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Pharmacology > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Tricyclic Antidepressants

Name (3) and MoA

A

Amitriptyline, Lofepramie, Imipramine

Inhibit neuronal reuptake of NA and 5HT-3 at synaptic cleft to increase neuroavailability

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2
Q

TCAs - Indications

A

Moderate-severe depression treatment, neuropathic pain (unlicensed)

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3
Q

TCAs - Contraindicaitons

A

Elderly, CVD (prolongs QT), epilepsy, constipation, BPH, raised intraocular pressure

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4
Q

TCAs - Side effects

A

Mainly caused by reuptake inhibition of muscarinic, histamine, alpha-adrenergic and dopamine receptors.
Toxicity at high dose –> cardiac arrest.
High risk of suicidal thoughts
Dry mouth, constipation, retention, blurred vision, sedation, hypotension, QT^, sexual dysfunction, extrapyramidal sx (tremor, dyskinesia)

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5
Q

TCA - interactions

A

MAOIs - synergistic

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6
Q

SSRIs - name (4) and mechanism

A

Citalopram, sertraline, fluoxetine, esciptalopram

MoA - preferential inhibition of 5-HT reuptake, improves mood and relieves panic/obsession

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7
Q

SSRI Indications

A

First line moderate-severe depression medicaiton, panic disorder, OCD

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8
Q

SSRI contraindicaitons

A

Epilepsy, PUD, young, hepatic imp

Paroxetine - C/I in pregnancy

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9
Q

SSRI side effects

A

GI - appetite/weight, nausea, vomiting, diarrhoea (squirtraline) hyponatraemia, suicidal thoughts (in young), serotonin syndrome, QT^

Neuro - insomnia, irritability, sometimes mania, anxiety
Spinal - ED

Discontinuation - other than fluoxetine, rapid withdrawal can cause anxiety, headaches, sweats

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10
Q

SSRI interactions

A 
MAOI/SNRIs - risk of serotonin syndrome
Fluoxetine - long T1/2
Paroxetine - short onset/offset
Aspirin/NSAIDs - caution with PUD
Other QT^ drugs (esp Citalopram)
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11
Q 
Benzodiazepines
Name (5) and mechanism
A 
Diazepam (2-keto, long half-life)
Lorazepam (3-hydroxy, short half-life)
Chlordiazepoxide
Midazolam
Nitrazepam

GABA(A) agonist increase Cl- inflow to decrease stimulation reducing anxiety, leads to sleepiness sedation, anti-convulsive

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12
Q

Benzos - Indications (5)

A 
Seizures
Alcohol WD
Sedation 
Short-term (severe) anxiety relief (e.g. pre-operative)
Insomnia
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13
Q

Benzos - Contraindications/Cautions

A 
Stronger in elderly (risk of falls)
Respiratory Depression
NMD
Liver failure (due to metabolism)
In drink - more potent
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14
Q

Benzos - Side Effects

A

Sedation/coma - risk of falls
Some central respiratory depression in OD
Anterograde amnesia/confusion
Loss of AW reflexes
Dependence/tolerance/withdrawal (minimise duration)

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15
Q

Benzos - Interactions (2)

A

Additive to other sedatives

Dep on CYP450 for clearance

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16
Q

Acetylcholinesterase inhibitors

Name (3) and Mechanism

A

Donepazil, galantamine, rivastigmine
Irreversibly binds cholinesterase to inhibit ACh hydrolysis and increase availability at synapse, thereby stimulating neurones

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17
Q

AChEi

Indications

A

Mild-severe dementia assoc with Alzheimer’s

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18
Q

AChEi

Side Effects

A

Muscle cramping, joint pain, ^micturition/incontinence, seizures, faints, arrhythmias, GI ulceration

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19
Q

AChEi

Interactions

A

Atropine - counters

CYP450 as elimination hepatic

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20
Q

Z-drugs

Name (2) and Mechanism

A

Zopidem/Zopiclone

Act on GABA(A) receptor subunit alpha-1 to increase Cl- influx into neurone and reduce stimulation (hyperpolarisation)

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21
Q

Z-drugs

Indication

A

Insomnia

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22
Q

Z-drugs

Cautions/Contraindications

A

Contra-indicated in myaesthenia gravis, hepatic impairment

Caution dependence, withdrawal

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23
Q

Z-drugs

Side Effects

A

Dry mouth

CNS depression - drowsiness, dysguesia (bitter)

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24
Q

Name a drug used for Generalised Anxiety Disorder AND/OR Neuropathic pain (/Epilepsy)

A

Pregabalin

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25
Q

Pregabalin

Cautions/Contraindications

A

Renal clearance - caution in renal impairment

Increases appetite - caution in diabetes

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26
Q

Pregabalin

Side Effects

A 
Increased appetite/weight gain
Nasopharyngitis
Euphoria/confusion
Dizziness/drowsiness
Diplopia
GI upset
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27
Q

Mechanism of Action of Memantine

A

Memantine is an NMDA antagonist - this prevents the excitotoxic glutamate from opening the NMDA channel to inhibit Na influx to cells, reducing toxic excitation

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28
Q

Monoamine Oxidase Inhibitors (MAOIs)
Name (2)
Mechanism

A

Hydrazine / Selegiline

Inhibit pre-synaptic monoamine oxidase enzyme to increase neurotransmitter availability

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29
Q

MAOIs

Cautions

A

Interact with CYP process so increase concentration of other drugs.
Very restrictive diet - fruits, alcohol, dairy, meats
Effects all NTMs

30
Q

SNRIs

Name and Mechanism

A

Venlafaxine
Duloxetine
Selectively inhibits noradenrenaline reuptake

31
Q

SSRIs

Counselling

A

Start at a half dose and titrate up after two weeks.
Likely to take up to 4 weeks to have an effect, then will persist for at least 6 months once desired effect is achieved.

Side effects, if any, likely to occur in first week, but will improve with time. If not resolved in 4 weeks then we’ll reconsider.

Esp young - risk of suicidal thoughts. If that occurs, safety net is ring GP or talk to family.

May be nauseous, diarrhoea, vomiting initally, but should improve with time

May cause irritability, restlessness, insomnia

Can cause erectile dysfunction.

Fluoxetine esp likely to increase appetite and cause weight gain.

32
Q 
SNRIs
Name (2) and Mechanism
A

Venlafaxine/Duloxetine

Selectively inhibit serotonin and noradrenaline reuptake

33
Q

SNRIs

Indications

A

Depression (2 x failed SSRIs for 6/12)
Anxiety
Neuropathy & Fibromyalgia
(Migraine - amitryptiline)

34
Q

SNRIs

Side Effects

A

NA - increased HR & BP
Risk of narrow-angle glaucoma
Otherwise as SSRIs

35
Q

SNRIs

Cautions

A

Coupled with SSRIs can lead to increased risk of serotonin syndrome
Venlafaxine cam cause hypertension (due to NA)

36
Q

NaSSAs

Name and Mechanism

A

Mirtazapine

Noradrenergic receptor antagonist and selective serotonin antagonist

37
Q

Mirtazapine

Side Effects

A

Histamine inhibitor - sleepiness, increased appetite

Anti-cholinergic - dry mouth, postural hypotension

38
Q

Mirtazapine

Side Effects

A

Histamine inhibitor - sleepiness, increased appetite

Anti-cholinergic - dry mouth, postural hypotension

39
Q

First Line Mood Stabiliser and Mechanism

A

Lithium

?Inhibit of neuronal membrane lipid recycling

40
Q

Alternative uses of lithium

A

Mania
Recurrent/refractory depression
Bipolar Affective Disorder

41
Q

Target therapeutic range for lithium

A

Acute: 0.8-1.2
Chronic: 0.4-0.8

42
Q

Side effects of Lithium

A 
Thirst
Polyuria (lithium-induced diabetes insipidus)
Tremor
QT prolongation
Toxicity
Hyponatraemia (nephrotoxic)
Hypothyroidism
43
Q

Lithium Toxicity presentation

A

Mild - N&V, dizzy
Moderate - Confusion, fasciculations, choreoathetoid movements
Severe - coma, convulsions, sinoatrial block, circulatory collapse

44
Q

Alternative Mood stabilisers (to lithium) (3)

A

(semi)Sodium Valproate
Lamotrigine
Carbamazepine

45
Q

Contraindication of Sodium Valproate

A

Women of child bearing age (unless on pregnancy prevention programme) due to teratogenicity - NTDs
Acute porphyria
Liver failure - hepatic necrosis

46
Q

Side effects of Sodium Valproate

A 
GI upset
Agitation, confusion
Movement disorders
Nystagmus
Hyponatraemia
47
Q

Lamotrigine uses

A

Bipolar

Antiepileptic

48
Q

Lamotrigine side effects

A 
Aggression
Agitation
GI upset
Fatigue
Sleep disorders
49
Q

Action of Serotonin

A

Head - satisfaction, sociality (less impulsive), reduced sex drive
Red - reduced platelets
Fed - GI motility, nausea

50
Q

Two broad categories of antipsychotics and related info

A

Typical/1st Generation - more neurological side effects, as ‘neuroleptics’

Atypical/2nd Generation - more metabolic side effects, act on DA and SER

51
Q

DOPAMINE role mnemonia

A 
Drive (motivation)
PsychOsis
Parkinsonism
Attention
Motor control
Inhibition of prolactin
Narcotics
Extrapyramidal SE
52
Q 
To which pathway do each of these belong
Drive
PsychOsis
Prolactin 
Narcotic addiction
EPSE
A 
Drive - mesocortical
PsychOsis - mesolimbic
Prolactin - tuberoinfundibular
Narcotics - Ventral Tegmental Area (nucleus accumbens)
EPSE - nigrostriatal
53
Q

Describe the gait (parkinsonian)

A

Slow to start, stooped, shuffling, fenestrating (speeds up)

54
Q

Describe EPSE

A

Acute Dystonia (muscle) - hours
Akathisia (rustle) - days
Akinesia (hustle) - month
Tardive Dyskinesia - can become irreversible (esp 1st Gen)

55
Q

Treatment for acute dystonia

A

Anticholinergic e.g. Procyclidine IM

56
Q

Result of excess prolactin

A

Hyperprolactinaemia results in gynaecomastia (esp risperidone), reduced libido, galactorrhoea

57
Q

Patient is confused, agitated, hyperthermic, muscular rigidity and seizures - recently started on typical antipsychotic - Dx and Rx

A

Neuroleptic malignant syndrome - Dantrolene

58
Q

Cautions for Depot

A

Ensure patient has trialled drug PO to ensure no hypersensitivity

59
Q

Use of Haloperidol

A

Strongly binds to D2 giving strong effect but also results in EPSE.
Can be given as depot

60
Q

Defining side effect of chlorpromazine

A

Corneal Deposits

61
Q

Most effective antipsychotic and cautions.

A

Clozapine

3rd Gen - highly effective
Leads to agranulocytosis, and reduce seizure threshold

62
Q

Strong antipsychotic with pro-appetite effect and cautions.

A

Olanzapine

Dyslipidaemia/metabolic syndrome and QTc prolongation.

63
Q

This antipsychotic is preferred in elderly to reduce sedation and low EPSE side effects.

A

Risperidone

64
Q

Cautions with quetiapine

A

Required titrating dose and can cause postural hypotension

65
Q

Aripiprazole mechanism

A

Regulatory effect on DA and SER receptors - used for augmentation of antidepressant (refractory)

66
Q

Other than serotonin syndrome, which dangerous condition can be caused by SSRIs

A

Hyponatraemia - due to SIADH

67
Q

SIADH Presentation

A 
Anorexia/Nausea
Aches
Myoclonus/ataxia
Cheyne-Stokes breathing
Seizures
68
Q

Common abnormality associated with taking lithium in pregnancy

A

Ebstein’s Anomaly - low implanted tricuspid valve

69
Q

Name two nocturnal benzodiazepines

A

Temazepam

Nitrazepam

70
Q

TCA overdose signs

A

Arrhythmia, seizures, metabolic acidosis, coma

71
Q

TCA overdose ECG findings

A

Sinus tachycardia
Wide QRG
QT prolongation

72
Q

Opioid misuse signs and complications

A

Rhinorrhoea, tracks, pinpoint pupils, drowsy, watering eyes, yawning

Infection (Hep, IE, septic arthritis, sepsis, nec fasc)
VTE
Resp depression
Craving - psych
Social - cost/crime

Pharmacology (14 decks)

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