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Pharmacology > Psychiatric Disease > Flashcards

Psychiatric Disease Flashcards

1
Q

Factors affecting risk of developing a psychiatric disease?

A 
Genetics
Life events eg divorce, bereavement
Individual personality
Coping skills
Social support
Environmental influences such as viruses, toxins and other diseases
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2
Q

What would be a biological predisposing, precipitating and perpetuating factor?

A

Predisposing - genetics
Precipitating - cannabis use
Perpetuating - not complying with medication

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3
Q

What does depression present with?

A

2 of the 3 core symptoms

  • low mood
  • anhedonia (lack pleasure in anything)
  • decreased energy

Associated symptoms

  • loss of concentration
  • decreased appetite
  • sleep disturbance
  • irritability
  • suicidal thoughts
  • self harm
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4
Q

What is thought to be the underlying pathology in depression?

A

Monoamine neurotransmitters eg noradrenaline and serotonin are deficient

Or…

Depletion of or abnormalities in receptors for the monoamine transmitters at the post-synaptic membrane, despite adequate neurotransmitter levels

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5
Q

Name the four classes of anti-depressants and give an example of each

A

Selective serotonin reuptake inhibitors

  • fluoxetine
  • citalopram
  • paroxetine
  • sertraline

Tricyclic anti-depressants

  • amitryptiline
  • imipramine
  • clomipramine

Serotonin-noradrenaline re-uptake inhibitors

  • venlafaxine
  • duloxetine

Monoamine oxidase inhibitors

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6
Q

Mechanism of action of selective serotonin reuptake inhibitors

A

Prevent reuptake of serotonin by the pre-synaptic membrane

Increases 5-HT concentration in the synaptic cleft

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7
Q

Absorption, metabolism and elimination of selective serotonin re-uptake inhibitors?

A

Absorbed from the gut
Metabolised by the liver
Long elimination - once daily dose

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8
Q

ADRs of selective serotonin reuptake inhibitors?

A

Anorexia
Nausea
Diarrhoea

Mania
Increased social ideation
Tremor
Extra-pyramidal syndromes

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9
Q

When are selective serotonin reuptake inhibitors used?

A

Moderate to severe depression

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10
Q

What is an important ADR of citalopram?

A

Torsades de Pointes

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11
Q

How do tricyclics antidepressants (TCAs) work?

A

Block re-uptake of 5-HT and NA by the pre-synaptic membrane

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12
Q

Absorption, metabolism and half-life of TCAs?

A

Absorbed in the gut
(Lipid soluble)

Metabolised by the liver
Long half-life

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13
Q

ADRs of TCAs?

A

CNS:

  • sedation
  • impaired psychomotor function
  • lower seizure threshold

ANS

  • reduced glandular secretions
  • eye accommodation block

GI
-constipation

CVS

  • tachycardia
  • postural hypotension
  • impaired myocardial contractility
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14
Q

When are TCAs used?

A

Not a lot

  • have many side effects
  • can block α-1 adrenoceptors, suppressing NA transmission
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15
Q

Mechanism of action of serotonin-noradrenaline re-uptake inhibitors (SNRIs)?

A

At low doses, affect 5HT only

At higher doses, block reuptake of noradrenaline also

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16
Q

Absorption and half life of SNRIs?

A

GI absorption

Short half-life

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17
Q

ADRs of SNRIs?

A

Same as SSRIs

  • anorexia, nausea, diarrhoea
  • mania, increased suicidal ideation, tremor, extra-pyramidal syndromes

Plus

  • sleep disturbances
  • raised BP
  • dry mouth
  • hyponatraemia
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18
Q

When are SNRIs used?

A

As second or third line drugs

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19
Q

Mechanism of action of monoamine oxidase inhibitors?

A

Block degradation of neurotransmitters

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20
Q

When are monoamine oxidase inhibitors used?

A

Rarely - highly toxic

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21
Q

Which class of anti-depressants can cause withdrawal syndrome if suddenly stopped?

A

SNRIs (eg venlafaxine, duloxetine)

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22
Q

Define psychosis

A

When patients are not in touch with reality

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23
Q

What are the positive symptoms in paranoid schizophrenia?

A

Hallucinations
Disturbances of thinking
Delusions
Behavioural change

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24
Q

What are the negative symptoms seen in paranoid schizophrenia?

A

Social withdrawal

Unusual speech and though

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25
Q

What are some cognitive symptoms and affective symptoms seen in paranoid schizophrenia?

A

Cognitive

  • selective attention
  • poor memory
  • reduced abstract though

Affective

  • anxiety
  • depression
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26
Q

What are hallucinations?

A

A perception in the absence of an external stimulus eg auditory, olfactory, visual, gustatory, tactile

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27
Q

What is a delusion?

A

A fixed false belief that is out of keeping with someone’s culture or religious belief

28
Q

What is thought to be the underlying pathophysiology of paranoid schizophrenia?

A

There is an excess of dopamine being released by the brain

29
Q

What are the main dopamine pathways in the brain and what are they important for?

A

Meso-limbic: emotional response and behaviour

Meso-cortical: arousal and mood

Nigrostriatal: control of movement - damaged in Parkinson’s

Tuberoinfundibular: function of the hypothalamus and pituitary gland

30
Q

Mechanism of action of drugs used to treat paranoid schizophrenia?

A

D2 antagonism, blocking the dopamine pathways

Produce sedation and tranquilisation within first few hours and anti-psychotic effects set in within a few days

31
Q

General ADRs of dopamine antagonists for schizophrenia?

A

Enhanced negative and cognitive symptoms
Potential dyskinesia
Hyperprolactinaemia

32
Q

What molecular effects can typical D2 anti-psychotics have?

A

D2-antagonist in the CNS
Anticholinergic effects
α-adrenergic blockade
Antihistamine effect

33
Q

What extra-pyramidal side effects can typical anti-psychotics cause?

A

Parkinsonism
Acute dystonia
Akathasia (constant motion)
Tardive dyskinesia

34
Q

What is the really serious side effect that typical anti-psychotics can cause?

A

Neuroleptic malignant syndrome

  • severe rigidity, hyperthermia, increased CPK and autonomic lability
  • fluctuating consciousness and confusion
  • medical emergency, 10% mortality
35
Q

What are some other ADRs of typical anti-psychotics?

A

Postural hypotension
Weight gain
Prolactinaemia
Pigmentation

36
Q

What can an overdose of typical anti-psychotics cause?

A

CNS depression
Cardiac toxicity - prolonged QTC
Risk of sudden death

37
Q

Name some typical anti-psychotics

A

Haloperidol

Chloropromazine

38
Q

When else is haloperidol used?

A

In an acute emergency setting for sedation and tranquilisation

39
Q

Name some atypical anti-psychotics

A

Olanzipine
Risperidone
Clozapine
Quetiapine

40
Q

ADRs of atypical anti-psychotics

A

Better than typical because they’re newer

Excessive weight gain (olanzapine) due to effects on satiety centres, never feel full

Increased prolactin secretion (risperidone)

Extra-pyramidal side effects (less common)

Postural hypotension

Cardiac toxicity (long QT syndrome)

41
Q

Advantages of atypical anti-psychotics over typical?

A

Fewer extrapyramidal side effects so more acceptable to the patient
Different preparations eg dissolvable
Some can be taken once a day
Differing side-effect profiles can be matched to the patient’s characteristics

42
Q

What is anxiety?

A

A fear out of proportion of the situation so that individuals undergo avoidance of the certain scenario
May have physical symptoms

43
Q

What are the symptoms of anxiety?

A

Light-headedness
Shortness of breath
Hot or cold flushes
Fear of dying or going crazy

44
Q

First line treatment of anxiety?

A

CBT - gradually increase the exposure threshold by working up stage by stage

45
Q

When are pharmacological agents used in anxiety?

A

As adjuncts in severe cases

46
Q

Which drugs are used for anxiety?

A

Benzodiazepines (anxiolytics)
Anti-depressants
Anti-psychotics

47
Q

Mechanism of action of benzodiazepines?

A

Enhance the effects of GABA by acting on GABA receptors
-bind to BZD receptors of which there are two groups, high affinity and low affinity

-high affinity group is important for the anxiolytics, hypnotic and anti-convulsants effects

48
Q

Bioavailability of BZDs?

A

Almost 100%

Reaches max concentrations 30-90 mins after taking them

49
Q

Distribution of BZDs?

A

Highly lipid soluble so diffuse through the CNS rapidly

50
Q

Excretion and half life of BZDs?

A

Excreted via kidneys

Long half life

51
Q

ADRs of BZDs?

A

Drowsiness
Dizziness
Psychomotor impairment

Dry mouth
Blurred vision
GI upset
Ataxia
Headache 
Hypotension 
Amnesia
Restlessness
Rash
52
Q

Effect of taking BZDs in pregnancy?

A

Can cause a cleft lip

Respiratory depression and feeding difficulties

53
Q

What are the withdrawal effects of BZDs?

A

Insomnia
Agitation
Anxiety
-can build up a tolerance

54
Q

How can BZDs cause death?

A

Overdose - however they are rare

Respiratory depression

55
Q

Treatment of a BZD overdose?

A

Flumazenil - acts as a BZD antagonist on the GABA receptor

Only give if you are sure that no other drug has been taken with the benzodiazepine

56
Q

What is bipolar characterised by?

A

Episodes of depression and hypomania and then mania

57
Q

Symptoms of mania?

A

Feeling unusually excited, optimistic, happy or irritable
Overactive
Poor concentration and attention span
Rapid speech, jump from one idea to another
Poor judgement eg over-spending
Increased interest in sex
Psychotic symptoms such as hallucinations, grandiose delusions

58
Q

Which drugs are used in the treatment of bipolar?

A 
Lithium
Sodium valproate
Carbamazepine
Lamotrigine
Atypical anti-psychotics
59
Q

Mechanism of action of lithium?

A

Theories
-affect electrolytes and channels: may compete with magnesium and calcium ions

  • neurotransmitters: increases 5-HT, chronic lithium can reduce 5-HT a receptor sites
  • second messenger systems: Li attenuates the effects of certain neurotransmitters on their receptors without altering receptor density
60
Q

How is the dose of lithium decided?

A

Narrow therapeutic window so dose needs to start low and be gradually titrated upwards
Levels are monitored at least 3-monthly

61
Q

What tests need to be checked before starting lithium?

A

Renal and thyroid function before starting and every six months

62
Q

How is lithium excreted?

A

Renally

-nephrotoxic

63
Q

Uses of lithium?

A

Prophylaxis of mania and depression in bipolar disorder

Augmentation of anti-depressants in unipolar depression where anti-depressants are not enough

Evidence for reducing suicidality

Best evidence of all mood-stabilisers

64
Q

ADRs of lithium?

A 
Memory problems 
Thirst and polyuria
Tremor
Drowsiness
Weight gain
Hypothyroidism
Nephrotoxic
Hair loss
Rashes
65
Q

What can an overdose of lithium cause?

A 
Vomiting and diarrhoea
Coarse tremor
Dysarthria
Cognitive impairment
Restlessness
Agitation 
Coma and death
66
Q

Treatment of a lithium overdose?

A

Supportive - fluids
Anticonvulsants
Haemodialysis

67
Q

General mechanisms of action of drugs for psychiatric disease?

A

Agonists or antagonists of neurotransmitter receptors

Inhibit regulatory enzymes

Pharmacology (23 decks)

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