Psychopharmacology Flashcards
1
Q
What is the monoamine hypothesis of depression?
A
Due to decreased:
- Seretonin
- Dopamine
- Noradrenaline
2
Q
Give generic examples of some anti-depressants and explain them
A
- TCA = TRICYCLIC ANTIDEPRESSANT (e.g. Trazodone)
- Block serotonin and noradrenaline re-uptake, increasing noradrenergic and serotinergic neurotransmission
- SSRI = SELECTIVE SEROTONIN REUPTAKE INHIBITOR (e.g. sertraline, citalopram, fluoxetine)
- Block serotonin re-uptake, increasing serotinergic neurotransmission
- SNRI = SEROTONIN / NORADRENALINE REUPTAKE INHIBITOR (e.g. Venlafaxine)
- Block serotonin, noradrenaline (and dopamine?) re-uptake, increasing serotinergic and noradrenergic neurotransmission
- NaSSA = NORADRENALINE & SPECIFIC SEROTINERGIC ANTIDEPRESSANT (e.g. mirtazapine)
- Block pre-synaptic alpha2-adrenoceptors, increasing noradrenergic and serotinergic neurotransmission
- MAOI = MONO-AMINE OXIDASE INHIBITOR (e.g. phenelzine)
- Block enzymatic breakdown of noradrenaline, serotonin, dopamine and tyramine, increasing neurotransmission
3
Q
Advantages and notes of anti-depressants
A
4
Q
What to be aware of when prescribing antidepressants?
A
- All antidepressants are associated with a risk of increased suicidal thoughts and ideation during the first few weeks of treatment.
- Risk of hyponatraemia due to inappropriate secretion of ADH – particularly in elderly and with SSRIs
- Other indications:
- Anxiety disorders (SSRIs, venlafaxine)
- Obsessive Compulsive Disorder (SSRIs, clomipramine)
- Panic disorder (SSRIs)
- Eating disorders (fluoxetine)
- Neuropathic pain (TCAs)
- Migraine prophylaxis (amitriptyline)
- Nocturnal enuresis (imipramine)
5
Q
Dopamine levels and symptoms in schizophrenia
A
- Increased dopamine causes positive symptoms of schizophrenia
- Decreased dopamine causes negative symptoms of schizophrenia
6
Q
Give some examples of anti-psychotic drugs
A
FIRST GENERATION
- Oral
- Haloperidol
- Depot
- Haloperidol
SECOND GENERATION
- Oral
- Clozapine
- Olanzapine
- Risperidone
- LAIs
- Olanzapine
- Risperidone
7
Q
How do first and second generation antipsychotics work?
A
First generation antipsychotics:
- Act predominantly by blocking DOPAMINE D2 receptors
- Are not selective for any of the four dopamine pathways in the brain, therefore cause a range of side-effects, e.g. EPSE, elevated prolactin
Second generation antipsychotics:
- “Atypical antipsychotics”
- Act on a range of receptors, including SEROTONIN receptors
- More distinct clinical profiles, particularly with regard to side-effects
8
Q
Why isnt clozapine used as much?
A
- Most effective antipsychotic – why don’t we it for everyone?
- Hypersalivation
- Hyperthermia
- Tachycardia
- Constipation
- Seizures
- Myocarditis
- Agranulocytosis
ALSO…
- Mandatory blood monitoring for neutropenia and agranulocytosis (CPMS)
- Fatalities from bowel impaction
- Only available from specialist prescribers/registered pharmacies
9
Q
What needs to be done before someone is put on an antipsychotic?
A
- A baseline ECG is recommended before initiating any antipsychotic and continued monitoring is advised, including repeat ECGs at dose changes and at regular review
- U&Es, FBC, lipid profile, Glucose (fasting if possible) or HbA1c, TFTs, LFTs, Prolactin, CK, Weight, BP
10
Q
Why are anti-muscarinics prescribed with antipsychotics?
A
- For antipsychotic-induced parkinsonism/EPSEs:
- Procyclidine
- Trihexyphenidyl
- Orphenadrine
- For hypersalivation:
- Hyoscine hydrobromide – patches or sublingual tablets
11
Q
Explain the difference between depression and bipolar (brief)
A
12
Q
What drugs are used for bipolar disorder and mania?
A
-
Acute phase:
- Benzodiazepines, e.g. lorazepam – short term
- Antipsychotics, e.g. quetiapine, asenapine
- Mood Stabilisers for long-term management:
- CARBAMAZEPINE
- VALPROATE – as valproic acid or sodium valproate
- LAMOTRIGINE
- LITHIUM (mood stabiliser)
13
Q
Explain lithium
A
- Most effective long-term treatment option
- Narrow therapeutic index – prescribe by brand name
- Close monitoring required – Trust lithium registers
- Lithium levels (target range 0.6-0.8 mmol/litre) – weekly until stable, then every 3 months - take sample 12 hours after last dose
- eGFR/U&Es, TFTs, weight, calcium – baseline, then every 6 months
- Signs of toxicity (>1.0 mmol/litre) – loss of appetite, nausea, diarrhoea, muscle weakness/twitching, drowsiness, coarse tremor, ataxia
- Levels <0.6mmol/litre – check timing of sample; adjust dosage if correct and recurrent
- Interactions – NSAIDs, thiazide diuretics, ACE inhibitors
14
Q
Give examples of hypnotics
A
Benzodiazepines
- TEMAZEPAM (short-acting)
- Act at receptors associated with GABA (inhibitory transmitter)
- High potential for dependency
Z drugs (are new drugs)
- Zaleplon
15
Q
Give examples of anxiolytics
A
Benzodiazepines
- DIAZEPAM
- Long-acting
- LORAZEPAM
- Short-acting
Others
- Pregabalin
- Antiepileptic
