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Buzzwords > Psychiatry Pharmacology > Flashcards

Psychiatry Pharmacology Flashcards

1
Q

What are the two types of antipsychotics?

A

typical and atypical

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2
Q

What are typical antipsychotics and how do they work?

A

1st generation drugs

Block D2 receptors

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3
Q

What causes a large number of psychotic symptoms?

A

overactivity of dopamine pathways

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4
Q

2 examples of typical antipsychotics?

A

Haloperidol

Chlorpromazine

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5
Q

What are atypical antipsychotics and how do they work?

A

2nd generation drugs

Antagonists to D2 receptors and 5HT2a (serotonin receptor)

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6
Q

3 examples of atypical antipsychotics?

A

rispiridone
olanzapine
clozapine

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7
Q

First line drug in schizophrenia?

A

rispiridone

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8
Q

Why are atypical antipsychotics preferred?

A

less likely to produce extrapyramidal side effects

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9
Q

What are the main extrapyramidal side effects?

A

parkinsonism
akathisia (severe restlessness)
dystonia (uncontrollable contraction of muscles)
dyskinesias (abnormality of voluntary movement)

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10
Q

What are positive symptoms of schizophrenia?

A

psychosis- delusions and hallucinations

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11
Q

What drug do you give for psychosis in parkinsons?

A

clozapine

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12
Q

What effect does D2 blockade have?

A

decreases psychotic symptoms

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13
Q

What effect does 5HT2a blockade have?

A

decreases negative symptoms

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14
Q

What are the main side effects of typical antipsychotics?

A

drowsy
anticholinergic, antihistamine and antisympathetic (blockade of M1, H1, alpha1)
EPSE

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15
Q

What is the main side effect of clozapine?

A

agranulocytosis (leukopenia and neutropenia)

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16
Q

When can you give cloazapine?

A

resistant schizophrenia

after trial of 2 other drugs

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17
Q

Depression 1st 2nd and 3rd line line treatment?

A

SSRI- fluextetine, citalopram
TCAs- amitryptiline, clomipramine
MAOIs- pheelzine, moclobemide

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18
Q

What antidepressant is indicated for young and why?

A

fluoxetine- safest for suicide risk

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19
Q

Give 2 examples of tricyclic antidepressants?

A

amitryptiline and clomipramine

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20
Q

How do TCAs work?

A

block serotonins and noradrenaline transporters

(SERT & NET) inhibiting the reuptake of Na and 5-HT to increase its availability in the synapse

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21
Q

What causes depression?

A

imbalance (usually deficiency) of monoamine neurotransmitters- dopamine (DA), noradrenaline (NA), serotonin (5HT)

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22
Q

What does monoamine oxidase do?

A

catalyses breakdown of monoamine neurotransmitters

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23
Q

Give an example of monoamine oxidase inhibitors?

A

phenelzine

moclobemide

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24
Q

How do MAOIs work?

A

inhibit the breakdown of monoamine neurotranmitters- DA, 5HT, NA increasing their availability in synapse

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25
Q

Depression with anxiety treatment?

A

SSRI

MAOIs

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26
Q

Panic disorder treatment?

A

SSRI
TCAs
MAOIs

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27
Q

Atypical depression treatment?

A

SSRI

MAOIs

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28
Q

Schizophrenia treatment?

A 
rispiridone
olanzapine (ass with metabolic syndrome dont use in diabetics)
clozapine
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29
Q

Triad in ADHD?

A

inattention, hyperactivity, impulsivity

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30
Q

Triad in Autism?

A

social impairment
impairment of language and communication
ritual and compulsive phenomena

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31
Q

Acute management of agitation and anxiety?

A

respiredone

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32
Q

Acute management in autism?

A

respiredone

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33
Q

Drug for difficult sleep problems?

A

melatonin

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34
Q

Pharmacological management of ADHD?

A

1st line- stimulants: methylphenidate (ritalin), dexamfetamine
2nd line- atomoxetine

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35
Q

Alcohol relapse prevention treatment?

A

naltrexone
acamprosate
disulfiram (antabuse)

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36
Q

Give examples of benzodiazepines?

A

diazepam

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37
Q

How do benzodiazepines achieve the anxiolytic effects?

A

increase the inhibitory effects of GABA at GAPA-A receptor. calming effect

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38
Q

When are benzodiazepines used?

A

short term relief of severe disabling and distressing anxiety and insomnia symptoms
alcohol withdrawal
status epilepticus

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39
Q

What is the maximum use of benzodiazepines and why?

A

4 weeks

addictive with increasing tolerence

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40
Q

when do you never give benzodiazepines and why?

A

delirium- makes it worse
respiratory depression
sleep apnoea

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41
Q

when do you never give benzodiazepines and why?

A

respiratory depression
sleep apnoea
caution in delirium as can make it worse (only use if alcohol dependence/benzodiazepine withdrawal)

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42
Q

What is disinhibition?

A

impulsivity and disregard for social norms and authority

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43
Q

physiological management of ADHD?

A

1- parent training, classroom behaviour strategies

2- social skills training, sleep and diet

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44
Q

When is peak onset for delirium tremens in alcohol withdrawal?

A

2 days abstinence

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45
Q

When do symptoms typically resolve for alcohol withdrawal?

A

5-7 days

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46
Q

How does naltrexone achieve its affects?

A

opiod antagonist

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47
Q

mechanism of acamprosate?

A

reduces cravings by acting on glutamate and GABA systems

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48
Q

mechanism of disulfiram (antabuse)?

A

blacks the effect of acetaldehyde dehydrogenase. Normally when alcohol is ingested enzymes in the liver convert it into acetaldehyde which is then broken down by acetaldehyde dehydrogenase into harmless acetic acid. When this is stopped build up of acetaldehyde causes hangover like symptoms.

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49
Q

mechanism of disulfiram (antabuse)?

A

blacks the effect of acetaldehyde dehydrogenase. Normally when alcohol is ingested enzymes in the liver convert it into acetaldehyde which is then broken down by acetaldehyde dehydrogenase into harmless acetic acid. When this is stopped build up of acetaldehyde causes hangover like symptoms.

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50
Q

Treatment of alcohol withdrawal?

A

benzodiazepines- diazepam
titrate depending on severity of symptoms and reduce over 7 days
paraentral thiamine as prophylaxis to wernickes

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51
Q

triad in wernickes and what is it?

A

opthomaplagia (weakness of eye muscles)
ataxia (lack of volunary muscle control)
confusion
vitamin B1/thiamine deficiency

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52
Q

What effects do prolonged alcohol use have?

A

alcohol inhibits excitatory glutamate NMDA ion channels and chronic use leads to upregulation of receptors
increases the inhibitory effect of GABA and chronic use leads to down regulation of receptors
alcohol withdrawal leads to excessive glutamate activity (which is toxic to nerve cells) and reduced GABA activity causing CNS excitability and neurotoxicity

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53
Q

What are the hallmarks of delirium?

A

acute and fluctuating
inattention
altered level of consciousness
change in cognition

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54
Q

pharmacological management of uncomplicated delirium?

A

haloperidol- typical antipsychotic

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55
Q

pharmacological management of PD/LB dementia with delirium?

A

quetiepine- atypical antipshychotic

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56
Q

pharmacological management of delirium if seizure/alcohol or benzodiazepine withdrawal?

A

lorazepam- benzodiazepines

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57
Q

Cause of velocardiofacial/ di george syndrome?

A

deletion of segment on chromosome 22

AD

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58
Q

Key features of di george syndrome?

A

congenital heart defects
learning disabilities
facial features
recurrent infections

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59
Q

Cause and genetics of Prader willi syndrome?

A

deletion segment on chromosome 15

60
Q

Features of prader willi syndrome?

A

newborns- weak muscles, feeding difficulties and delayed growth
childhood- constant hunger and overeating- obesity and diabetes
learning difficulties and behavioural problems

61
Q

cause of angelman syndrome?

A

deletion of segment from maternal chromosome 15

62
Q

What are the features of angelman syndrome?

A 
intellectual and developmental disability
sleep disturbance
seizures
happy/excitable demeanour
short attention span
jerky movements especially hand flapping
63
Q

cri du chat syndrome genetics?

A

deletion of short arm on chromo 5

64
Q

Features of cri du chat syndrome?

A

microcephaly
severe learning disabilities
high pitched cry (usually lost at about 2yrs)
wide eyes

65
Q

learning disabilities categories?

A

borderline >70
mild 50-70 mental age 9-12
moderate 35-50 6-9, delayed self care and motor skills, physical disability and epilepsy common
severe 20-35 3-6, epilepsy
profound <20 <3, severe mobility restriction

66
Q

antisocial personality disorder treatment?

A

group based therapy

67
Q

borderline personality disorder treatment?

A

dialectibal behavioural therapy

68
Q

Cluster A personality disorders?

A

(odd & eccentric) WEIRD
Paranoid- distrust and suspicious od others and their motices ACCUSATORY
Schizoid- detachment from social relationships and restricted emotional range ALOOF
Schizotypal- social anxiety and paranoia AWKWARD

69
Q

Cluster B personality disorders?

A

(dramatic and emotional) WILD
Antisocial- disregard for others BAD
Borderline- instability in interpersonal relationships, self image, impulsive BORDERLINE
Histrionic- very emotional and attention seeking BULLSHIT

70
Q

Cluster C personality disorders?

A

(anxious and fearful) WORRIED
Avoidant- social inhibition, hypersensitive to negative evaluation COWARD
Dependent- need to be taken care of CLINGY
Obsessive- Compulsive- order and perfectionist COMPULSIVE

71
Q

1st rank symptoms of schizophrenia?

A 
auditory hallucinations (commentary, thought echo, third person)
thought disorder (thought withdrawal, insertion, broadcasting)
passivity phenomena (senses controlled by external)
delusions
72
Q

atypical antipsychotics in the elderly increase risk of what?

A

stroke and VTE

73
Q

What is conversion disorder?

A

typical loss of motor and sensory function with no apparent cause
patient indifferent to their condition

74
Q

post MI antidepressant?

A

sertraline

75
Q

main side effects with antidepressants?

A

GI
transient increased anxiety
increased suicide risk

76
Q

emergency schizophrenia treatment?

A

im lorezepam 1-2mg

77
Q

long term treatment of schizophrenia?

A

typical antipsychotics- risperidone, olanzapine, clozapine

78
Q

non pharmacological treatment of PTSD?

A

CBT

eye movement desensitisation and reprocessing

79
Q

pharmacological treatment in PTSD?

A

SSRI- paraxoitine

NASSAs- mirtazapine

80
Q

Treatment for OCD?

A

CBT, exposure and response prevention
SSRI
TCA- clomipramine

81
Q

What is a NASSAs?

A

noradrenaline and specific serotonergic antidepressants

82
Q

Depression treatment?

A

SSRI

NASSA or TCAs

83
Q

First line depression treatment in individual with history of CVD?

A

SSRI- Sertraline

84
Q

What else should you provide if a patient is on an NSAID/ aspirin and about to start an SSRI and why?

A

PPI

SSRI and NSAID increase risk of GI bleeding

85
Q

What is the first line SSRI in adolescents?

A

fluoxetine

86
Q

What are the main SE of SSRIs?

A

GI symptoms
Increased risk of GI bleed with NSAID
increase suicidality
transient anxiety

87
Q

What do you give a patient on warfarin/heparing and depression?

A

NaSSA: mirtazapine

88
Q

What SSRI doesnt need to be decreased gradually?

A

fluoxetine

89
Q

What effect do antipsychotics have on PD?

A

worsening of symptoms

90
Q

What is the pharmacological treatment of delirum- 3 main scenarios?

A

first line sedative: Typical antipsychotic-
haloperidol
alcohol withdrawal or benzodiazepine dependence: low dose benzodiazepines-
chlordiazepoxide or diazepam
parkinsons or LB dementia: benzodiazepine-
lorazepam

91
Q

How long to symptoms have to be present for diagnosis of depression?

A

2 weeks with no manic or hypo manic episodes

92
Q

What are the core symptoms of depression?

A

low mood
anhedonia
anergia

93
Q

What is anhedonia?

A

inability to feel pleasure in normally pleasurable activities

94
Q

What are the the classifications for mild, mod and severe depression?

A

mild- 2 core total 4
mod- 2 core total 6
severe- 3 core total 8

95
Q

What are some other common symptoms of depression?

A 
loss of confidence
guilt
thoughts of death/suicide
reduced concentration
early morning wakening
decreased appetite
96
Q

When do you prescribe antidepressants for sub threshold/mild depressive symptoms?

A

present for > 2 yrs
history of mod or severe depression
if no improvement with other interventions
other chronic health problem

97
Q

What is first line treatment for sub threshold/mild depression?

A

CBT

do not use antidepressants routinely

98
Q

mod to severe depression general management?

A

CBT or interpersonal therapy and antidepressants

99
Q

What class are first line antidepressants?

A

SSRIs

100
Q

SSRI post MI or previous CVD?

A

sertraline

101
Q

SSRI in younger patients?

A

fluoxetine

102
Q

first line SSRI?

A

citalopram

103
Q

Adverse effects of SSRIs?

A

GI symptoms
increased risk of GI bleed
transient anxiety

104
Q

SSRI with least drug interactions?

A

sertraline?

105
Q

What should also be prescribed with an SSRI if patient is already on NSAIDs?

A

PPI

106
Q

What is citilopram associated with?

A

dose dependent QT interval prolongation

107
Q

What should be given instead of an SSRI if patient on warfarin/heparin?

A

mirtazapine

108
Q

How long should patients continue on SSRI after remission?

A

6 months

109
Q

When should patients be reviewed after starting SSRI?

A

after 2 weeks

if < 30 or increased suicide risk after 1 week

110
Q

How do you stop SSRIs and what is the exception?

A

reduce dose over 4 weeks

not needed in fluoxetine that has a long half life

111
Q

what are some common SSRI discontinuation symptoms?

A 
restless
sleeping problems
unsteady
sweating
increased mood change
GI
parathesia
112
Q

What are the features of atypical depression?

A 
mood reactivity 
>2 of:
weight gain/increased appetite
hypersomnia
leaden paralysis
interpersonal rejection sensitivity
113
Q

How do monoamine oxidase inhibitors work?

A

inhibit monoamine oxidase to prevent breakdown of monoamine neurotransmitters (5HT, NA, DA)

114
Q

Give some examples of MAOIs?

A

Phenelzine

Tranylcypromine

115
Q

When are MAOIs inhibitors used?

A

2nd line depression with anxiety

2nd line atypical anxiety

116
Q

How long must you be off a TCA or SSRI before starting an MAOI?

A

2-3 weeks

117
Q

What foods must you avoid on MAOIs and why?

A

soft cheese, pickled herring, wine, chocolate
inhibitors prevent the breakdown of dietary tyramine which increases NE release and causes blood vessels to constrict (binds to alpha recepors) leading to hypertensive crisis

118
Q

treatment of MAOI induced hypertensive crisis?

A

alpha blocker

119
Q

What is somatic symptom disorder?

A

multiple physical symptoms but no underlying cause

patient worried about symptoms

120
Q

What is dysthymia?

A

chronic low mood but not fulfilled criteria for depression

usually able to cope with demands of life

121
Q

baby blues key features?

A

3-7 days post birth

anxious tearful irritable

122
Q

key features of postnatal depression?

A

1-3 months

123
Q

Treatment of postnatal depression?

A

CBT

SSRI- paroxetine

124
Q

What SSRI to avoid in breast feeding mothers and why?

A

fluoxetine

long half life

125
Q

key features of puerperal psychosis?

A

onset 2-3 weeks
severe mood swings similar to bipolar
disordered perception

126
Q

treatment for puerperal psychosis?

A

hospital referral

127
Q

What differentiates mania from hypomania?

A

presence of psychotic symptoms

128
Q

What are two common psychotic symptoms in mania?

A

delusions of granduer

third person auditory hallucinations

129
Q

what are the features of mania and hypomania?

A 
Mood
predominately elevated
irritable
Speech and thought
pressured
flight of ideas
poor attention
Behaviour
insomnia
loss of inhibitions: sexual promiscuity, overspending, risk-taking
increased appetite
130
Q

Acute management of mania?

A

olanzapine with valproate or lithium

131
Q

What are the main SE of typical antipsychotics?

A

hyperprolactinaemia
metabolic syndrome
agranulocytosis (clozapine)
increased stroke risk

132
Q

Diagnosis of bipolar?

A

two or more episodes of mania +/- depression

133
Q

How long is an average untreated episode in bipolar?

A

3 months

134
Q

What is bipolar 1?

A

mania or a mixed episode of mania and depression

135
Q

what is bipolar 2?

A

hypomania and depression

136
Q

What is cyclothymia?

A

hypomania and mild depression

137
Q

What is meant by rapid cycling in bipolar disorder?

A

> /=4 mood episodes in a year

138
Q

What is lithium?

A

mood stabiliser

139
Q

What are the main side effects of lithium?

A

nephrotoxicity, weight gain, fine tremor, N,V,D, hypothyroid (+/- goitre)

140
Q

When should lithium blood levels be checked?

A

weekly at first then every 3 months when stable aim for 0.4-1
12hrs post dose

141
Q

What should be routinely checked with lithium use?

A

blood levels every 3 months

thyroid and renal function every 6 months (U&Es, LFTs, TFTs)

142
Q

When does lithium toxicity occur?

A

> 1.5mmol/L

143
Q

What are the features of lithium toxicity?

A 
coarse tremor
hyperreflexia
confusion
seizure
coma
144
Q

how do you treat lithium toxicity?

A

saline volume resus
haemodialysis
sodium bicarbonate

145
Q

prophylactic treatment in bipolar?

A

lithium

146
Q

What must be checked before starting someone on lithium?

A

U&Es
ECG
T4

Buzzwords (9 decks)

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