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Psychiatry > Psychopharamcology > Flashcards

Psychopharamcology Flashcards

1
Q

What is the action of serotonin?

A

Stabilises mood, feelings of well being and happiness, enables brain cells and other nervous system cells to communicate with each other
Helps with sleeping, eating, and digestion

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2
Q

What is the action of NA?

A

Increases arousal and alertness

Enhances formation and retrieval of memory and focusses attention, increases restlessness and anxiety

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3
Q

What is the action of dopamine?

A

Released when brain is expecting a reward and associated with reward

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4
Q

Why are MAO inhibitors rarely used?

A

Due to S/E

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5
Q

What is the mechanism of action of MAO inhibitors?

A

MAO enzyme works in gut to aid tyramine breakdown and down and works in brain to remove NA, serotonin and dopamine
Inhibitors prevent MAO working and so prevent the removal of NA, serotonin and dopamine from the brain

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6
Q

What are the S/E are MAO inhibitors?

A

Cheese effect - lack of breakdown of tyramine rich foods such as aged cheese, beer, dried meats, red wine - leads to migraines and life threatening BP spikes
Drug interactions - nasal decongestants, salbutamol and many more

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7
Q

Give 2 examples of MAO inhibitors

A

Isocarboxazid

Phenelzine

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8
Q

How do TCAs work?

A

Blocks 5-HT and NA transporters therefore blocking reuptake of serotonin and NA in presynaptic terminals therefore increasing mood and focus
Non-specific

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9
Q

Why are TCAs often not used?

A

S/E

Worse in an overdose

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10
Q

Give 2 examples of TCAs

A

Amitriptyline
Clopipramine
Nortriptyline

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11
Q

What are the S/E of TCAs?

A

Anticholinergic effects - can’t pee, can’t see, can’t spit, can’t shit
Alpha-1 adrenergic antagonism
- Antihistaminergic (H1) - sedation, weight gain
Overdose, seizures (lowers seizure threshold)
More likely to have a cardiac arrest

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12
Q

Give 2 examples of SSRIs

A

Citalopram
Fluoxetine
Sertraline

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13
Q

Why are SSRIs preferential?

A

Fairly safe in overdose

Fewer S/E

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14
Q

How do SSRIs work?

A

Blocks serotonin reuptake

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15
Q

What are SSRIs used for?

A 
Depression
GAD
PTSD
Eating disorders
OCD
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16
Q

What are the S/E of SSRIs?

A

Nausea, headache, GI upset (5-HT3)
Agitation, akathisia, anxiety, sexual dysfunction, insomnia (5-HT2)
S/E tend to wear off after a few weeks

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17
Q

Give 2 examples of SNRIs

A

Duloxetine

Venlafaxine

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18
Q

Give 2 examples of antipsychotics

A

Risperidone
Olanzapine
Clozapine

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19
Q

How do antipsychotics work?

A

Inhibit dopaminergic neurotransmission (D2)
Block D2 receptors in the meso-limbic system - reduces positive symptoms of psychosis BUT they feel less pleasure and have less ability to feel pleasure (meso-limibic system is activated by drugs
Block D2 receptors in the meso-cortical pathway - decreases the negative symptoms of psychosis - more control over emotions

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20
Q

What are the S/E of antipsychotics and why do they occur?

A

Also block D2 receptors in nigrostriatal pathway leading to a reduction in movement
Motor - acute dystonia, akathisia, tardive dyskinesia
Hyperprolactinaemia - infertility, irregular/no periods, galactorrhoea, pain in breasts, loss of libido, increased risk of ovarian and breast cancer
Metabolic - increased appetite and weight gain
Hypertriglyceridaemia
Lower seizure threshold
Postural hypotension

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21
Q

What is the first line treatment for depression?

A

SSRIs

SNRIs second line

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22
Q

How does mirtazapine work?

A

Antagonist effects on central presynaptic alpha-2 adrenergic receptors causing an increased release of serotonin and noradrenaline

23
Q

Why is mirtazapine given to older adults?

A

Fewer drug interactions

24
Q

What is the S/E of mirtazapine?

A

Weight gain

25
Q

What are the S/E of SSRIs?

A

Initially nausea, vomiting, anxiety, weight loss, diarrhoea, insomnia
Sexual dysfunction may persist

26
Q

What are the S/E of TCAs?

A 
Postural hypotension
Blurred vision
Urinary retention
Constipation
Dry mouth
Weight gain
Drowsiness
Confusion
Agitation
Adverse effects on cardiac function
27
Q

What are the S/E of SNRIs?

A

Nausea, sexual dysfunction, headache, insomnia, anxiety and sweating
Dose related increased in BP

28
Q

What are the S/E of MAOIs?

A

Postural hypotension/dizziness
Constipation
Interactions with foods

29
Q

What are the discontinuation symptoms of anti-depressants?

A 
GI disturbances
Headache
Anxiety
Dizziness
Paraesthesia
Electric shock sensation in head, neck and spine
Tinnitus
Sleep disturbances
Fatigue
Flu like symptoms
Sweating
30
Q

What are first generation anti-psychostics?

A

Typical

Purely block D2 and cause extra-pyramidal S/E causing movement disorders

31
Q

What are second generation anti-psychotics?

A

Atypical

5-HT2a occupancy too meaning you get some dopamine and extra-pyramidal S/E are reduced

32
Q

Name a S/E of aripiprazole?

A

Get constant agitation

Unable to feel settled

33
Q

What are the complications of anti-psychotic S/E?

A

Physical health complications - require full yearly health checks - ECG, weight, waist circumference
Confound assessment of clinical condition
Too much can make them seem psychotic
Functional impairment - sedation levels
Social stigma
Negative attitudes towards treatment

34
Q

Name 3 mood stabilisers

A 
Lithium
Olanzapine
Lamotrigine
Carbamazepine
Sodium valproate
35
Q

What does lithium work for?

A

Mania and depression but better for mania

36
Q

What does olanzapine work for?

A

Mania/manic episodes

37
Q

What does lamotrigine work for?

A

Bipolar if bipolar is mainly depressive episodes

38
Q

What does carbamazepine work for?

A

Not NICE recommended
Bipolar
But only when bipolar is unresponsive to lithium

39
Q

What does sodium valproate work for?

A

Mania and depression
Not as good as lithium
Better for mania

40
Q

What are the S/E of lithium?

A 
Fine tremor
Sedation
Lethary
Impaired coordination
Gastric disturbances
Polyuria
Weight gain
Oedema
Hypothyroidism
41
Q

What are the S/E of valproate?

A 
GI pain
Drowsiness
Tremor
Ataxia
Sedation
Hair loss
Increased appetite
Weight gain
Blood dyscrasias (low white cells, liver damamge)
42
Q

What are the S/E of lamotrigine?

A 
Headache
Drowsiness
Nausea
Diarrhoea
Ataxia
Tremor
Blurred vision
Skin rash
Blood disorders
Liver failure
43
Q

What are the S/E of carbamazepine?

A 
Fatigue
Nausea
Blurred vision
Ataxia
Headache
Drowsiness
Rare - blood, liver, and skin disorders potentially serious in nature
44
Q

What do you need to monitor with lithium and how long for?

A

Thyroid function - at start and every 6m
Calcium - at start and every 6m
Renal function - at start and every 6m
Serum levels - 1 week after initiation, at every dose change, 3m once stable

45
Q

What do you need to monitor with valproate and how long for?

A

Liver function - at start and during first 6m
Serum levels - only if evidence of poor effectiveness or toxicity
FBC - at start

46
Q

What do you need to monitor with carbamazepine and how long for?

A

Liver function - at start and periodically
Serum levels - only useful in verification of compliance
FBC - at start and periodically

47
Q

What does the mnemonic LITHIUM stand for?

A

L - levels 0.6-1.0 mmol/L, leukocytosis (older adults < 1.0)
I - nephrogenic diabetes insipidus (v rare)
T - tremors mild, coarse = toxicity
H - hydration - dry mouth, diarrhoea, thirsty - must drink, NA restricted diet, no diuretics, and NSAIDs, regular renal function tests
I - increased GI, skin, and memory problems
U - under active thyroid
M - metallic taste, mums beware - Ebsteins phenomena

48
Q

What level does lithium need to be to be determined toxic?

A

> 1.5 mmol/L

49
Q

What are the symptoms of lithium toxicity?

A 
N&V
Diarrhoea
Confusion
Excessive sleeping
Seizures
Myoclonic jerks
Coarse tremor
50
Q

What are the causes of lithium toxicity?

A 
Fluid depletion
Changes in salt level in diet
Reduced renal function
Certain medications (diuretics, NSAIDs, BP medication)
Change in brand of lithium
51
Q

How do you treat lithium toxicity?

A

Stop lithium
Rehydrate
Consider haemodialysis

52
Q

What is the problem with valproate?

A

Highly teratogenic

High risk of developmental abnormalities

53
Q

Who should you not prescribe valproate to?

A

Female patients of childbearing age unless only option

54
Q

How do you look after young women on valproate?

A

Pregnancy prevention programme
Irreversible/long term forms of contraception
Require a checklist going through yearly

Psychiatry (15 decks)

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