Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

*Psychiatry > Psycho-pharmacology I > Flashcards

Psycho-pharmacology I Flashcards

1
Q

What are the indications for antidepressants?

A 
Unipolar/bipolar depression
Organic mood disorders 
Schizoeffective disorder
Anxiety disorders 
Impulsivity associated with personality disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What delay is associated with antidepressants?

A

3-6 weeks after therapeutic dose achieved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When are antidepressants changed post-usage?

A

At least 2 months trial period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the main classes of antidepressants?

A 
Tricyclics
Monoamine Oxidase inhibitors
SSRIs
SNRIs
Novel antidepressants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the side effects associated with Tricyclic antidepressants?

A 
Antihistaminic
Anticholinergic 
Antiadrenergic
QT lengthening
Lethal in overdose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are tertiary TCAs?

A

Tertiary amine side chains

Worsen side effects (antihistaminic, anticholinergic, antiadrenergic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are antihistaminic side effects?

A

Sedation

Weight gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are anticholinergic side effects?

A

Dry eyes, mouth
Constipation
Memory deficits
Delirium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are antiadrenergic side effects?

A

Orthostatic hypotension
Sedation
Sexual dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Tertiary TCAs act on what?

A

Serotonin receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Give an 2 examples of tertiary TCAs?

A

Imipramine
Amitriptyline
Doxepin
Clomipramine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the active metabolites of tertiary TCAs?

A

Desipramine

Nortriptyline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are secondary TCAs?

A

Metabolites of tertiary TCAs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do secondary TCAs work?

A

Block noradrenaline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Give 2 examples of secondary TCAs?

A

Desipramine

Nortriptyline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What side effects are associated with secondary TCAs?

A

Same as tertiary TCAs (but less severe)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do Monoamine Oxidase inhibitors work?

A

Bind irreversibly to monoamine oxidase, prevent inactivation of amines:
Norepinephrine, dopamine, serotonin (increasing levels)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What side effects are associated with Monoamine Oxidase inhibitors?

A 
Orthostatic hypotension
Weight gain
Dry mouth
Sedation
Sexual dysfunction
Sleep disturbance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What risks are associated with Monoamine Oxidase inhibitors?

A

Hypertensive crisis when taken with tyramine rich foods or sympathomimetics
Serotonin syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Serotonin syndrome is associated with which antidepressants?

A

Monoamine Oxidase inhibitors taken with Serotonin increasing drugs/sympathomimetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the symptoms of serotonin syndrome?

A 
Abdominal pain
Diarrhoea 
Sweats
Tachycardia
HTN
Myoclonus 
Irritability
Delirium
Hyperpyrexia
Cardiovascular shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How do SSRIs work?

A

Prevent presynaptic serotonin reuptake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

SSRIs are used in the treatment of what?

A

Anxiety

Depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What side effects are associated with SSRIs?

A 
Sexual dysfunction
GI upset
Anxiety
Restless/Nervous
Insomnia
Sedation
Discontinuation syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is discontinuation syndrome?

A 
Effects of stopping SSRIs
Agitation
Nausea
Disequilibrium
Dysphoria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the advantages of Sertraline?

A

Weak P450 interactions
Short half life
Slow metabolite build up
Less sedating than paroxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the disadvantages of Sertraline?

A

Requires full stomach for absorption

Increased GI ADRs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the advantages of Fluoxetine?

A

Long half life (reduced risk discontinuation syndrome)
Increased energy
Can be given to taper off SSRI use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the disadvantages of Fluoxetine?

A

Active metabolite may build up (risk in hepatic illness)
P450 interactions
Initial anxiety and insomnia
Risk of mania over other SSRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Name 3 commonly used SSRIs?

A 
Paroxetine
Sertaline
Fluoxetine
Citalopram
Escitalopram
Fluvoxamine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How do SNRIs work?

A

Inhibit Serotonin AND Noradrenergic reuptake

Without antihist/adrenergic/cholinergic sides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

SNRIs are used for what?

A

Depression
Anxiety
Neuropathic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Name 2 commonly used SNRIs?

A

Venlafaxine

Duloxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the advantages of Venlafaxine?

A

Minimal drug interactions
Short half life
Fast renal clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the disadvantages of Venlafaxine?

A 
Can cause 10-15mmHg dose dependent BP increase
Nausea (IR tabs)
Bad discontinuation syndrome 
QT prolongation
Sexual side effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the advantages of Duloxetine?

A

Efficacy for physical symptoms of depression

Less BP increase than Venlafaxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the disadvantages of Duloxetine?

A

CYP2D6 and CYP1A2 inhibitor

Active ingredient not stable in stomach (cannot break capsule)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Name 2 commonly used Novel antidepressants?

A

Mirtazepine

Buproprion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the advantages of Mirtazepine?

A

Different mechanism to SSRIs

Hypnotic at lower doses (antihistaminic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the disadvantages of Mirtazepine?

A

Increased Cholesterol and triglycerides
Very sedating at low doses
Weight gain at low doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the advantages of Buproprion?

A 
Augmenting agent 
Inhibits dopamine + norepinephrine 
No weight gain, sexual sides 
Low mania 
2nd line for ADHD
42
Q

What are the disadvantages of Buproprion?

A

Seizure risk
Avoid in TBI, bulimia, anorexia
Can cause anxiety, agitation and insomnia
Psychotic at high doses

43
Q

How can resistance to antidepressants be managed?

A

Combination of antidepressants
Add lithium
Add atypical antipsychotic

44
Q

What atypical antipsychotics may be used to aid in antidepressant resistance?

A

Quetiapine
Olanzapine
Aripiprazole

45
Q

What are the indications for the use of mood stabilisers?

A

Bipolar
Cyclothymia
Schizoeffective disorder

46
Q

What are the classes of mood stabilisers?

A

Lithium
Anticonvulsants
Antipsychotics

47
Q

What are the indications for lithium?

A

Patient at risk of suicide

Long-term mania and depressive episodes

48
Q

What are the factors predicting a positive response to lithium?

A

FH of good response
Prior long-term response
Classic pure mania
Mania followed by depression

49
Q

Outline the use of Lithium

A 
Baseline U+E and TSH 
Pregnancy test
Monitor until steady state achieved
Check TSH and creatinine 3 and 6mo, Thyroid function
Blood level between 0.6 and 1.2
50
Q

Lithium use during pregnancy is associated with what?

A

Ebstein’s anomaly

51
Q

What are the side effects of lithium use?

A 
GI distress, reduced appetite 
Thyroid abnormalities
Nonsignificant leukocytosis
Polyuria (can cause interstitial renal fibrosis)
Hair loss 
Acne 
Reduced seizure threshold
52
Q

What are the levels of Lithium toxicity?

A

Mild - 1.5-2
Moderate - 2-2.5
Severe - >2.5

53
Q

What are the symptoms of mild lithium toxicity?

A 
Vomiting
Diarrhoea
Dizziness
Ataxia
Nystagmus
54
Q

What are the symptoms of moderate lithium toxicity?

A 
N+V 
Anorexia
Blurred vision
Clonus 
Convulsions 
Delirium
Syncope
55
Q

What are the symptoms of severe lithium toxicity?

A

Convulsions
Oliguria
Renal failure

56
Q

What are the main groups of anticonvulsants?

A

Valproic acid
Carbamazepine
Lamotrigine

57
Q

What factors predict a positive response to Valproic acid?

A 
Rapid cycling patients
Female
Comorbid substance abuse
Mixed patients
Comorbid anxiety disorders
58
Q

What is the first line agent for acute mania/mania prophylaxis?

A

Carbamazepine

59
Q

When is Carbamazepine indicated?

A

Acute mania
Mania prophylaxis
Rapid cycling/mixed patients

60
Q

Outline the use of Carbamazepine?

A

Before: LFTs, FBC, ECG
Monitor: steady state, repeat FBC, LFTs
Target: 4-12mcg/ml
Check after a month

61
Q

What side effects are associated with use of Carbamazepine?

A 
Rash
N+V, Diarrhoea
Sedation
Dizziness, ataxia
AV conduction delay
Drug-drug interactions
Hyponatremia
62
Q

What side effects are associated with Lamotrigine?

A

N+V
Sedation, dizziness
TEN/SJS

63
Q

What are the indications for discontinuing Lamotrigine use?

A

ANY Rash

64
Q

What drugs increase lamotrigine use?

A

VPA

Sertraline

65
Q

What antipsychotics are indicated for Bipolar disorder?

A

Aripiprazole
Risperdone
Quetiapine
Olanzapine

66
Q

How do anticonvulsants affect liver function?

A

LFT increase expected

No change unless >3x change

67
Q

What are the indications for antipsychotics?

A 
Schizophrenia
Schizoaffective disorder
Bipolar (mood stabilisation or for psychotic features)
Psychotic depression
Augmenting agent (anxiety)
68
Q

What pathways in the brain are affected by dopamine?

A

Mesocortical
Mesolimbic
Nigrostriatal
Tuberoinfundibular

69
Q

Outline the mesocortical pathway and its role in psychosis?

A

Brain stem to the cerebral cortex
Causes negative symptoms and cognitive disorders
Psychosis is related to too little dopamine here

70
Q

Outline the mesolimbic pathway and its role in psychosis?

A

Dopaminergic cell bodies in ventral tegmentum to limbic system
Positive symptoms
Psychosis is related to too much dopamine here

71
Q

What are positive symptoms?

A

Hallucinations
Delusions
Thought disorders

72
Q

Outline the nigrostriatal pathway and its role in psychosis?

A

Dopaminergic cell bodies in substantia nigra to basal ganglia
Involved in movement
Dopamine hypoactivity can cause parkinsonian movements, akathisia, dystonia

73
Q

How does dopamine affect acetylcholine?

A

Dopamine suppresses acetylcholine activity

74
Q

Outline the tuberoinfundibular pathway and its role in psychosis?

A

Hypothalamus to anterior pituitary

Blocking dopamine to TI pathway predisposes patient to hyperprolactinaemia

75
Q

How does dopamine affect prolactin release?

A

Dopamine release inhibits prolactin release

76
Q

What are the symptoms of hyperprolactinaemia?

A

Gynaecomastia
Galactorrhea
Decreased libido
Menstrual dysfunction

77
Q

How do high potency typical antipsychotics affect dopamine?

A

D2 dopamine receptor antagonists

Bind to D2 receptors with high affinity.

78
Q

High potency typical antipsychotics increase the risk of what?

A

Extrapyramidal side effects

79
Q

Give 2 examples of typical antipsychotics?

A

Fluphenazine
Haloperidol
Pimozide

80
Q

How do low potency typical antipsychotics affect dopamine?

A

Less affinity for D2 receptors
Interact with non-dopaminergic receptors
Cardiotoxic + anticholinergic ADRs

81
Q

How do Atypical antipsychotics work?

A

Serotonin-dopamine 2 antagonists

Affect dopamine AND serotonin in 4 pathyways

82
Q

What side effects are associated with Risperidone?

A

Extrapyramidal
Hyperprolactinaemia
Weight gain
Sedation

83
Q

What side effects are associated with antipsychotics?

A

Tardive Dyskenesia
Neuroleptic Malignant syndrome
Extrapyramidal side effects

84
Q

What is tardive dyskinesia?

A

Involuntary muscle movements

may not resolve with drug discontinuation

85
Q

What is Neuroleptic Malignant syndrome?

A 
Severe muscle rigity
Fever
Altered mental state
Autonomic instability
Elevated WBC, CBK, LFTs
86
Q

What are Extrapyramidal side effects?

A

Acute Dystonia
Parkinson syndrome
Akathisia

87
Q

What agents treat extrapyramidal side effects?

A

Anticholinergics
Dopamine facilitators
Beta blockers

88
Q

What are the indications for anxiolytics?

A 
Panic disorder
Generalised anxiety disorder
Substance related/withdrawal
Insomnias
Parasomnias
89
Q

What are the indications for benzodiazepines?

A 
Insomnia
Parasomnia
Anxiety disorders
CNS depressant withdrawals
Acute sedation
90
Q

What side effects are associated with benzodiazepines?

A 
Somnolence
Cognitive deficits
Amnesia
Disinhibitions
Tolerance
Dependence
91
Q

What are the pros and cons of buspirone?

A 
Pro:
No sedation
Con:
2 week to take effect
Will not work on patients used to benzodiazepines
92
Q

What are the main Anxiolytics?

A

Buspirone

Benzodiazepines

93
Q

Name 2 atypical antipsychotics?

A 
Risperidone
Olanzapine
Quetiapine
Clozapine
Aripiprazole
94
Q

What antidepressants are associated with hypertensive crisis?

A

MAOIs and tyramine rich foods/sympathomimetics

95
Q

What foods are rich in tyramine?

A

Cheese
Red wine
Processed meat
Beans

96
Q

How long after 1st, 2nd and 3rd incidences of depression should a patient be on antidepressants?

A

1st - 6 months
2nd - 2 years
3rd - lifelong

97
Q

What are the side effects of low-potency antipsychotics?

A

Cardiotoxic

Anticholinergic effects - sedation, hypotension

98
Q

How are first line drugs for schizophenia chosen?

A

Choose based on a drugs side effect profile for first line

99
Q

What is the rule of efficacy for antipsychotics?

A

1/3 Very effective
1/3 reasonably effective
1/3 inaffective

100
Q

How is clozapine use managed?

A

Check bloods continuously though use to monitor for agranulocytosis

101
Q

What is seen before a psychosis relapse?

A

Loss of compliance
Lack of insight
May need to use mental health act

102
Q

How is akathisia as a side effect managed?

A

(Reduce dose if possible)
Benzodiazepine
Propanalol

*Psychiatry (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions