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3a > Psychiatry: Pharmacology > Flashcards

Psychiatry: Pharmacology Flashcards

1
Q

what happens when you are the same drug for a long time ?

A

tolorance
- down regulation (give more drugs => fewer synapses)

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2
Q

describe how a drug can act on a NT (agonist stuff) (4) briefly ascribe each one

A
  • Full agonist (mimics NT effect)
  • Partial agonist (mimic but only to certain lower point)
  • netral antagonist (blocks effect of NT)
  • inverse agonist (opposite effects of NT)
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3
Q

Name some NT in the brain ? (7)

A
  • Dopamine
  • Serotonin
  • NAd
  • Glutamate
  • GABA
  • Histamine
  • Opiods (endorphins)
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4
Q

What are the effects of dopamine ? (8)

A
  • Drive (motivations)
  • Psychosis
  • Parksinsonism
  • Attention (increase dopamine => increase conc)
  • Motor function
  • Inhibits proclatin
  • Narctoics
  • Extrapyramidal
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5
Q

what NT involved in addiction? which bit of the brain is important in this bit ?

A

dopamine is involved in reward pathway (nucleus accumbens in the ventral tegmental area)
- overexerted in addicts

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6
Q

What are some of the effects of serotonin ?

A
  • satisfaction
  • Siciality
  • reduce anxiety
  • reduce impulsivity
  • reduce sex drive
  • GI motility/nasuea
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7
Q

What is serotonin syndrome ? Px ? complication ? which structure in brain involved ?

A

serotonin syndrome: headache, agitation, confusion, hyperopia, sweating
- mortality risk
- comes from raphe nuclei in brain

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8
Q

NAd effects ? para or sympathetic ? produce where in the brain ?

A

key component of sympathetic NS Fight of flight)
- Produced in Los cerulean (think Cerberus => fight of flight ahhhh)

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9
Q

What NT is main on switch in brain ? main off switch ?

A
  • Glutamate: main brain on switch
  • GABA: main brain off switch
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10
Q

What are the effects of GABA ? (6)

A

main brain off switch
- relaxation, euphoria, reduced muscle tone, reduce breathing
- reduce anxiety, reduce seizures
(think of lecturers gabaring on making you bored)

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11
Q

what are the effects of glutamate ? (3)

A

main brain on switch
- mating
- memory
- cognition

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12
Q

Histamine effects ? (3)

A
  • hayfever
  • itching
  • sleeping
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13
Q

what are endorphins ?

A

endogenous opioids (act of opiod receptors)

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14
Q

opined effects ? (6)

A
  • analgesia
  • respiratory depression (brain insensitive to rising CO2)
  • Miosis (pinpoint pupil)
  • euphoria
  • drowsiness
  • constipation
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15
Q

what different classes of antidepressants are there ? (4)

A
  • SSRI
  • TCA
  • SNRI
  • MOAI
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16
Q

how do SSRIs work ?

A

inhibit transporte on presynaptic neurone (that takes serotonin back up into cell) => increase active serotonin available in synaptic cleft

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17
Q

Name some SSRIs (3)

A
  • fluoxetine
  • sertraline
  • citalopram
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18
Q

SSRI SE ?

A
  • low sex drive
  • bleeding
  • GI effects (diarrhoea)
  • restlessness
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19
Q

How long do SSRIs take to work ? SE ?

A

can take 4-6 weeks to work
(but SE can be instant - diarrhoea :/)

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20
Q

which SSRI has the longest half life ? why might this be good ? why might this be bad ?

A

fluoxetine
- longest half life => stay in blood longer => better if likely to miss doses
- needs longer period between staring different drug (TCA) due to this long half life (risk of SS)

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21
Q

what addition guidance needs to be said for sertraline ?

A

take with a meal to reduced the GI SE

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22
Q

what additional scan do you need if on citalopram ?

A

if on high dose => get yearly echoes
(cancause prolonged QT syndrome)

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23
Q

what does SNRI stand for ? name one ?

A

serotonin + noradrenaline reuptake inhibitors - duloxetine

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24
Q

what is duloxetine used for ? drug class ?

A

SNRI
- depression (first line for mild/mod/severe)
- Anxiety (second line (sertraline is first)
- Pain managment

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25
Q

SNRI SE ?

A
  • Nausea, GI upset, constipation, loss of appetite, dry mouth
  • Hypertension
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26
Q

name a dopamin-reuptake inhibitor ?

A

bupropion

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27
Q

Px present with history of overdose + wide QRS complex. what was the overdose ? and how is this treated ?

A

TCA overdose
- bicarbonate is the antidote for tricyclic overdose

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28
Q

Name TCA (2) ? pros and cons briefly

A

amytriptypline, clomipramine
can be v effective (as targets loads of NT but this also means v large SE profile)
- also overdose risk

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29
Q

what is clomipramine used in ? what drug class ?

A

TCA used in OCD

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30
Q

what is amitriptyline used in ? what drug class ?

A

TCA used more for pain management (neuropathic pain)

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31
Q

what does MAOI stand for ? useful in what condition ? pros + cons (comp)

A

monamine oxidase inhibitors
- useful in atypical depression
- can be v effective by big SE profile
- associated with hypertensive crisis

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32
Q

What are the 2 main categories of antipsychotics ? different names for these categories ?

A
  • First generation AP: typical, dopamine receptor antgonists (DRA)
  • Second generation AP: atypical, serotonin-dopamine antagonists
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33
Q

on what receptors to first generation AP work on ?

A

block post-synaptic dopamine D2 receptors

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34
Q

what receptors do second gen AP work on ?

A

D2 receptor dopamine receptors as well as serotonin receptor antagonist action (5-HT2A)

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35
Q

What is Parkinson’s treated with and what is a side effect?

A
  • Treated with levodopa
  • side effect is psychosis
    (reverse of psychosis management - nice)

(so treating psychosis is sometimes like medically inducing Parkinsonism)

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36
Q

Examples of typical AP ? (3)

A
  • Haloperidol
  • Chlorpromazine
  • loxapine
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37
Q

Examples of atypical AP ? (5)

A
  • Risperidone
  • Olanzapine
  • Quetiapine
  • Aripiprazole
  • Clozapine
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38
Q

Which generation of antipsychotics has more varied side effect profile?

A

Second: atypical act on different receptors so has varied side effect profile. Really varies form drug to drug.
- mainly metabolic SE

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39
Q

describe how first and second gen antipsychotics affect positive and negative symptoms of schizophrenia?

A
  • FGA better for treating positive symptoms (hallucinations + delusions)
  • SGA treat both positive and negative symptoms (withdrawal, ambivalence)
40
Q

Typical antipsychotic SE? (4)

A

FGA SE:
- Extrapyramidal side effects (EPS)
- Anticholinergic SE: dry mouth, constipation, urinary retention
- Sedation
- Hyperprolactinaemia

41
Q

Atypical antipsychotics SE?

A

SGA SE: more variable
- Weight gain
- Metabolic SE (increased cholesterol, Increased blood sugar (=> increased diabetes risk)
- Sedation
- Sexual
- QTc prolongation
- EPSE (not as much)

42
Q

What are extra pyramidal side effects ? describe the time course (3). associated with what drugs ?

A

EPSE: motor effects - argue involuntary muscles (main typical AP)
- 4hrs: acute dystonia (muscles that won’t stop contracting)
- 4 days: akathisia (inner restlessness)
- 4 weeks: akinesia + pill rolling
- Tardive dyskinesia (can be irreversible): chewing motion

43
Q

what can be given to manage acute dystonia. associated with which drugs ?

A

EPSE brought on by typical AP
- Mx anticholingeric - Benadryl

44
Q

what can be given to manage akathisia . associated with which drugs ?

A

inner restlessness Brough on by typical AP
- Tx with propranolol

45
Q

how do AP cause hyperprolactinaemia ?

A

inhibit dopamin => promote prolactin

46
Q

what is a serious complciaotn of AP that you must consider ? presentation of this ?

A

neuroleptic malignant syndrome (50% mortality)
- sever confuion
- agitation
- msucular rigidity
- hyperthermia

47
Q

patient present with hyperthermia and recent AP use. what is this a sing of ? Mx?

A

neuroleptic malignant syndrome (v serious)
- Dantrolene

48
Q

What medication indicated for severe agitation?
(severely agitated, irritable, hostile, hyperactive)

A
  • short-term course of FGA (haloperidol)
49
Q

What is the most most effective AP ? why is this not always used ?

A

clozapine - deadly SE of agranulocytosis (WBC depletion => death, so not used first line)

50
Q

When is clozapine indicated ?

A

used for treatment restart schizophrenia (after at least 2 other antipsychotics have been trialled at therapeutic dose)

51
Q

Which antipsychotic has risk of granular psychosis? which other drug ?

A

Clozapine
- carbamazepine (?) but not as high risk

52
Q

Why does clozapine need to be prescribed under a certain brand name?

A

Patient will be attached to a monitoring service that goes along with a brand name

53
Q

describe clozapine monitoring. what looking for?

A
  • Need to have blood test every week for first 18 week, then bloods every month
  • Done because risk of neutropenia and granular cytosis
54
Q

What is 48 rule and with which drug is it in relation to?

A

Clozapine
- if someone misses a dose then patient will need to start titration process again

55
Q

Which which antipsychotic drug is it important to know smoking status? why?

A

Clozapine
- some the hydrocarbons in cigarettes are enzyme induces => if patient stops smoking (like on ward) => would need to reduce clozapine dose

56
Q

Generally, what tests need to be done before starting antipsychotics ?

A
  • Bloods
  • ECG (can increase QT interval)
57
Q

what is olanzpine used for ? sig side effect ?

A

first line for schiophrenia
- but can cause side weight gain

58
Q

Name some mood stabilisers (4) what they used for ?

A

used for bipolar
- Lithium
- Sodium valproate
- Carbamazepine
- Lamotrigine

59
Q

bipolar manic acute and chronic Mx, depressive acute and chronic Mx ?

A
  • manic acute: AP (cos mood stabister takes too long) + mood stabilister
  • Manic chronic: moods stabilser
  • Depression acute: mood stabiliser
  • Depression chronic: mood stabilister
60
Q

which mood stabilister is most effective ? why not always used ?

A

lithium
- effective bt v small therperuic index (between therapeutic effect + toxic effect)
- big SE profile

61
Q

what is lithium therapeutic window ?

A

0.6-1.2

62
Q

lithium SE ?

A
  • tremor
  • nephrotoxicity (especially when dehydration)
  • hypothroidism
  • Ebsteins anomaly
  • lithium toxicity
63
Q
A
64
Q

what is ebsteins anomaly ? associated with what drug ?

A

lithium SE
- during pregnancy
- CHD - low implanted tripcuspid (big RA and smaller RL)

65
Q

Describe lithium metabolism and excretion. what does this mean you need to do?

A
  • Completely metabolised and excreted by kidneys
  • need to monitor renal function
66
Q

Lithium contraindications (3)

A
  • Impaired renal function
  • Cardiac failure (can worsen arrhythmias)
  • Pregnancy
67
Q

When checking lithium levels, how many hours post-dose should the sample be taken ?

A

12 hours post dose

68
Q

Which mood stabilisers need monitoring? what needs to be monitored ?

A
  • Lithium (Thyroid, ECG, renal)
  • Sodium valproate (LFT)
69
Q

which mood stabiliser has risk of agranulocytosis ?

A

carbamazepine

70
Q

What is carbamazepine used in the management of ? (3)

A
  • trigeminal neuralgia
  • BP mood stabiliser
  • Epilepsy
71
Q

lamotrigine SE (1)

A

lam-ITCH-ragine
- widespread itch rash => sevens-johnson syndrome

72
Q

What should you think about before prescribing sodium valproate?

A

Woman of child bearing age? teratogenic!
woman would need to use highly effective contraceptive method (coil or implant)

73
Q

on what NT do antianxiolytics work ? effects ? drug class ?

A

GABA - benzodiazepines
- relaxation, euphoria, reduce muscle tone, slow breathing, reduce anxiety, reduce seizures

74
Q

short term use for benzodiazepines ? (2)

A
  • panic attack
  • status epileptics
  • (catatonia?)
75
Q

medium term use for benzodiazepines (3) ?

A
  • anxiety
  • insomnia
  • panic disorder
76
Q

longer term use for benzodiazepines ? (2)

A
  • chronic panic disorder
  • alcohol withdrawal
77
Q

How do NSAIDs work ? name some (3) ? SE ?

A

aspirin, ibuprofen, naproxen
- inhibit COX enzyme => prevent prostaglandin production
- SE: AKI

78
Q

name some prescription opioids ?

A
  • morhpine
  • codeine
  • Tramadol
  • Fentanyl (most potent)
79
Q

what SNRI can be used for pain management ? in what conditions ?

A

duloxitine
- fibromyalgia
- diabetic neuropathy
- PMS

80
Q

what drug is used for neuropathic pain ?

A

pregabalin (anticonvulsant)

81
Q

what kind of drugs are used for ADHD management ? how do they work ?

A

stimulates: work by increasing dopamine, NAd, serotonin => increase attention

82
Q

name some prescription stimulants used for ADHD ? (3)

A
  • amphetamine salts (adderal)
  • methylphenidate
  • Lisdexamfetamine
83
Q

Name some types of psychotherapy ?

A
  • CBT
  • exposure therapy
  • DBT
  • supportive therpy
    -family therpy
  • support groups
  • art therapy
84
Q

what can CBT be used for ?

A
  • anxiety disorder
  • mood disorder
  • eating disorder
  • personality disorder
  • psychiatric disorder
  • substance disorder
  • chronic pain
85
Q

what is the theory behind CBT ? how does it work ?

A

break the cycle between thorn, feeling and behaviour
- short + cost efective
- first line treatment for many disorders

86
Q

what is exposure theory used for ? (2)

A

phobias
- also useful for PTSD

87
Q

what id DBT used for ? focuses on what ?

A

BPD
- focuses a lot on mindfulness

88
Q

what is supportive therapy ? used for what ?

A

building trust through emotional validation + encouragement
- useful in adjustment disorder

89
Q

what is ECt indicated in ? (4)

A

sever derpession
Treatment resistant schizophrenia
mania
catatonia
(effective but risk of amnesia)

90
Q

What is the only absolute contraindication for ECT ?

A

Raised ICP

91
Q

How does ECT work ?

A

using an electric current to induce a seizure
- using the lowest voltage to reach seizure threshold

92
Q

what is EMDR therapy ?

A

Eye movement desensitization and reprocessing therapy
- treats mental health conditions that happen because of memories from traumatic events in your past
(usually used in PTSD)

93
Q

SSRI + NSAID given. risk of what ? what should be prescribed ?

A

SSRI + NSAID = GI bleeding risk - give a PPI

94
Q

what psychotherapy managment is best for OCD ? be specific

A

Exposure and response prevention
- involves exposing a patient with OCD to an anxiety provoking situation (e.g. having dirty hands)

95
Q

give an example of Aversive conditioning (behavioural therapy)

A

pairing the taste of alcohol with the feeling of nausea

96
Q
A

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