down of thoughts
  • EPSEs
27
Q

Dopamine in Parkinson’s disease?

A

PArkinson’s Disease = doPAmine Down

same thing happens with antipsychotics

28
Q

What are the ESPEs?

Including timelines

A

These are seen with typical antipsychotics.

Hours - Acute dystonia

  • Muscles don’t stop contracting
  • Tx with anticholinergic

Days - Akasthisia

  • Constant jitteriness and restlessness
  • Can treat with propanolol

Weeks - Akinesia (bradykinesia)

  • Pill-rolling tremor
  • Shuffling gait
Also...
TARDIVE DYSKINESIA
- Constant rhythmic movement of the peri-oral muscles
- Can be IRREVERSIBLE
- Higher risk with long-term use 
- Can treat with tetrabenzine

HYPERPROLACTINAEMIA

  • Gynaecomastia
  • Risperidone is notorious for this!
29
Q

Neuroleptic Malignant Syndrome

A

Features:

  • Confusion
  • Agitation
  • Hyperthermia
  • Muscular rigidity
  • Seizures

RECENTLY STARTED ON ANTIPSYCHOTICS

HIGH CK!

Tx

  • Withdraw the antipsychotic
  • Lorazepam
30
Q

Chlorpromazine

A
  • Typical antipsychotic
  • Rarely used today due to wide side-effect proficle

Blocks:

  • Dopamine
  • ACh - memory problems
  • Noradrenaline - hypotension
  • Histamine - Sedation

Long-term use can lead to corneal deposits

31
Q

Haloperidol

A
  • Typical anti-psychotic
  • Blocks only DA
  • High rate of ESPEs

Used for patients who are acutely psychotic

Can be given DEPOT

32
Q

Clozapine

A
  • Atypical antipsychotic
  • Used in schizophrenia

Side-effects

  • Agranulocytosis (1% chance in first year of use)
  • Need to get a baselines neutrophil count before starting
33
Q

Olanzapine

A
  • Causes WEIGHT GAIN
34
Q

Risperidone

A

Atypical antipsychotic

  • Less sedating
  • Good in eldelry patients
  • Higher risk of gynaecomastia
35
Q

Quetiapine

A

Atypical antipsychtoic

  • Blocks DA, 5HT, NA and Histamine
  • It is a POWERFUL SEDATIVE
36
Q

Aripiprazole

A
  • Blocks DA and 5HT
  • Reduces DA to 25% of its normal activity
  • So it is useful for maintenance, but not for treatment of acute episodes
37
Q

How long to mood stabilisers take to work?

A

Usually about 10 days

38
Q

Lithium

A
  • Mood stabiliser
  • Massive decrease in risk of suicide

Narrow therapeutic index:

  • Check lithium levels 12h after administration
  • Aim for 0.4-1.0 mmol/L
Side-effects of lithium
"LMNOP"
Lithium side-effects
Movement (Tremor)
Nephrotoxic
hypOthyroid
Pregnancy - contraindicated!
39
Q

Nephrotoxic effects of lithium

A

Can cause collapse in dehydrated patients

Can cause nephrogenic diabetes insipidus

40
Q

Pregnancy effects of lithium

A

Risk of Ebstein’s anomaly -

L ow
I mplantation of the
T ricuspid valve

41
Q

What should you monitor with lithium?

A
  • Lithium levels
  • Electrolytes
  • Creatinine and BUN
  • FBC
  • TSH
  • Pregnancy test
42
Q

Valproate

A
  • Inhibits VGSCs and increases GABA
  • Can be used in acute mania and as prophylaxis
  • Does not need monitoring

Side-effects

  • TERATOGENIC
  • Hepatic necrosis
  • Hair loss
  • GI upset
  • Weight gain
  • Thrombocytopenia
43
Q

Carbamazepine risk

A
  • There is some risk of agranulocytosis
44
Q

Lamotrigine

A
  • Better suited in patients presenting with a depressive episode

Side-effects:

  • SKIN RASH (can be fatal SJS)
  • Headache
  • Dizziness
  • Insomnia
  • Arthralgia
45
Q

Anxiolytics - overview

A
  • Act to enhance GABA channels
  • These are highly addictive

2 main classes:
Benzodiazepines (-azepams)
- Increase frequency of opening GABA channels

Barbiturates
- Increase duration of opening GABA channels

46
Q

Benzodiazepines - half-life

A

Short half-lives (1-12h)

  • Midazolam
  • Oxazepam

Medium half-lives (12-40h)

  • Lorazepam
  • Clonazepam
  • Temazepam

Long half-lives (40+ hours)

  • Diazepam (valium)
  • Chlordiazepoxide
47
Q

Buspirone

A
  • Anti-anxiety effects which can be used to enhance the effects of SSRIs
  • Takes weeks to work
  • No sedation
  • No withdrawal effects
48
Q

Temazepam

A
  • Benzodiazepine

- Used for sleep

49
Q

Z-drugs

A

ZOPICLONE
ZOLPIDEM
ZALEPLON

  • Non-benzodiazepine
  • Hypnotics - these induce sleep (but it is poor quality sleep)
  • max 4 weeks use

Side-effects

  • Anterograde amnesia
  • Sleepwalking
  • Zopiclone can impair driving
50
Q

Methadone

A
  • used for patient with opioid addiction
  • Half-life 2-3 days
  • Makes withdrawal much more tolerable
51
Q

Buprenorphrine

A
  • High affinity for mu partial agonist (high affinity but low activity)
  • Less likelihood of abuse
  • Can give a longer supply
52
Q

Drugs used in Dementia

A

Acetylcholinesterase inhibitors

  • Donezepil
  • Rivastigmine
53
Q

Benzodiazepine withdrawal symptoms

A
  • Insomnia
  • Anxiety
  • Loss of appetite
  • Weight loss
  • Tremor
  • Perspiration
  • Tinnitus
  • Perceptual disturbances
54
Q

Antidote for BDZ overdose?

A

Flumenazil

  • Given IV
  • Half life of 1h
55
Q

Side-effects of lithium overdose

A

MILD

  • Fine tremor
  • GI upset
  • Metallic taste in mouth

MODERATE

  • Polyuria and polydipsia (nephrogenic DI)
  • Lethargy
  • Weight gain
  • Persistent tremor
  • Change in hair texture

SEVERE TOXICITY

  • dysarthria
  • Ataxia
  • Coarse tremor
  • Marked GI upset
  • Impaired consciousness

Year 5 (22 decks)

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