Brainscape's Knowledge GenomeTM

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


See full index

Psychiatry > Psycho-pharmacology I & II > Flashcards

Psycho-pharmacology I & II Flashcards

1
Q

What are the general pharmacological startegies when prescribing for psychiatric patients?

A

Indication - Establish a diagnosis and identify target symptoms that will be used to monitor therapy response

Choice of agent & dosage - Choose an agent with an acceptable side effect profile and use lowest effective dose

Management - Adjust dosage for optimum benefit, safety and compliance. Use combination therapies if required but always aim for the simplest regime

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

What are the indications for antidepressants?

A

1 - Unipolar and bipolar depression

2 - Organic mood disorders

3 - Schizoaffective disorder

4 - Anxiety disorders (OCD, Panic, social phobia, PTSD)

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

What are the general guidelines for antidepressant use?

A

1 - Antidepressant efficacy is similar so selection is based on:

  • Past history of a response
  • Side effect profile
  • Coexisting medical conditions

2 - Delay of around 3-6 weeks after symptoms improve

3 - If no imporvement after at least 2 months and adequate dose:

  • Switch to another agent
  • Add another agent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the different classifications of antidepressant medications?

A

1 - Tricyclics (TCA’s)

2 - Monoamine Oxidase Inhibitors (MAOI’s)

3 - SSRI’s

4 - Serotonin/Noradrenaline reuptake inhibitors (SNRI’s)

5 - Novel antidepressants

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

What are the side effects of Tertiary TCA’s?

A

1 - Antihistaminic (sedation & weight gain)

2 - Anticholinergic (dry mouth, dry eyes, constipation, memory deficits)

3 - Antiadrenergic (orthostatic hypotension, sedation, sexual dysfunction)

4 - Can cause QT lengthening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where is the site of action of Tertiary Tricyclic anti-depressants?

A

Serotonin receptors

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

What are common examples of Tertiary TCA’s?

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

What are the side effects of secondary TCA’s?

A

Same as Tertiary TCA’s but less severe

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

What is the site/mechanism of action of secondary TCA’s?

A

Primarily block noradrenaline

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

What is the mechanism of action of Monoamine oxidase inhibitors?

A

1 - Bind irreversibly to monoamine oxidase

2 - This prevents inactivation of amines such as norepinephrine, dopamine & serotonin

3 - This results in increased synaptic levels for dopamine, serotonin etc.

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

What are the side effects of MAOI’s?

A

1 - Orthostatic hypotension

2 - Weight gain

3 - Dry mouth

4 - Sedation

5 - Sexual dysfunction

6 - Sleep disturbance

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

What can happen with MAOI’s are taken with tyramine-rich foods?

A

Hypertensive crisis

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

What condition can occur if SSRI’s are combined with MAOI’s?

A

Serotonin syndrome

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

What are the symptoms of serotonin syndrome?

A

1 - Abdo pain

2 - Diarrheoa

3 - Sweats

4 - Tachycardia

5 - Hypertension

6 - Myoclonus

7 - Irritability

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

If switching between an SSRI and an MAOI, how long should be left between starting the MAOI?

A

2 weeks (5 weeks if fluoxetine)

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

What is the site of action/mechanism of action of SSRI’s?

A

Block presynaptic serotonin reuptake

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

What conditions can be treated by SSRI’s?

A

Anxiety

Depression

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

What are the most common side effects of SSRI’s?

A

1 - GI upset

2 - Sexual dysfunction

3 - Anxiety

4 - Restlessness

5 - Insomnia

6 - Fatigue or sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the benefits of paroxetine?

A

1 - Short half-life with no active metabolites

2 - Sedating properties offers good initial relief from anxiety

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

What are the downsides to paroxetine?

A
  • CYP2D6 inhibition
  • Sedating properties
  • Weight gain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the benefits of sertraline?

A

1 - Very weak P450 interactions

2 - Short half-life

3 - Less sedating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the disadvantages of sertraline?

A

1 - Max absorption requires a full stomach

2 - Increased number of GI adverse drug reactions

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

What are the benefits of fluoxetine (prozac)?

A

1 - Long half-life so decreased occurence of discontinuation syndrome

2 - Initially activating so can provide increased energy

3 - To prevent discontinuation syndrome, can give one 20mg tab when trying to take someone off SSRI

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

What are the downsides to prozac?

A
  • Long half-life and metabolite build-up bad in patients with hepatic illness
  • Initial activation may increase anxiety and insomnia
  • More likely to induce mania than other SSRI’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the benefits of citalopram?

A
  • Low inhibition of P450 enzymes so fewer drug-drug interactions
  • Intermediate half-life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the downsides to citalopram?

A
  • There can be QT interval prolongation with doses of 10-30mg/day
  • Can be sedating
  • GI side effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the benefits of escitalopram?

A
  • Cleaner than citalopram so fewer drug-drug interactions
  • More effective than citalopram in acute response and remission
28
Q

What are the downsides to escitalopram?

A
  • Dose-dependant QT interval prolongation in doses of 10-30mg/day
  • Nausea & headache
29
Q

What are SNRI’s?

A

Serotonin/Noradrenaline Reuptake Inhibitors

30
Q

What are the benefits of SNRI’s?

A
  • They inhibit serotonin and noradrenaline reuptake (like TCAS) but without the antihistamine, antiadrenergic or anticholinergic side effects
31
Q

What are SNRI’s used for?

A
  • Depression
  • Anxiety
  • Neuropathic pain
32
Q

Give examples of SNRI’s?

A

Venlafaxine

Duloxetine

33
Q

What are the benefits of venlafaxine?

A
  • Minimal drug interactions and no P450 activity
  • Short half-life and fast clearance (good for elderly patients)
34
Q

What are the downsides of venlafaxine?

A
  • Can cause a 10-15mmHg increase in diastolic BP
  • Can cause significant nausea
  • Can cause a bad discontinuation syndrome
  • Can cause QT prolongation
  • Sexual side effects
35
Q

What are the benefits of duloxetine?

A
  • Less BP increase than Venlafaxine
  • Can treat physical symptoms of depression
36
Q

What are the downsides of duloxetine?

A
  • Inhibits liver enzymes
37
Q

What would be the 1st line treatment for a patient suffering with the following:

  • Non-psychotic unipolar depression
  • Depressed mood
  • Psychomotor retardation
  • Excessive day time sleepiness (hypersomnolence)
  • Over-eating (hyperphagia)
A

SSRI’s that have low sedating properties:

  • Citalopram
  • Sertraline
  • Fluoxetine
38
Q

Why would SNRI’s and TCA be inappropriate in the case of someone suffering their 1st depressive episode?

A

SSRI’s should be used initially and if there is no response then SNRI’s can be tried

TCA’s have strong side effects

39
Q

What would be the best choice of treatment in a patient suffering with the following symptons & history:

  • Mild HTN
  • Painful diabetic neuropathy
  • Previous episodes & one suicide attempt
  • Tried 3 different SSRI’s and depression never remitted
A

Duloxetine:

  • It won’t increase his diastolic BP like venlafaxine would
  • It will help his neuropathic pain
  • SSRI’s have not helped, so next step would be SNRI’s
40
Q

In the case of treatment resistance, what pharmacological options are available?

A

1 - Combination of SSRI or SNRI with Mirtazepine

2 - Add lithium to current treatments

3 - Add atypical antipsychotic

4 - ECT

41
Q

What are the indications for mood stabilizers?

A

1 - Bipolar

2 - Cyclothymia

3 - Schizoaffective

42
Q

What are the different classes of mood stabilizers?

A

1 - Lithium

2 - Anticonvulsants

3 - Antipsychotics

43
Q

How is the class of mood stabilizer chosen?

A

Depends on:

1) What symptoms you are treating
2) Side effect profile

44
Q

What is the only medication shown to reduce suicide rate?

A

Lithium

45
Q

Lithium is an effective prophylactic measure for which conditions?

A

Manic & depressive episodes in Bipolar affective disorder

46
Q

Which factors predict a positive response to lithium?

A

1 - Prior response or family member has had a good response

2 - Classic pure mania

3 - Mania followed by depression

47
Q

How is lithium used?

A

Before treatment begins:

1 - Check U&E’s and TSH level

2 - If female do pregnancy test (lithium in 1st trimester associated with Ebsteins anomaly)

Monitoring:

1 - Steady state achieved after 5 days - check levels 12 hours after last dose

2 - Check every 3 months once stable

3 - Check TSH and creatinine every 6 months

48
Q

What are the most common side effects of lithium?

A

1 - Reduced appetite

2 - Nausea/vomitting/diarrhoea

3 - Thyroid abnormalities

4 - Polyuria

5 - Hair loss

49
Q

What are the blood levels of lithium for mild, moderate and severe toxicity to occur?

A

Mild - 1.5-2

Moderate - 2-2.5

Severe - >2.5

50
Q

What are the symptoms associated with mild, moderate and severe lithium toxicity?

A

Mild - Vomitting, diarrhoea, dizziness, slurred speech

Moderate - Nausea, vomitting, blurred vision, delirium

Severe - Generalized convulsions, oliguria & renal failure

51
Q

Give examples of anticonvulsants:

A

1) Valproic acid
2) Carbamazepine
3) Lamotrigine

52
Q

What are the indications for valproic acid?

A

1 - Mania prophylaxis

2 - Rapidly cycling bi-polar patients

3 - Patients with comorbid anxiety disorders

53
Q

Before valproic acid is started, what blood tests should be performed?

A

1 - LFT’s

2 - Pregnancy test

3 - FBC

54
Q

What are the side effects of valproic acid?

A

1 - Thrombocytopenia & platelet dysfunction

2 - Nausea

3 - Vomitting

4 - Weight gain

5 - Sedation

6 - Tremor

7 - Increased risk of neural tube defect

8 - Hair loss

55
Q

What is the 1st line agent for acute mania and mania prophylaxis?

A

Carbamazepine

56
Q

What blood tests should be performed before commencing carbamazepine?

A

1 - LFT’s

2 - FBC

3 - ECG

57
Q

How long does it take for carbamazepine to reach a steady state within the body?

A

5 days

58
Q

What are the side effects of carbamazepine?

A

1 - Rash (most common)

2 - Nausea, vomitting, diarrhoea

3 - Sedation, dizziness, ataxia, confusion

4 - AV conduction delays

59
Q

Which anti-convulsant drug can cause Stevens Johnsons syndrome as a side effect?

A

Lamotrigine

60
Q

What are the side effects of lamotrigine?

A

1 - Nausea/vomitting

2 - Sedation/dizziness/confusion

3 - Toxic epidermal necrolysis (rash)

61
Q

What would be the best medication to give a patient suffering with their first episode of mania and what tests would you perform before commencing treatment?

A

Lithium:

  • Pregnancy test
  • Serum creatinine
  • TSH
62
Q

What would be the best medication to prescribe the following patient and why:

  • Admitted secondary to a manic episode
  • History shows 5-6 manic or depressive episodes/year
  • Alcohol abuse
A

Valproic acid:

  • Patient is a rapid cycler
  • Patient abuses alcohol
63
Q

How many cycles of manic-depressive episodes would be enough to consider a patient as a rapid cycler?

A

> or = 4/year

64
Q

What is an acceptable change in LFT’s for patients who have just been commenced on Valproic acid?

A

< 3 times increase in LFT’s is acceptable

65
Q

What are the pathways in the brain affected by dopamine?

A

1 - Nigrostriatal

2 - Mesolimbic

3 - Mesocortical

4 - Tuberoinfundibular

66
Q
A

Psychiatry (18 decks)

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