Psychiatric Drugs Flashcards
What are the 3 core symptoms of depression? Name some other associated symptoms
Low mood, lack of pleasure, decreased energy
Loss of concentration, loss of appetite, sleep disturbances, irritability
What are the main theories for depression?
Mono amine neurotransmitter deficient
Monoamine receptor deficient
E.g. Seratonin, noradrenaline
What are the 4 classes of drugs used to treat depression?
SSRIs, tricyclic antidepressants (TADs), seratonin noradrenaline reuptake inhibitors, MAO inhibitors (rarely prescribed)
Name some SSRIs and state when they would be used
Fluoxetine, citalopram, paroxetine
Moderate to severe depression
What are the main ADRs for SSRIs?
Anorexia, nausea, diarrhoea, mania, suicidal thoughts
Safe in overdose
Name a tricyclic antidepressant and explain how they work
Amitriptyline
Block reuptake of seratonin, noradrenaline, anticholinergic effect at muscarinic receptors, suppress noradrenergic transmission at alpha 1 adrenoreceptors
What are the main side effects of tricyclic antidepressants?
Sedation, impaired psychomotor function, lowering of seizure threshold, autonomic effects (reduction in gland function and accommodation block), tachycardia, postural hypotension, constipation
Name 2 serotonin noradrenaline reuptake inhibitors and what are the additional side effects to those with SSRIs?
Venalfaxine, duloxetine
Sleep disturbance, increased BP, dry mouth, hyponatraemia
What is schizophrenia?
A psychotic condition where patients are not in touch with reality
What are some symptoms of schizophrenia
Hallucinations (perception in the absence of a stimulant), disturbances of thinking, delusions, behavioural change, social withdrawal, unusual speech and thought, selective attention, poor memory, anxiety
What is dopamine theory?
The suggested cause of schizophrenia being caused by excess dopamine e.g. Amphetamine causes schizophrenia like symptoms and it is best treated with dopamine antagonists (however not negative symptoms)
What are the 4 dopamine pathways?
Mesolimbic - emotional response and behaviour
Mesocortical - arousal and mood
Nigrostriatal - pathway damaged in Parkinson’s
Tuberoinfundibular - hypothalamus and pituitary
What effects do dopamine receptor blockers have on the dopamine pathways?
Nigrostriatal - extrapyridaminal
Mesocortical - enhanced negative and cognitive symptoms
Mesolimbic - THERAPEUTIC ACTION ON POSITIVE SYMPTOMS
Tuberoinfundibular - hyperprolactinaemia, infertility
What are the actions of antipsychotics?
Sedation, tranquilisation, antipsychotic
Name 2 typical antipsychotics
Haloperidol, chlorpromazine
What is the first line treatment for schizophrenia? Name some of these drugs
Atypical anti psychotics (less extrapyramidal signs)
Olanzipine, risperidone, clozapine, quetiapine
What are the main ADRs of atypical antipsychotics?
Weight gain (olanzipine), increased prolactin (risperidone), sedation
Clozapine can cause severe constipation, sedation, hyperventilation, weight gain
What are the main ADRs of typical antipsychotics? What toxicities can they cause?
Extrapyramidal side effects, Parkinsonism, dystonia, postural hypotension, weight gain, hyperprolactinaemia
CNS depression, cardiac toxicity, sudden death with high dose
What are the physical symptoms of anxiety?
Lightheaded, shortness of breath, hot and cold flushes, nausea, palpitations, numbness, pins and needles
What is the first line treatment for anxiety?
CBT
What pharmacological treatment can be used to treat anxiety? How do they work?
Benzodiazepines diazepam, lorazepam
Act on GABA receptors (agonist) to increase inhibitory activity
What are the main ADRs of benzodiazepines?
Drowsiness, dizziness, psychomotor impairment, dry mouth, blurred vision, tolerance, dependence
Which class of drug is teratogenic and what can it cause?
Benzodiazepines
Cleft lip
Respiratory depression
How would you treat a benzodiazepine overdose?
Support for respiratory depression
Flumazenil (GABA receptor antagonist)
Bipolar disorder is episodes of depression and mania. What is mania?
Excited, happy, optimistic, overactive, poor concentration, poor sleep, rapid speech, psychotic symptoms
What drugs can be used to treat bipolar disorder?
Lithium - monitor, narrow TW
Valproate
Carbamazepine
Lamotrigine
Antipsychotics
What are the main ADRs for lithium?
Memory problems, thirst, polyuria, tremor, drowsiness, weight gain
