Psychopharm Flashcards
What are the two main groups of antipsychotics?
Typical and atypical
What are some examples of typical antipsychotics? (x3)
- Chlorpromazine
- Haloperidol
- Fluphenazine
What are some examples of atypical antipsychotics? (x4)
- Clozapine
- Olanzapine
- Quetiapine
- Risperidone
What is the mechanism of action of antipsychotics?
Block D2 dopamine receptors in the brain (excess dopamine causes psychosis)
What is Chlorpomazine also known as?
Largactil (due to its large action - acts on many receptor types)
What type of symptoms are ALL antipsychotics useful against?
POSITIVE symptoms - eg. hallucinations, delusions
What percentage of patients are antipsychotics effective for, and how long does it take to achieve therapeutic effects?
Effective in 70% of all cases
Takes 6 weeks
What type of antipsychotics are useful against negative symptoms?
Atypical, but in varying degrees
Why are antipsychotics associated with such a large range of adverse effects?
Because they have such a broad spectrum of activity
What classes of psych drugs can cause dependence and withdrawal and when does this occur?
Classes of drugs include:
- Antidepressants
- Antipsychotics
- Mood stabilisers
- Anxiolytics
Occurs when these drugs are abruptly stopped
What are some examples of the adverse effects associated with antipsychotics?
- EPSEs (extrapyramidal side effects)
- NMS (neuroleptic malignant syndrome)
- Prolactin elevation (manboobs)
- Sedation
- Weight gain
What are antipsychotics used to treat?
Treatment of choice for schizophrenia and other psychoses, also used as prophylaxis for relapse
What are anticholinergics also known as?
Antimuscarinic or antiparkinsonian medications
What is the mechanism of action of anticholinergics?
Block the effects of acetylcholine
Why is the prophylactic use of anticholinergics avoided? (x3)
- Efficacy of antipsychotics at lower doses
- Long term use may mask the development of Tardive Dyskinesia (severe EPSE)
- Abuse problems - creates a euphoric effect that is addictive
What are some examples of anticholinergics? (x4)
- Benztropine
- Biperiden
- Procyclidine
- Orphenadrine
How long does it take for antidepressants to have a therapeutic effect?
Takes 6-8 weeks due to the complexity of biochemical alterations occurring in the brain
How long is antidepressant therapy recommended for and why?
1-2 years, in order to prevent relapse.
Many patients stop too soon due to how long it takes for the drugs to have therapeutic effects.
How long a period should a patient be weaned off antidepressants for?
6-12 months (even if they feel good)
What drug groups of antidepressants are the first line of therapy for the treatment of depression?
- SSRIs - selective serotonin reuptake inhibitors
- RMAOIs - reversible monoamine oxidase inihibitors
- Tetracyclic antidepressants (Mirtazapine)
What are some examples of SSRIs? (x3)
- Fluoxetine
- Paroxetine
- Escitalopram
What are 4 advantages of SSRIs?
- Long half life = one daily dose = increased adherence
- Usually well tolerated
- Minimal toxicity in overdose (unless combined with other drugs)
- High therapeutic index
What are some adverse effects of SSRIs? (x4)
- GI disturbances (most common)
- Sexual dysfunction
- Insomnia
- Agitation
What is an example of a RMAOI?
Moclobemide
What type of drug is Moclobemide?
RMAOI (antidepressant)
What kind of receptor is Moclobemide selective for?
MAO-A receptors (binds reversibly)
Are consumers on Moclobemide allowed to have tyramine? Why/why not?
Yes they are!
Acts on MAO-A which IS NOT found in the liver, and so has nothing to do with tyramine breakdown
What kind of drug is Mirtazapine?
Tetracyclic antidepressant
What do RMAOIs allow for?
Allow metabolism of dietary amines
What is the mechanism of action of Mirtazapine?
Presynaptic alpha2 receptor antagonist
To a lesser extent, also increases serotonin release
When are tricyclic antidepressants (TCAs) a first line of therapy?
When a sedative effect is required
What are some examples of TCAs? (x3)
- Amitrityline
- Imipramine
- Doxepin
What time of day are TCAs usually given and why?
At night, due to sedative effects
Can still cause daytime drowsiness - caution when driving and operating machinery
Other than sedative effects, what other effects do TCAs exert?
- Anxiolytic properties
- Anticholinergic
- Antiadrenergic
- Antihistaminergic
(last three are all secondary effects)
What happens during overdose of TCAS?
HIGHLY LETHAL - cardiotoxic
Blocks muscarinic receptors on the myocardium of the heart, resulting in cardiac arrest
What are the contraindications of TCAs? (x3)
- MAOIs
- SSRIs
- Alcohol
Also not to be given to suicidal consumers due to lethality in overdose
What is an example of a second line antidepressant?
IMAOI (irreversible monoamine oxidase inhibitor)- Phenelzine
What is the mechanism of action of Phenelzine?
Acts on both MAO-A and MAO-B receptors
Can those on Phenelzine have tyramine in their diet? Why/why not?
NO
MAO-B is found in the liver - associated with tyramine metabolism = REQUIRES DIETARY RESTRICTION
When are IMAOIs used? Why?
Used when SSRIs and TCAs do not work for a consumer -
limited use due to toxicity and lower efficacy than SSRIs and TCAs
Also used when there has been a previous response to IMAOIs
What is a contraindication of IMAOIs?
Foods containing tyramine - eg. cheese, beer, wine, sour cream, vegemite, soy sauce
What are some adverse effects of IMAOIs? (x5)
- Headache
- Postural hypotension
- Insomnia
- Ankle oedema
- Weight gain
Which two classes of antidepressants have a similar efficacy and what is the rate of efficacy?
SSRIs and TCAs have a similar efficacy with about 60% of patients responding in 6 weeks
What are mood stabilisers used to treat?
Acute and long term management of bipolar disorder for the prevention of mood swings
Which drug is the ONLY effective mood stabiliser?
Lithium Carbonate
even though some antiepileptic and anticonvulsants are used for this purpose
Why might anticonvulsants be used with lithium?
Because lithium has a long response period, takes 1-2 to have any therapeutic events, and so anticonvulsants are used during this period to manage manic episodes
What are some examples of anticonvulsants that might be used with lithium?
- Sodium valporate (Valporic acid)
- Carbamazepine
- Lamotrigine
What are some common adverse effects of lithium? (x4)
- GI disturbances
- Increased thirst and urination
- Muscle weakness
- fine hand tremor
How much water to consumers need to drink when taking lithium and why?
6-8 glasses
Because Li with compete with Na in the renal system. When there is too little water, Li will be absorbed and block Na/K pump function, leading to toxicity
What are some symptoms of lithium toxicity? (x4)
- Coma
- Confusion
- Lethargy
- Cardiac arrest
Why should you NOT give lithium to consumers with renal dysfunction?
Because lithium is metabolised solely by the kidneys, no kidney function = lithium toxicity. The liver does not metabolise Li as it is a metal
How do epileptic drugs stabilise mood?
Inactivate Na channels - leads to decreased neuron excitability, increased GABA release and GABA(A) receptor density, inhibition of GABA degradation
What classes of drugs are used in the treatment of anxiety disorders?
- Sedatives
- Hypnotics
- Anxiolytics
- SSRIs and Quetiapine (antipsychotic)
What are two examples of hypnotics?
- Nitrazepam
- Temazepam
What are three examples of anxiolytics?
- Diazepam
- Alprazolam
- Oxazepam
Benzodiazepines are safe compared to which class of drug?
Barbiturates - these cause excessive sedation and fatalities in overdose
Why are benzodiazepines regarded as dangerous?
Due to their high potential for dependency and withdrawal problems
What are some adverse effects of sedatives, hypnotics and anxiolytics? (x6)
- Drowsiness (hangover effect)
- Slowing of cognitive function
- Suppression of REM sleep
- Confusion in older patients
- Rebound insomnia
- Vivid dreams
When are sedatives, hypnotics and anxiolytics fatal in overdose?
When taken in excess with alcohol and other drugs
Otherwise overdose is rarely fatal in healthy adults
What is the mechanism of action of psychostimulants?
Enhance DA and NA transmission - causes these neurotransmitters to hit their ceiling effect and drop back down, leaving the consumer feeling calmer
What is an example of a psychostimulant and what is it used to treat?
Ritalin (amphetamine derivative)
Used to treat ADHD
What are some examples of drugs used in substance dependence? (x4)
- Disulfiram
- Acamprosate
- Methadone
- Naltrexone
What is Disulfiram use for?
Makes consumers feel physically ill when they consume alcohol - promotes abstinence in people with chronic alcohol abuse
What is Acamprosate used for?
Decreases craving and withdrawal symptoms, used in combination with psychosocial support
What is Methadone used for?.
Reduces craving and withdrawal symptoms in heroin abusers
What is Naltrexone used for?
Blocks the actions of endogenous opioid and peptides released by drugs of abuse
Which groups of people require extra care during drug administration?
Breastfeeding or pregnant mothers, children and older patients
What is the rule for psych drug administration?
Give ONLY if it has been established that the benefits of the drug outweigh the risks associated with the drug, monitor closely and stop/review if concerned
What is non-adherence?
Deviations from recommendations of drug treatment (major issue in the mental health setting)
What is adherence?
The active involvement in taking medication following diet and/or executing lifestyle changes
What are some common reasons for non-adherence?
- Denial of mental illness and stigma
- Lack of belief in drug efficacy
- Fear of losing control
- Concerns about unwanted side effects
- Personal and cultural beliefs
- Costs of medications
What are some nursing strategies that can be implemented to improve adherence (x4)
- Establish a good relationship and effective reporting system
- Honestly and explore the client’s view on medication
- Correct misinformation and share information - evidence for and against
- Discuss risks and benefits
What is ECT (electroconvulsive treatment) used to treat?
- Persistent and severe depression
- Bipolar disorder
- Schizophrenia
What is ECT?
Induction of controlled seizures to give a therapeutic effect, considered safe and should be offered as treatment during all stages of illness
What are the mechanisms of actions of ECT? (x4)
- Increase serotonin, has an indirect impact on the levels of endogenous opioids
- Increase DA - improve Parkinson-like symptoms
- Upregulation of cAMP - increases BDNF for regulation of neuronal strength, growth and survival, also regulates 5-HT and NA receptor expression
- Increase GABA transmission and endogenous opioids for the suppression of neuronal excitation
