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Psych > Psychiatric Pharmacology > Flashcards

Psychiatric Pharmacology Flashcards

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1
Q

What are the mechanism of action of typical antipsychotics?

A

Dopamine D2 receptor antagonists, blocking dopaminergic transmission in the mesolimbic pathways.

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2
Q

What is the mechanism of action of atypical antipsychotics?

A

Act on a variety of receptors (D2, D3, D4, 5-HT).

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3
Q

What are the adverse effects of typical antipsychotics?

A

Extrapyramidal side effects
Hyperprolactinaemia (amenorrhoea)/galactorrhea),:
Impotence, galactorrhoea, headaches, hypopituitarism, visual field defects)

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4
Q

What are the examples of typical (first generation) anti psychotics?

A

Haloperidol

Chlopromazine

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5
Q

What are the side effects of atypical antipsychotics?

A

Metabolic

Extra pyramidal and hyperprolactinaemia side effects are less common.

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6
Q

What are the extrapyramidal side effects?

A

Parkinsonism
Acute dystocia
Akathisia
Tardive dyskinesia

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7
Q

What are the other side effects of antipsychotics?

A

C- dry mouth, blurred vision, urinary retention, constipation

Sedation, weight gain. 
Raised prolactin 
Impaired glucose tolerance 
Neurlopectic malignant syndrome 
Reduced seizure threshold (greater with atypical) 
Prolonged QT interval (haloperidol)
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8
Q

What are the specific warnings when antipsychotics are used in elderly patients?

A

Increased risk of stroke

Increased risk of VTE.

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9
Q

What is meant by Parkinsonism?

A

Any condition which causes a combination of the movement abnormalities seen in Parkinson’s disease- tremor, slow movement, impaired speech or muscle stiffness.

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10
Q

What is meant by acute dystocia?

A

Sustained muscle contraction

Can be managed with procyclidine

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11
Q

What is akathisia?

A

Severe restlessness

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12
Q

What is tardive dysknesia?

A

Face and/or body make sudden, jerky or slow wasting movements which a person cannot control.

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13
Q

What drug is particularly associated with prolonged QT interval?

A

Haloperidol

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14
Q

What is neuroleptic malignant syndrome?

A

Rare but potentially life threatening reaction to the use of almost any of a group of anti psychotic drugs or major tranquillisers (neuroleptic). It affects the nervous system and causes symptoms like a high fever and muscle stiffness.

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15
Q

Why is it anti psychotics cause hyperprolactinaemia?

A

Anti psychotics are dopamine antagonists

Dopamine is a prolactin antagonist

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16
Q

What are the metabolic side effects of antipsychotics?

A

Dysgylcaemia
Dyslipidaemia
Diabetes mellitus

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17
Q

What is the timeline like for alcohol withdrawal?

A

Symptoms start at 6-12 hours: tremor, sweating, tachycardia, anxiety
Peak incidence of seizure is at 36 hours
Peak incidence of delirium tremens is at 48-72 hours

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18
Q

What are the signs someone is in delirium tremens?

A 
Coarse tremor 
Confusion 
Delusions 
Auditory and visual hallucinations 
Fever 
Tachycardia
19
Q

What is the management of alcohol withdrawal?

A

Benzodiazepines- chlordiazepoxide

(Lorazepam maybe favoured in patients with hepatic failure)

Carbamazepine also effective in treatment of alcohol withdrawal

20
Q

What are the 5 stages of grief?

A 
Denial 
Anger 
Bargaining 
Depression 
Acceptance
21
Q

What investigations are needed before starting antipsychotics?

A 
FBC (also clozapine requires this weekly) 
U &E
LFTS
Lipids
Weight
Fasting blood glucose 
Prolactin 
ECG 
Blood pressure (both at baseline and frequently during dose titration)

(Also should do a CV risk assesment annually)

22
Q

What should you do if someone has missed their clozapine?

A

If doses are missed for more than 48 hours they need to be tapered, this is because when you start it after a break it can actually make the side effects much worse ie: blood pressure changes, drowsiness and dizziness. If there is a gap in treatment of 3 days (72 hours) then you may also require more frequent blood tests for a short period.

23
Q

What are the features of anorexia nervosa?

A 
Reduced body mass index
Bradycardia hypotension 
Enlarged salivary glands 
Cold intolerance 
Hypercarotenaemia
24
Q

What is physiological abnormalities?

A 
Hypokalaemia 
Low FSH, LH, oestrogen and testosterone  
Raised cortisol and growth hormone 
Impaired glucose tolerance 
Hypercholesterolaemia 
Hypercarotinaemia 
Low T3
25
Q

What is the difference between somatisation and illness anxiety disorder (hypochondriasis)?

A

S= stands for symptoms
Multiple physical symptoms present for at least 2 years
Patient refuses to accept reassurance or negative test results

Illness anxiety disorder (hypochondriasis)
Persistent belief in the presence of an underlying SERIOUS DISEASE- cancer
Patient again refuses to accept reassurance or negative test results

26
Q

What is conversion disorder?

A

Typically involves loss of motor or sensory function that cannot be explained medically and may be caused by stress.

27
Q

What is dissociative disorder?

A

Process of separating off certain memories from normal consciousness
In contrast to conversion disorder involves psychiatric symptoms eg: amnesia, fugue, stupor
Dissociative identity disorder is the new term for multiple personality disorder as it is the most severe form of dissociative disorder.

28
Q

What is factitious disorder?

A

The intentional production of physical or psychological symptoms- purposefully causing symptoms for example; a diabetic taking too much insulin to cause hypos

Also called Munchausens syndrome

29
Q

What is malingering?

A

Lying or exaggerating for financial gain

30
Q

What is raised in anorexia?

A 
Growth hormone 
Glucose 
Salivary glands 
Cortisol 
Cholesterol 
Carotinaemia
31
Q

What is the SSRI of choice in children and adolescents?

A

Fluoxetine

32
Q

If someone is on an antipsychotic (clozapine) and they develop an infection, what should you do?

A

You need to do a

FBCto exclude life threatening side effects of clozapine (neutropaenia)/agranulocytosis

33
Q

What is clozapine?

A

One of the first atypical agents to be developed

For this reason clozapine should only be used in patients resistant to other anti psychotic medication.

34
Q

What are the adverse effects of clozapine?

A 
Agranulocytosis neutropenia 
Reduced seizure threshold 
Constipation
Myocarditis 
Hyper-salivation
35
Q

When might dose adjustment of clozapine be necessary?

A

If smoking is started or stopped during treatment

36
Q

What is used antidepressant wise as a second line for depression?

A

Mirtazapine

37
Q

What is a benefit of mirtazapine despite its side effects?

A

Large increase in appetite and subsequent weight gain and drowsiness

These side effects are so pronounced that mirtazapine has been known to be used as an appetite stimulant and sleep aid off formulary.

38
Q

What class is mirtazapine?

A

NASSAs

Noradrenaline serotonin specific antidepressants

39
Q

What class is venlafaxine?

A

Serotonin and noradrenaline reuptake inhibitor

40
Q

What are the side effects of serotonin antagonist and reuptake inhibitors (like venlafaxine)?

A

Minimal anticholinergic side effects and relatively low cardio toxicity compared with TCAs
May cause dry mouth, blurry vision, constipation, drowsiness, sedation, hallucinations, memory problems, urinary retention.

41
Q

What are the poor prognostic indicators of schizophrenia

A 
Strong family history 
Gradual onset 
Low IQ 
Prodromal phase of social withdrawal 
Lack of an obvious precipitant
42
Q

How does zopiclone work?

A

Binds to GABAA containing receptors, causing an enhancement of the actions of GABA to produce the therapeutic and adverse effects of zopiclone.

43
Q

What are the side effects of zopiclone?

A

Agitation, bitter taste in mouth, constipation, decreased muscle tone, dizziness, dry mouth and increased risk of falls (especially in elderly)

Convulsions, tremor, hyperventilation May be seen in zopiclone withdrawal

Psych (12 decks)

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