Psychiatry: Pharmacology Flashcards
what happens when you are the same drug for a long time ?
tolorance
- down regulation (give more drugs => fewer synapses)
describe how a drug can act on a NT (agonist stuff) (4) briefly ascribe each one
- 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)
Name some NT in the brain ? (7)
- Dopamine
- Serotonin
- NAd
- Glutamate
- GABA
- Histamine
- Opiods (endorphins)
What are the effects of dopamine ? (8)
- Drive (motivations)
- Psychosis
- Parksinsonism
- Attention (increase dopamine => increase conc)
- Motor function
- Inhibits proclatin
- Narctoics
- Extrapyramidal
what NT involved in addiction? which bit of the brain is important in this bit ?
dopamine is involved in reward pathway (nucleus accumbens in the ventral tegmental area)
- overexerted in addicts
What are some of the effects of serotonin ?
- satisfaction
- Siciality
- reduce anxiety
- reduce impulsivity
- reduce sex drive
- GI motility/nasuea
What is serotonin syndrome ? Px ? complication ? which structure in brain involved ?
serotonin syndrome: headache, agitation, confusion, hyperopia, sweating
- mortality risk
- comes from raphe nuclei in brain
NAd effects ? para or sympathetic ? produce where in the brain ?
key component of sympathetic NS Fight of flight)
- Produced in Los cerulean (think Cerberus => fight of flight ahhhh)
What NT is main on switch in brain ? main off switch ?
- Glutamate: main brain on switch
- GABA: main brain off switch
What are the effects of GABA ? (6)
main brain off switch
- relaxation, euphoria, reduced muscle tone, reduce breathing
- reduce anxiety, reduce seizures
(think of lecturers gabaring on making you bored)
what are the effects of glutamate ? (3)
main brain on switch
- mating
- memory
- cognition
Histamine effects ? (3)
- hayfever
- itching
- sleeping
what are endorphins ?
endogenous opioids (act of opiod receptors)
opined effects ? (6)
- analgesia
- respiratory depression (brain insensitive to rising CO2)
- Miosis (pinpoint pupil)
- euphoria
- drowsiness
- constipation
what different classes of antidepressants are there ? (4)
- SSRI
- TCA
- SNRI
- MOAI
how do SSRIs work ?
inhibit transporte on presynaptic neurone (that takes serotonin back up into cell) => increase active serotonin available in synaptic cleft
Name some SSRIs (3)
- fluoxetine
- sertraline
- citalopram
SSRI SE ?
- low sex drive
- bleeding
- GI effects (diarrhoea)
- restlessness
How long do SSRIs take to work ? SE ?
can take 4-6 weeks to work
(but SE can be instant - diarrhoea :/)
which SSRI has the longest half life ? why might this be good ? why might this be bad ?
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)
what addition guidance needs to be said for sertraline ?
take with a meal to reduced the GI SE
what additional scan do you need if on citalopram ?
if on high dose => get yearly echoes
(cancause prolonged QT syndrome)
what does SNRI stand for ? name one ?
serotonin + noradrenaline reuptake inhibitors - duloxetine
what is duloxetine used for ? drug class ?
SNRI
- depression (first line for mild/mod/severe)
- Anxiety (second line (sertraline is first)
- Pain managment
SNRI SE ?
- Nausea, GI upset, constipation, loss of appetite, dry mouth
- Hypertension
name a dopamin-reuptake inhibitor ?
bupropion
Px present with history of overdose + wide QRS complex. what was the overdose ? and how is this treated ?
TCA overdose
- bicarbonate is the antidote for tricyclic overdose
Name TCA (2) ? pros and cons briefly
amytriptypline, clomipramine
can be v effective (as targets loads of NT but this also means v large SE profile)
- also overdose risk
what is clomipramine used in ? what drug class ?
TCA used in OCD
what is amitriptyline used in ? what drug class ?
TCA used more for pain management (neuropathic pain)
what does MAOI stand for ? useful in what condition ? pros + cons (comp)
monamine oxidase inhibitors
- useful in atypical depression
- can be v effective by big SE profile
- associated with hypertensive crisis
What are the 2 main categories of antipsychotics ? different names for these categories ?
- First generation AP: typical, dopamine receptor antgonists (DRA)
- Second generation AP: atypical, serotonin-dopamine antagonists
on what receptors to first generation AP work on ?
block post-synaptic dopamine D2 receptors
what receptors do second gen AP work on ?
D2 receptor dopamine receptors as well as serotonin receptor antagonist action (5-HT2A)
What is Parkinson’s treated with and what is a side effect?
- Treated with levodopa
- side effect is psychosis
(reverse of psychosis management - nice)
(so treating psychosis is sometimes like medically inducing Parkinsonism)
Examples of typical AP ? (3)
- Haloperidol
- Chlorpromazine
- loxapine
Examples of atypical AP ? (5)
- Risperidone
- Olanzapine
- Quetiapine
- Aripiprazole
- Clozapine
Which generation of antipsychotics has more varied side effect profile?
Second: atypical act on different receptors so has varied side effect profile. Really varies form drug to drug.
- mainly metabolic SE
describe how first and second gen antipsychotics affect positive and negative symptoms of schizophrenia?
- FGA better for treating positive symptoms (hallucinations + delusions)
- SGA treat both positive and negative symptoms (withdrawal, ambivalence)
Typical antipsychotic SE? (4)
FGA SE:
- Extrapyramidal side effects (EPS)
- Anticholinergic SE: dry mouth, constipation, urinary retention
- Sedation
- Hyperprolactinaemia
Atypical antipsychotics SE?
SGA SE: more variable
- Weight gain
- Metabolic SE (increased cholesterol, Increased blood sugar (=> increased diabetes risk)
- Sedation
- Sexual
- QTc prolongation
- EPSE (not as much)
What are extra pyramidal side effects ? describe the time course (3). associated with what drugs ?
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
what can be given to manage acute dystonia. associated with which drugs ?
EPSE brought on by typical AP
- Mx anticholingeric - Benadryl
what can be given to manage akathisia . associated with which drugs ?
inner restlessness Brough on by typical AP
- Tx with propranolol
how do AP cause hyperprolactinaemia ?
inhibit dopamin => promote prolactin
what is a serious complciaotn of AP that you must consider ? presentation of this ?
neuroleptic malignant syndrome (50% mortality)
- sever confuion
- agitation
- msucular rigidity
- hyperthermia
patient present with hyperthermia and recent AP use. what is this a sing of ? Mx?
neuroleptic malignant syndrome (v serious)
- Dantrolene
What medication indicated for severe agitation?
(severely agitated, irritable, hostile, hyperactive)
- short-term course of FGA (haloperidol)
What is the most most effective AP ? why is this not always used ?
clozapine - deadly SE of agranulocytosis (WBC depletion => death, so not used first line)
When is clozapine indicated ?
used for treatment restart schizophrenia (after at least 2 other antipsychotics have been trialled at therapeutic dose)
Which antipsychotic has risk of granular psychosis? which other drug ?
Clozapine
- carbamazepine (?) but not as high risk
Why does clozapine need to be prescribed under a certain brand name?
Patient will be attached to a monitoring service that goes along with a brand name
describe clozapine monitoring. what looking for?
- Need to have blood test every week for first 18 week, then bloods every month
- Done because risk of neutropenia and granular cytosis
What is 48 rule and with which drug is it in relation to?
Clozapine
- if someone misses a dose then patient will need to start titration process again
Which which antipsychotic drug is it important to know smoking status? why?
Clozapine
- some the hydrocarbons in cigarettes are enzyme induces => if patient stops smoking (like on ward) => would need to reduce clozapine dose
Generally, what tests need to be done before starting antipsychotics ?
- Bloods
- ECG (can increase QT interval)
what is olanzpine used for ? sig side effect ?
first line for schiophrenia
- but can cause side weight gain
Name some mood stabilisers (4) what they used for ?
used for bipolar
- Lithium
- Sodium valproate
- Carbamazepine
- Lamotrigine
bipolar manic acute and chronic Mx, depressive acute and chronic Mx ?
- manic acute: AP (cos mood stabister takes too long) + mood stabilister
- Manic chronic: moods stabilser
- Depression acute: mood stabiliser
- Depression chronic: mood stabilister
which mood stabilister is most effective ? why not always used ?
lithium
- effective bt v small therperuic index (between therapeutic effect + toxic effect)
- big SE profile
what is lithium therapeutic window ?
0.6-1.2
lithium SE ?
- tremor
- nephrotoxicity (especially when dehydration)
- hypothroidism
- Ebsteins anomaly
- lithium toxicity
what is ebsteins anomaly ? associated with what drug ?
lithium SE
- during pregnancy
- CHD - low implanted tripcuspid (big RA and smaller RL)
Describe lithium metabolism and excretion. what does this mean you need to do?
- Completely metabolised and excreted by kidneys
- need to monitor renal function
Lithium contraindications (3)
- Impaired renal function
- Cardiac failure (can worsen arrhythmias)
- Pregnancy
When checking lithium levels, how many hours post-dose should the sample be taken ?
12 hours post dose
Which mood stabilisers need monitoring? what needs to be monitored ?
- Lithium (Thyroid, ECG, renal)
- Sodium valproate (LFT)
which mood stabiliser has risk of agranulocytosis ?
carbamazepine
What is carbamazepine used in the management of ? (3)
- trigeminal neuralgia
- BP mood stabiliser
- Epilepsy
lamotrigine SE (1)
lam-ITCH-ragine
- widespread itch rash => sevens-johnson syndrome
What should you think about before prescribing sodium valproate?
Woman of child bearing age? teratogenic!
woman would need to use highly effective contraceptive method (coil or implant)
on what NT do antianxiolytics work ? effects ? drug class ?
GABA - benzodiazepines
- relaxation, euphoria, reduce muscle tone, slow breathing, reduce anxiety, reduce seizures
short term use for benzodiazepines ? (2)
- panic attack
- status epileptics
- (catatonia?)
medium term use for benzodiazepines (3) ?
- anxiety
- insomnia
- panic disorder
longer term use for benzodiazepines ? (2)
- chronic panic disorder
- alcohol withdrawal
How do NSAIDs work ? name some (3) ? SE ?
aspirin, ibuprofen, naproxen
- inhibit COX enzyme => prevent prostaglandin production
- SE: AKI
name some prescription opioids ?
- morhpine
- codeine
- Tramadol
- Fentanyl (most potent)
what SNRI can be used for pain management ? in what conditions ?
duloxitine
- fibromyalgia
- diabetic neuropathy
- PMS
what drug is used for neuropathic pain ?
pregabalin (anticonvulsant)
what kind of drugs are used for ADHD management ? how do they work ?
stimulates: work by increasing dopamine, NAd, serotonin => increase attention
name some prescription stimulants used for ADHD ? (3)
- amphetamine salts (adderal)
- methylphenidate
- Lisdexamfetamine
Name some types of psychotherapy ?
- CBT
- exposure therapy
- DBT
- supportive therpy
-family therpy - support groups
- art therapy
what can CBT be used for ?
- anxiety disorder
- mood disorder
- eating disorder
- personality disorder
- psychiatric disorder
- substance disorder
- chronic pain
what is the theory behind CBT ? how does it work ?
break the cycle between thorn, feeling and behaviour
- short + cost efective
- first line treatment for many disorders
what is exposure theory used for ? (2)
phobias
- also useful for PTSD
what id DBT used for ? focuses on what ?
BPD
- focuses a lot on mindfulness
what is supportive therapy ? used for what ?
building trust through emotional validation + encouragement
- useful in adjustment disorder
what is ECt indicated in ? (4)
sever derpession
Treatment resistant schizophrenia
mania
catatonia
(effective but risk of amnesia)
What is the only absolute contraindication for ECT ?
Raised ICP
How does ECT work ?
using an electric current to induce a seizure
- using the lowest voltage to reach seizure threshold
what is EMDR therapy ?
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)
SSRI + NSAID given. risk of what ? what should be prescribed ?
SSRI + NSAID = GI bleeding risk - give a PPI
what psychotherapy managment is best for OCD ? be specific
Exposure and response prevention
- involves exposing a patient with OCD to an anxiety provoking situation (e.g. having dirty hands)
give an example of Aversive conditioning (behavioural therapy)
pairing the taste of alcohol with the feeling of nausea
