Psychiatric drugs Flashcards by Fleur Archer

What are examples of BZDs?

Diazepam
Flurazepam
Chlordiazepoxide

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What is the antidote for BZDs?

Flumazenil

Note may provoke seizures in mixed overdoses (as take away BZD’s anticonvulsant role)

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What are the indications for BZDs?

Induction and maintenance of sleep
Anxiety disorders
Alcohol withdrawal, pre-operation and muscle spasms

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What is the MOA of BZDs?

Open Cl- channels

Hyperpolarisation and inhibition of GABA

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What are ADRs of BZDs?

Dependence and memory loss

Respiratory function effect potentially if IV

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What is important with BZD withdrawal?

45% get anxiety and perceptual disturbances
Need to monitor
Gradual decrease over 4-16 weeks

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How should BZDs be dosed?

Lowest dose for shortest time

Warn about side effects - tolerance and dependence!

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What are indications for use of Pregabalin?

General Anxiety Disorder
Social phobia
Epilepsy
Neuropathic pain and fibromyalgia

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What is the MOA of Pregabalin?

Binds to subunit of voltage gated Ca2+ channels
Reduces effects of excitatory NTs –>glutamate
Attenuates amygdala response to emotional visual stimuli

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What are ADRs of Pregabalin?

Dizziness
Vertigo
Weight gain
Dependence and abusive potential (1-10% experience euphoria)
Discontinuation
Rarely cause oedema, deranged LFTs and AV block

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What are examples of Tricyclic Antidepressants?

Amitriptyline
Imipramine
Clomipramine

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What is important to think about with TCAs?

Titrating dose as cardiac toxicity

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What is the MOA of TCAs?

Block mACh, H1 and a-1-adrenergic receptors

Inhibit serotonin and NA uptake

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When are TCAs indicated?

Depression

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What interactions doe TCAs have?

Interactions with CYP450 metabolised drugs
SSRIs
MAOIs
Cimetidine 
Warfarin 
Haloperidol 
Alcohol

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What are contraindications for TCAs?

Heart block, arrhythmias and recent MIs
Hypomania and mania
Acute porphyria

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What are ADRs of TCAs?

Anticholinergic:
Dry mouth 
Blurred vision 
Constipation 
Urinary retention

Antihistaminergic:
Weight gain
Sedation

a-1-adrenergic:
Postural hypotension
Dizziness
Sedation

5HT2 blockade: Weight gain (Amitriptyline)

Cardiotoxic:
Arrhythmias
QTc prolongation
(+STEMI)

Neurotoxic:
Delirium
Seizures
Coma

Manic switch

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What are examples of NRIs?

Reboxetine

Atomoxetine

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What is Reboxetine indicated for?

Major depression

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What is Atomoxetine indicated for?

ADHD

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When should NRIs be used with caution?

BAD

Epilepsy

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What is the MOA of NRIs?

Inhibits NA re-uptake

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What are the ADRs of NRIs?

Hand tremors
Increased HR and BP
Note QTc prolongation and arrhythmias
Anxiety

Anticholinergic effects:
Dry mouth 
Constipation 
Urinary retention 
Blurred vision

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What are examples of SNRIs?

Venlafaxine

Duloxetine

When are SNRIs indicated?

MDD Neuropathy GAD Used in px with depression not responding to SSRIs

What are ADRs of SNRIs?

``` Increase BP and HR Tremors Anticholinergic effects Increased risk of seizures Anxiety ```

When are SNRIs contraindicated?

Should be avoided if hepatic impairment Arrhythmias QTc prolongation

What are examples of SSRIs?

``` Citalopram Fluoxetine Fluvoxamine Paratexetine Sertraline ```

When are SSRIs indicated?

First line treatment against anxiety and depression Used in treatment of premature ejaculation

What is the MOA of SSRIs?

Inhibit serotonin transporter | Increases serotonin in synapse

What are ADRs of SSRIs?

``` GI effects (5HT3) Sedation and dizziness Sexual dysfunction (5HT2a) Hyponatraemia Increased risk of bleeding Weight gain Nausea and vomiting (5HT3) ```

What drugs are metabolised slower due to SSRIs?

Codeine BZDs Erythromycin

What can be combined with NaSSAs?

SSRIs | SNRIs

When are NaSSAs indicated?

Depression

What is the MOA of NaSSAs?

Antagonist of a-2, 5HT2, 5HT3 and H1 receptors No reuptake a-2 blocks negative feedback of inhibitory autoreceptors so enhances NA and serotonin Increase dopamine release in PFC

What are ADRs of NaSSAs?

Weight gain Sedation Blood dyscrasias

Bupropion

Atypical antidepressant | Inhibits DA re-uptake

Mirtazapine

Atypical antidepressant Sometimes used in anxiety and OCD Antagonist of a-2, 5HT2 and 5HT3 receptors

When are MAOIs indicated?

3rd line! and specialist use Severe depression Treatment resistant depression Atypical

What is the MOA of MAOIs?

Inhibit breakdown of monoamines MAO-A: adrenergic and dopaminergic neurones --> antidepressive MAO-B :serotonergic and histaminergic --> Parkinson's Increase storage and release of serotonin and NA

What are examples of MAOIs?

``` Rasagiline Segelinine Isocarboxazid Phenelzine Tranylcypromine ```

What needs to be noted with MAOIs?

Last 2 weeks Need to give time when switching drugs CHEESE effect

What are ADRs of MAOIs?

``` Nausea and dizziness Restlessness Sweating Tremor Insomnia Postural hypotension Peripheral oedema Sexual dysfunction ```

What interactions do MAOIs have?

``` Other antidepressants Insulin Alcohol Anti-epileptics Sympathomimetics Dobutamine ```

When are MAOIs contraindicated?

CVS Pheochromocytoma Cerebral vascular disease Delirium

What are examples of antipsychotics?

Typical: Haloperidol Chlorpromazine Atypical: Clozapine Risperidone Quetiapine Olanzapine

Haloperidol

Antagonise D receptors

Chlorpromazine

EPSEs - D2 blockage Negative symptoms

Clozapine

Block D2, serotonin and other MA D2 = ESPEs Sedation and weight gain Decreased craving for illegal drugs and alcohol Take week to days to work

What are EPSEs?

- Dystonias - Parkinsonism - Akathesia - Tardive dyskinesia

Risperidone Quetiapine Olanzapine

5HT2A and D2 receptors Decreased EPSEs and better with negative symptoms Improve cognitive function May improve social impairments No bone marrow suppression

What are the results of elevated prolactin (due to dopamine blockade)?

``` Ammenorrhoea Gynaecomastia Galactorrhoea Sexual dysfunction Hypogonadism ```

Procyclidine

Used in treatment of dystonias and Parkinsonism | mACh antagonist

What can BZDs also be used for?

Treatment of tardive dyskinesia | Treatment of akathesia

Dantrolene

Anti spasmodic | Used in treatment of neuroleptic malignant syndrome

Bromocriptine

DA receptor antagonist | Used in treatment of neuroleptic malignant syndrome

Stopping smoking (+psychosis / schizophrenia)

Nicotine replacement therapy Bupropion (Schizophrenia) Varenicline

What is to be noted with Clozapine?

Nicotine is enzyme inhibitor | Dramatic smoking reduction may mean increase in toxicity

What needs to be measured early on in treatment?

Height, weight and BMI BP Fasting plasma glucose Fasting plasma lipids + smoking, physical activity and diet