Psycho-pharmacology I&II Flashcards by Hannah Falconer

What are the indications for anti-depressants?

Unipolar and bipolar depression
Organic mood disorders
Schizoaffective disorder
Anxiety disorders
OCD, panic, social phobia, PTSD
Premenstrual dysphoric disorder
Impulsivity associated with personality disorders

How well did you know this?

Not at all

Perfectly

What is antidepressant selected based on?

Past history of response
Side effect profile
Co-existing medical problems

How well did you know this?

Not at all

Perfectly

What is delay for anti-depressants to work?

3-6wks

How well did you know this?

Not at all

Perfectly

How long should trial of antidepressant be before switching?

At least 2mo

How well did you know this?

Not at all

Perfectly

What are the classes of antidepressants?

Tricyclics (TCAs)
Monoamine oxidase inhibitors (MAOIs)
Selective serotonin rey-take inhibitors (SSRIs)
Serotonin/noradrenaline re-uptake inhibitors (SNRIs)
Novel antidepressants

How well did you know this?

Not at all

Perfectly

What are the side effect profile of TCAs?

Antihistaminic: sedation and weight gain
Anticholinergic: dry mouth, dry eyes, constipation, memory deficits, potential delirium
Antiadrenergic: orthostatic hypotension, sedation, sexual dysfunction

How well did you know this?

Not at all

Perfectly

Which antidepressant is lethal in overdose?

TCAs

How well did you know this?

Not at all

Perfectly

Which antidrepressant can cause QT lengthening?

TCAs

How well did you know this?

Not at all

Perfectly

What receptors do tertiary TCAs work on?

Serotonin

How well did you know this?

Not at all

Perfectly

What are examples of tertiary TCAs?

Imipramine
Amitriptyline
Doxepin
Clomipramine

How well did you know this?

Not at all

Perfectly

What are examples of secondary TCAs?

Desipramine

Notrtriptyline

How well did you know this?

Not at all

Perfectly

What are side effects of MAOIs?

Orthostatic hypotension
Weight gain
Dry mouth
Sedation
Sexual dysfunction
Sleep disturbance

How well did you know this?

Not at all

Perfectly

What can happen if MAOIs taken with tyramine-rich foods?

Hypertensive crisis

How well did you know this?

Not at all

Perfectly

What are serotonin syndrome symptoms?

Abdo pain
Diarrhoea
Sweats
Tachycardia
HTN
Myoclonus
Irritability
Delirium
-->
Hyperpyrexia, CVS shock, death

How well did you know this?

Not at all

Perfectly

How to avoid serotonin syndrome?

Wait 2 weeks before switching SSRI to MAOI

5 wks for fluxetine

How well did you know this?

Not at all

Perfectly

How do MAOIs work?

Bind irreversibly to monoamine oxides preventing inactivation of amines e.g. norepinephrine, dopamine and serotonin

How well did you know this?

Not at all

Perfectly

How do SSRis work?

Block presynaptic serotonin re-uptake

How well did you know this?

Not at all

Perfectly

What do SSRIs treat?

Anxiety and depressive sx

How well did you know this?

Not at all

Perfectly

What are the most common side effects of SSRIs?

GI upset
Sexual dysfunction
Anxiety
Restlessness
Nervousness
Insomnia
Fatigue
Sedation
Dizziness

How well did you know this?

Not at all

Perfectly

What symptoms can develop with discontinuation of SSRIs?

Agitation
Nausea
Disequilibrium
Dysphoria

How well did you know this?

Not at all

Perfectly

What are examples of SSRIs?

Paroxetine
Sertraline
Fluoxetine (Prozac)
Citalopram
Excitalopram
Fluvoxamine

How well did you know this?

Not at all

Perfectly

What are the advantages of paroxetine?

Short half-life

Sedating properties fro anxiety/insomnia

How well did you know this?

Not at all

Perfectly

What are disadvantages of paroxetine?

Sedating, wt gain, more anticholinergic effects

Cause discontinuation syndrome

How well did you know this?

Not at all

Perfectly

What are advantages of sertraline?

Less sedating then paroxetine

How well did you know this?

Not at all

Perfectly

What are cons of sertraline?

Needs full stomach | Increase GI ADR

What are pros of fluoxetine (Prozac)?

Decreased incidence discontinuation syndromes | May provide increased energy

What are cons of fluoxetine (Prozac)?

Active metabolic may build up - not good liver illness May increase anxiety and insomnia More likely induce mania than other SSRIs

Which SSRI in particular can cause QT interval prolongation?

Escitalopram

What do SNRIs inhibit?

Both serotonin and noradrenergic reuptake

What do SNRIs lack that TCAs have?

Antihistamine, antiadrenergic and anticholinergic side effects

What are examples of SNRIs?

Venlafaxine | Duloxetine

Which SNRI can cause QT prolongation?

Venlafaxine

Which SNRI can have sexual side effects?

Venlaxfaxine

What are novel antidepressant examples?

Mirtazapine | Buproprion

What novel antidepressant does not treat anxiety but cause it?

Buproprion

What are good SSRIs which are less sedating?

Citalopram Fluoxetine Sertraline

What anti-depressants can cause sedation and weight gain?

Paroxetin | Mirtazapine

What treatment would you move to if a patient has not achieved remission with SSRIs or novel agent?

SNRI | Dual reuptake inhibitor

Why are TCAs not good choice in suicidal people?

Can overdose

What medication has indication for neuropathic pain, depression and anxiety?

Duloxetine

What are indications for mood stabilisers?

Bipolar Cyclothymia Schizoaffective disease

What are the classes of mood stabilisers?

Lithium Anticonvulsants Antipsychotics

What is the only medication to reduce suicide rate?

Lithium

What are factors predicting positive response to lithium?

Prior long-term response or family member with good response Classic pure mania Mania followed by depression

What tests should be done before starting lithium?

Baseline U&Es and TSH | Pregnancy

What anomaly during the first trimester is lithium associated with?

Ebstein's anomaly

What are lithium side effects?

GI distress Thyroid abnormalities Non-significant leukocytosis Hair loss, acne

What is the goal blood level of lithium?

0.6-1.2

What is the blood level in mild, moderate and severe lithium toxicity?

Mild: 1.5-2.0 Moderate: 2.0-2.5 Severe: >2.5

What happens in mild lithium toxicity?

Vomiting, diarrhoea, ataxia, dizziness, slurred speech, nystagmus

What happens in moderate lithium toxicity?

Nausea, vomiting, anorexia, blurred vision, clonic limb movements, convulsions, delirium, syncope

What happens in severe lithium toxicity?

Generalised convulsions, oliguria, renal failure

What is valproic acid indicated for?

Mania prophylaxis

What are factors predicting a positive response to valproic acid?

Rapid cycling patients Comorbid substance abuse Mixed patients Patients with anxiety disorders

What tests should be done before starting valproic acid?

LFTs Pregnancy test FBC Start folic acid women

What is the target blood level for sodium valproate?

50-125

What are valproic acid SE?

Thrombocytopenia, platelet dysfunction N&V, weight gain, sedation, tremor Neural tube defect Hair loss

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

Carbamazepine (Tegretol)

What tests should be done before starting carbamazepine?

LFTs FBC ECG

What is goal blood level of carbamazepine?

4-12mcg/ml

What are SE of carbamazepine?

Rash N&V, diarrhoea, sedation, dizziness, ataxia, confusion AV conduction delays

Which mood stabiliser has many drug interactions?

Carbamazepine

What are the most severe reactions to lamotrigine?

SJS | Toxic epidermal necrolysis

What is the first line treatment for first episode of mania?

Lithium

What is a rapid cycler?

4+ depressive or manic episodes/year

What is a good choice treatment for a rapid cycler with comorbid ETOH abuse?

Depakote

What is usual in LFTS in someone on anticonvulsant therapy?

Increase

What are indications for use of antipsychotics?

``` Schizophrenia Schizoaffective disorder Bipolar disorder for mood stabilisation and/or when psychotic features present Psychotic depression Treatment resistant anxiety ```

Which pathway is it thought that negative symptoms arise?

Mesocortical

Which pathway is it thought that positive symptoms arise?

Mesolimbic

What is the problem with the mesocortical pathway for a psychotic patient?

Too little dopamine

What is the problem with the mesolimbic pathway for a psychotic patient?

Too much dopamine

What type of drug are typical antipsychotics?

D2 dopamine receptor antagonists

What type of SE are related to typical antipsychotics?

Extrapyramidal

What are atypical antipsychotics?

Serotonin-dopamine 2 antagonists (SDAs)

What are examples of SDAs (atypical antipsychotics)?

``` Risperidone Olanzapine Quetiapine Aripiprazole Clozapine ```

What is the most likely atypical to induce hyperprolactinemia?

Risperidone

What are SE of olanzapine?

Weight gain | Hypertriglyceridemia, hypercholesterolemia, hyperglycaemia

What is the most likely atypical antipsychotic to cause orthostatic hypotension?

Quetiapine

What atypical antipsychotic can cause akathisia (restless legs)?

Aripiprazole

What atypical antipsychotic has large side effect profile so reserved for resistant patients?

Clozapine

What atypical antipsychotic SE include agranulocytosis and increased risk of seizures?

Clozapine

What are antipsychotic adverse effects?

Tardive dyskinesia (TD) Neuroleptic malignant syndrome (NMS) Extrapyramidal SE: acute dystonia, Parkinson syndrome

What are treatments for extrapyramidal SE?

Anticholinergics e.g. benztropine | B-blockers e.g. propranolol

What are baseline tests to do for atypical antipsychotics?

Fasting lipid profile Fasting blood sugar LFTs CBC

What are anxiolytics used to treat?

Panic disorder, GAD, substance-related disorders

What are anxiolytics usually used in combination with?

SSRIs | SNRIs

What are benzodiazepines used to treat?

Insomnia Parasomnias Anxiety disorders

What are SE of bentos?

Somnolence Cognitive defecits Amnesia Dependence