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5 - Pharmacology > Psychiatric Drugs > Flashcards

Psychiatric Drugs Flashcards

1
Q

Give some examples of typical antipsychotics

A

Haloperidol

Chloropromazide

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2
Q

Mechanism for typical antipsychotics

A

Antagonist dopamine D2 receptor

  • Sedation occurs with hours
  • Tranquillisation within hours
  • Acts as an antipsychotic within weeks
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3
Q

Give some ADRs for typical antipsychotics

A 
Extrapyramidal effects
Anti-adrenergic effects 
- sedation and postural hypotension
Anticholinergic effects 
Cardiac arrhythmias
Weight gain, diabetes & metabolic syndrome
Amennorhoea
Galactorrhoea 
Hypothermia 
Neuroleptic malignant syndrome
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4
Q

Give the toxicities associates with typical antipsychotics

A

CNS depression
Cardiac toxicity
Sudden death with high dose - prolonged QT syndrome and torsades de points

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5
Q

Give some atypical antipsychotics

A

Olanzapine
Risperidone
Clozapine
Quetiapine

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6
Q

Give the mechanism for atypical antipsychotics

A

Antagonists 5HT receptors but also D2 receptors, but have a higher affinity for 5HT
- Sedation occurs with hours
- Tranquillisation within hours
Acts as an antipsychotic within weeks

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7
Q

Give some ADRs of atypical antipsychotics

A

Olanzapine = significant weight gain
Risperidone = increased prolactin
Sedation
Extrapyramidal side effects

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8
Q

Give some toxicities associated with atypical antipsychotics

A

Cardiac toxicity

Risk of sudden death - prolonged QT leading to torsades de points

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9
Q

What is the first line treatment for schizophrenia?

A

Atypical antipsychotics

  • have better tolerated side effects
  • less extrapyramidal side effects
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10
Q

What kind of treatment would you give to someone with an anxiety disorder?

A

Cognitive behavioural therapy

- save the medications for the severe cases of anxiety

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11
Q

What type of medication can be used to treat anxiety?

A 
Antidepressants
Benzodiazepines
Antipsychotics
Beta blockers
Busiprone
Barbituates
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12
Q

Mechanism for benzodiazepines

A

Enhance the action of GABA-A receptors

  • positive allosteric modulation
  • increase Cl current into the nerve, causing hyper polarisation, increasing AP threshold
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13
Q

ADRs for benzodiazepines

A 
Sedation
Withdrawal
Tolerance (develops within weeks)
Confusion, impaired coordination
Aggression
Seizures can be triggered with an abrupt withdrawal
Respiratory and CNS depression
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14
Q

Give an antagonist for benzodiazepines

A

Flumazenil

- IV, can reverse overdose effects

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15
Q

Give some contraindications for benzodiazepines

A

Pregnancy - is teratogenic

Don’t use in someone with respiratory depression

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16
Q

Give some mood stabilisers

A

Lithium
Sodium valproate
Carbamezepine
Lamotrigine

17
Q

Describe lithium

A

Administered as lithium carbonate

  • mood stabiliser
  • prophylaxis of mania and depression in bipolar disorder
  • augments antidepressant action in unipolar depression
18
Q

Give some theories as to how lithium works

A
  • competes with Mg2+ and Ca2+
  • increases 5HT levels
  • antagonises effects of neurotransmitters without altering receptor density
    Good for preventing relapse into mania
19
Q

Lithium ADRs

A 
Memory problems - learning new info
Thirst
Polyuria
Tremor
Drowsiness
Weight gain
Hair loss 
Rashes
20
Q

Toxic effects of lithium

A 
Coarse tremor
Ataxia
Dysarthria
Reduced levels of consciousness
Convulsions
Coma
Death
21
Q

Give some characteristics of managing someone who is taking lithium

A

Good evidence that it reduces suicides
Need to monitor plasma levels as it has a narrow therapeutic window (0.5-1.0 mmol/L)
- need to check TFTs and U+Es

22
Q

How would you treat lithium toxicity?

A

Supportive treatment

  • Anticonvulsants
  • IV fluids
  • Haemodialysis
23
Q

Give some drugs used to treat Alzheimer’s disease

A

Acetylcholinesterase inhibitors

NMDA antagonists

24
Q

Give some examples of acetylcholinesterase inhibitors

A

Donepezil
Galantamine
Rivastigmine

25
Q

Give some ADRs of acetylcholinesterase inhibitors

A 
Nausea
Vomiting
Diarrhoea
Fatigue
Insomnia
Headache
Muscle cramps
Bradycardia
Syncope
26
Q

What is the first line treatment for alzheimer’s?

A

Acetylcholinesterase inhibitors

27
Q

Give an example of an NMDA antagonist

A

Memantine

28
Q

Give some ADRs of NMDA antagonists

A 
Hypertension
Dyspnoea
Headache
Dizziness
Drowsiness
29
Q

What are extra-pyramidal side effects?

A 
Parkinsonian side effects
Akathisia 
Tardive dyskinesia 
- choreo-athetoid movements in tongue, lips and face 
Dystonia 
- muscle/muscle groups go into spasm
30
Q

What is neuroleptic malignant syndrome?

A

Life-threatening reaction to medications which causes:
- Extreme EPSE
- Autonomic dysfunction
Complications include renal failure, pneumonia and thrombo-embolism.
Get increased creatine phosphokinase

31
Q

What is the pathophysiology of neuroleptic malignant syndrome?

A

Decrease dopamine function due to:

  • Dopamine blockade
  • reduced function of D2 receptor
32
Q

What is one of the side effects of clozapine?

A

Causes agranulocytosis and neutropenia

  • Regular FBC monitoring is needed
  • Drug should be discontinued if there are any concerns
33
Q

Give the half lives for varying bezodiazepines

A 
Diazepam = 20-100 hrs
Lorazepam = 8-24 hrs
Temazepam = 5-11 hrs 
Zopiclone = 4-6 hrs
34
Q

What are the equivalent doses of lorazepam or temazepam to diazepam 10mg?

A 
Lorazepam = 1mg 
Temazepam = 20mg
35
Q

How do acetyl cholinesterase inhibitors work?

A

Increase the amount of acetylcholine in the synaptic cleft. This improves the brain function by improving the strength of nerve transmission.

36
Q

When should you take caution in prescribing acetyl cholinesterase inhibitors?

A

COPD patients
Peptic ulcers
Hx of convulsions

37
Q

What are central nervous system stimulants?

A

Act to improve concentration in children who have ADHD.

38
Q

Give some examples of CNS stimulants

A

Methylphenidate

Dexamphetemine

39
Q

Give some side effects of methylphenidate

A 
GI disturbance
Hypertension
Tachycardia
Palpitations
Insomnia
Nervousness

5 - Pharmacology (17 decks)

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