Psychiatry Flashcards
SSRIs pharmacokinetics
Almost completely absorbed from gut
Metabolised in liver
Long T1/2 so once daily
SSRIs uses
First line for moderate to severe depression
SSRIs ADRs
Anorexia, nausea and diarrhoea Mania Suicidal ideation Tremor Extrapyramidal syndromes Reasonably safe in overdose
Fluoxetine
Prozac
SSRI
Citalopram
SSRI
Most selective
Anxiolytic effect but can cause more sedation
Paroxetine
Most potent
SSRI
Sertraline
SSRI
Tricyclics
First generation antidepressants
Still used but not first or second line
Tricyclics mechanism
Inhibit NA reuptake
Muscarinic receptor blockade
Alpha 1 adrenoceptor blockade
Tricyclics pharmacokinetics
Lipid soluble
Absorbed from gut
Long half life
Liver metabolism
Tricyclics ADRs
Sedation Psychomotor performance impairment Lowered seizure threshold Reduced glandular secretion Eye accommodation block Tachycardia Postural hypotension Impaired myocardial contractility Overdose leads to cardiac death Constipation
SNRIs
SSRIs with the property of Na uptake inhibitors grafted on
Amitryptiline
Tricyclic
Imipramine
Tricyclic
Clomipramine
Tricyclic
Lofrepramine
Tricyclic
Venlafaxine
SNRI
Duloxetine
SNRI
Urinary incontinence
SNRIs pharmacokinetics
Short half life - may have withdrawal syndrome
Olanzapine
Atypical antipsychotic
Risperidone
Atypical antipsychotic
Quetiapine
Atypical antipsychotic
Clozapine
Atypical antipsychotic
ADR: agranulocytosis
Atypical antipsychotics actions
Sedation within hours
Tranquilisation within hours
Antipsychotic takes several days to weeks
Negative symptom improved within weeks
Atypical antipsychotic ADRs
Sedation Extrapyramidal Weight gain (Olanzapine) Increased prolactin (Risperidone) Long QT syndrome
Typical antipsychotic actions
Dopamine receptor blockade
Anticholinergic
Alpha blockade
Antihistamine
Haloperidol
Typical antipsychotic
Safe in emergencies
Chlorpromazine
Typical antipsychotic
Typical antipsychotic ADRs
Extra pyramidal More sedation CNS depression Weight gain Prolactin Pigmentation Long QT Postural hypotension Neuroleptic malignant syndrome
Anxiety management
CBT is first line SSRIs or SNRIs Anxiolytics Occaisionally antipsychotics Not benzodiazepines unless need to sedate in emergency
Benzodiazepine action
Enhance GABA mediated inhibition
Mood stabilisers
Lithium Sodium valproate Carbamazepine Lamotrigine Antipsychotics
Lithium pharmacology
Renal excretion
Slow release preparation given once daily
Levels need monitoring
Monitor kidney and thyroid function
Lithium uses
Prophylaxis of mania and depression in bipolar
Augmentation of antidepressants in unipolar
Reduces suicidality
Best evidence of all mood stabilisers
Lithium ADRs
Memory problems Thirst Tremor Drowsiness Weight gain Kidneys Thyroid Hair loss Rash
Lithium toxicity
Narrow therapeutic window Tremor, dysarthria, agitation Give anticonvulsants and fluids Vomiting, diarrhoea Long term use can effect kidney and thyroid function
