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Misc. Notes Year 3 > Psychiatry Drugs > Flashcards

Psychiatry Drugs Flashcards

1
Q

How long do anti-depressants typically take to work

A

4-6 weeks

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2
Q

How is non-response to an anti-depressant defined

A

No response or inadequate response after six weeks at the maximum BNF dose or highest tolerated dose

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3
Q

How long should you continue treatment after full resolution of symptoms after a first episode

A

6-12 months

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4
Q

How long should you continue treatment after full resolution of symptoms after a second episode

A

12-24 months

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5
Q

How long should you continue treatment after full resolution of symptoms after a third recurrence

A

Continue indefinitely if willing

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6
Q

What is the mainstay of treatment for Bipolar Disorder

A

Mood stabiliser (lithium) + anti-convulsant + anti-psychotic

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7
Q

What should you never give on its own for someone with Bipolar disorder and why not

A

Anti-depressant should not be given without a mood stabiliser
Can set patient to rapid cycling bipolar

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8
Q

What does SSRI stand for

A

Selective Serotonin Reuptake Inhibitor

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9
Q

Give 3 examples of SSRI’s

A

Citalopram, Fluoxetine, Sertraline

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10
Q

What is the first line drug treatment for major depressive disorder

A

SSRI’s

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11
Q

What side effect can SSRIs cause in elderly patients

A

Hyponatraemia

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12
Q

What side effect can SSRIs cause in under 25’s

A

Transient increase in self-harm / suicidal ideation

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13
Q

What time of day should SSRIs be taken

A

In the morning

to avoid insomnia

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14
Q

Name some general SSRI side effects

A

GI upset, anxiety, agitation, insomnia, sexual dysfunction

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15
Q

What is there an increased risk of, if SSRIs are taken with NSAIDS

A

GI bleeding

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16
Q

Which SSRI is safest in a patient with cardiac problems

A

Sertraline

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17
Q

Which SSRI is safest in a patient with epilepsy

A

Citalopram

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18
Q

What is the mechanism of action of SSRIs

A

Selectively inhibit reuptake of serotonin (5-HT) from the synaptic cleft

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19
Q

What class of drug is Amitriptyline

A

Tricyclic Antidepressant

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20
Q

Name 3 tricyclic antidepressants (not amitriptyline)

A

Imipramine
Clomipramine
Dosulepin

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21
Q

Why are tricyclic antidepressants not the first line for depression despite being as effective as SSRIs

A

Cardiac side effects

Dangerous in overdose

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22
Q

What effect do tricyclics have on weight

A

Weight gain

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23
Q

What time of day should tricyclics be taken

A

At night due to sedation side effect

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24
Q

Name some anticholinergic effects and which anti-depressant drug class can cause these

A 
Tricyclic antidepressants can cause: 
Blurred vision
Dry mouth
Constipation
Urinary retention
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25
Q

What kind of drug is Mirtazapine

A

Noradrenergic and Specific Serotonergic Antidepressant (NaSSA)

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26
Q

When could Mirtazapine be used 1st line in depression

A

May be used first line if the patient has insomnia and/or poor appetite

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27
Q

What is a characteristic side effect of Mirtazapine

A

Increase in appetite

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28
Q

When should Mirtazapine be taken

A

Night time due to sedation effect

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29
Q

Which anti-depressant can cause GI upset when taken with alcohol

A

Mirtazapine

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30
Q

What does SNRI stand for

A

Serotonin Noradrenaline Reuptake Inhibitor

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31
Q

How do SNRIs work

A

Block the reuptake of monoamines (noradrenaline and 5-HT) into presynaptic terminals

32
Q

Name 2 SNRIs

A

Duloxetine

Venlafaxine

33
Q

Which drug combination can be very very effective in treating depression which hasn’t responded to SSRI’s

A

Mirtazapine + Venlafaxine

“california rocket fuel”

34
Q

Which SNRI can also be used to treat neuropathic pain and bladder instability

A

Duloxetine

35
Q

What time of day should SNRIs be taken

A

Morning to avoid insomnia side effect

36
Q

What are the side effects of SNRIs

A

Similar to SSRIs:

GI upset, anxiety, agitation, insomnia, sexual dysfunction

37
Q

What does MAOI stand for

A

Monoamine oxidase inhibitor

38
Q

How do MAOIs work

A

Inhibitors of MAO-A and B
-> decreased breakdown of the monoamine neurotransmitters (norepinephrine, serotonin, dopamine) leading to increased levels in the synapse

39
Q

What are the differences between reversible and irreversible MAOIs

A

Reversible MAOIs are typically less effective but also have fewer side effects

40
Q

Name a reversible MAOI

A

Moclobemide

41
Q

Name an irreversible MAOI

A

Phenelzine

42
Q

What are some minor side effects of MAOIs

A

Postural Hypotension
Insomnia
Peripheral oedema

43
Q

What is the major side effect of MAOIs (concerning diet)

A

Hypertensive crisis

44
Q

Which amine can cause a hypertensive crisis as a side effect of MAOIs

A

Tyramine

45
Q

How does a hypertensive crisis occur when a patient is on an MAOI

A

Tyramine is a potent releaser of norepinephrine -> elevated BP. Normally MAO-A breaks down norepinephrine. If MAO-A is inhibited and a high-tyramine meal is taken, norepinephrine can accumulate and cause a hypertensive crisis

46
Q

What are some symptoms of a hypertensive crisis

A

Headache, shortness of breath, nosebleed, anxiety. Can lead to arrhythmias, stroke, seizures, death

47
Q

What sort of foods have a high tyramine content

A

Red meats, cheese, wine

48
Q

How is hypertensive crisis treated

A

Phentolamine infusion (alpha-adrenergic antagonist)

49
Q

What is Trazodone

A

Serotonin 2 antagonist/reuptake inhibitors (SARI)

50
Q

When would Trazodone be used

A

Often used when sedation is needed and/or to augment other antidepressants

51
Q

When should Trazodone be taken

A

Should be taken at night due to sedation

52
Q

What are some side effects of Trazodone

A

GI upset, dizziness, sedation, tiredness, headache

53
Q

What is the most effective treatment for Bipolar disorder

A

Lithium carbonate

54
Q

What is the mode of action of Lithium (don’t bother about this too much)

A

May block phosphatidylinositol pathway (second messenger system) or inhibit Glycogen Synthase Kinase 3β

55
Q

Why must 12-hour post-dose blood levels be measured when a patient is on lithium

A

Because of lithium’s narrow therapeutic index

56
Q

What are some side effects of Lithium

A 
Dry mouth / strange taste
Polydipsia & polyuria
Tremor
Hypothyroidism
Weight gain
57
Q

Which endocrine condition can lithium cause as a side effect

A

Nephrogenic diabetes insipidus

58
Q

When should lithium be taken

A

At night due to sedation

59
Q

What are some toxic effects of lithium

A 
Vomiting
Diarrhoea
Ataxia / coarse tremor
Drowsiness
Convulsions
Coma
60
Q

What is the treatment of lithium toxicity

A

Stop lithium
IV fluids
Monitor renal function

61
Q

What kind of drug is Sodium Valproate

A

Anti-convulsant

62
Q

How does sodium valproate work

A

Blocks voltage sensitive sodium channels, increases levels of GABA

63
Q

What are some side effects of sodium valproate

A

sedation, tremor, dizziness, GI upset, tiredness, weight gain. Rarely hepatotoxicity, pancreatitis, increase in suicidal behaviour

64
Q

Why should sodium valproate not be given to women of childbearing age

A

Teratogenic

65
Q

Name an anticonvulsant apart from sodium valproate

A

Lamotrigine

66
Q

How does Lamotrigine work

A

Blocks voltage sensitive sodium channels

67
Q

What are some common side effects of Lamotrigine

A

GI upset, insomnia, sedation (not common), dizziness, ataxia, tiredness

68
Q

What is a potentially fatal side effect of Lamotrigine

A

Stevens-Johnson syndrome

69
Q

Name 2 typical antipsychotics

A

Haloperidol

Chlorpromazine

70
Q

Name 2 atypical antipsychotics

A

Quetiapine

Olanzapine

71
Q

How do antipsychotics work

A

Block D2 receptors

72
Q

What are the possible drug treatments for Generalised Anxiety Disorder (GAD)

A

SSRI/SNRI
Pregabalin
Benzodiazepines (short term only)

73
Q

What are the possible drug treatments for Panic Disorder

A

SSRI/SNRI
Tricyclic
Benzodiazepines (short term only)

74
Q

Which tricyclic antidepressant can be used to treat Obsessive Compulsive Disorder

A

Clomipramine

75
Q

Which receptor do benzodiazepines act on

A

GABA-A

76
Q

Which substances also act on the GABA-A receptor

A

Alcohol

Barbituates

77
Q

Which ion channel is the GABA-A receptor linked to

A

Chloride ion (allows influx when stimulated)

Misc. Notes Year 3 (25 decks)

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