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Psychiatry > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

Drug class used to treat depression

A

Anti-depressant

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2
Q

Mechanism of action

A

They work by increasing the availability of one or more neurotransmitter (monoamines such as dopamine, norepinephrine and serotonin).

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3
Q

Name the classes of anti-depressants

A 
TCA
SSRIs
SNRIs
MAOIs
Atypical antidepressants
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4
Q

TCA MOA

A
  • TCA are potent inhibitor of norepinephrine
  • TCAs also are antagonist histamine-H1 receptors, Alpha1-adrenergic receptors, and muscarinic receptors
  • They also block voltage- sodium channel.
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5
Q

Adverse effects of TCA

A 
Weight gain
Sedation
Nausea and vomiting
Postural hypotension
Dry mouth, constipation, urine retention
Confusion, blurred vision
Tachycardia and arrythmias

In overdose :
Cardiac toxicity
CNS toxicity

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6
Q

Contra-indication for TCA

A

Closed angle glaucoma
BPH
MI
Arrytmias

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7
Q

Safest TCA in pregnancy and elderly

A

Amitriptyline

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8
Q

TCA used in enuresis (loss of bladder control)

A

Imipramine

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9
Q

MOA of SSRI

A

Selective serotonin reuptake inhibitors (SSRIs) work by specifically inhibiting the reuptake of serotonin. – In addition to serotonin reuptake inhibition, fluoxetine has NE reuptake inhibition (clinically relevant at high doses), CYP450 2D6 and 3A4 inhibition (involved in metabolism), and serotonin 2C antagonist actions (activating effects).

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10
Q

Adverse effects of SSRI

A 
Anxiety, 
Drowsiness,
Insomnia, 
Nausea and vomiting, 
Sexual dysfunction (ejaculatory dysfunction, anorgasmia),
Drug interaction, 
Energizing.
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11
Q

Contra-indications and indications

A

In younger age groups, TCAs rather SSRIs. Contra-indicated in adolescents/children – may potentiate suicidality.
SSRIs relatively safe in early pregnancy (late pregnancy risk of neonatal pulmonary hypertension, apnea, floppy syndrome).
5-HT in brain, gut and platelets – SSRIs block serotonin uptake in platelets, thus increased risk of bleeding; warfarin and SSRI’s contra-indicated

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12
Q

SSRI examples

A 
Citalopram
 Fluoxetine
 vilazodone 
fluvoxamine
sertraline
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13
Q

Name mood stabilizers and uses

A

Lithium
- Primarily used for treatment for bipolar mood disorder - counteracts both mania and depression
Carbamazepine
- Anticonvulsant used for treatment of neuropathic pain and control of seizures - also used as treatment for bipolar mood disorder
Sodium Valproate
- Used in treatment of bipolar mood disorder and epilepsy - also used to treat migraine headaches

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14
Q

Lithium MOA

A

Increases the volume of brain structures involved in emotional regulation.

Reduces excitatory neurotransmission and increase inhibitory neurotransmission.

Intracellular and molecular mechanisms further modulate neurotransmission.

Lithium has neuroprotective effects

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15
Q

Lithium side effects on CNS

A 
Fine tremors
Dysphoria
Impaired memory
Lack of spontaneity
Slow reaction time
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16
Q

Lithium cardiac side effects

A

T-wave flattening
Arrhythmias
Cardiac arrest

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17
Q

Lithium renal side-effects

A 
Polyuria
Polydipsia
Minimal change disease
Interstitial nephritis
Impaired renal function & renal failure
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18
Q

Lithium thyroid, skin and weight side-effects

A 
Thyroid
 - Hypothyroidism
 - Non-toxic goiter
Skin
 - Hair loss
 - Cutaneous Lesions
Weight gain
19
Q

Carbamazepine MOA

A

Carbamazepine is a sodium channel blocker. It binds to voltage-gated sodium channels causing inhibition of action potentials and decreased synaptic transmission.

Acts as a GABA agonist and a glutamate antagonist, and decreases dopamine turnover.

20
Q

Carbamazepine side-effects

A 
Drowsiness
Dry mouth
Dizziness
Diplopia
Ataxia
GIT disturbances
 - Nausea, anorexia, constipation, epigastric discomfort
21
Q

Sodium valproate MOA

A

Its precise mechanism of action is unclear.

Proposed mechanisms include

  • Increasing GABA neurotransmission.
  • Blocking voltage-gated sodium channels.
  • Impacting various neuroprotective molecular pathways.
  • Inhibiting histone deacetylase
22
Q

Sodium valproate side-effects

A 
Nausea, vomiting, constipation & diarrhea
Fatigue & sedation
Dysarthria & ataxia
Skin rashes & hair loss
Increased appetite
Oligomenorrhea/Amenorrhea
23
Q

MOA and goal of sedatives

A

Tranquilizers or CNS depressants.

Slow down brain activity→ calming effect on the body.

24
Q

Name the commonly used sedative

A

BENZODIAZEPINES

25
Q

Name non-benzodiazepine sedatives

A

Droperidol / Haloperidol

Alpha 2 agonisists → clonidine

26
Q

Benzodiazepine MOA

A

GABA receptors are found in the:

  • Limbic system
  • Spinal cord
  • Cerebellum
  • Brainstem

Benzodiazepines enhance action of GABA (allosterically) at GABA-A receptor
o bind to A-type GABA receptors on different site from GABA binding site to enhance GABA action of opening channels, allowing entry of chloride ions → hyperpolarization
o reduce neuronal depolarization resulting in decreased action potentials

in response to increased GABA inhibitory effect the body neuoradapts and causes decreased GABA inhibition effect and increased glutamate excitability → when diazepam is stopped there is hyperexcitability/withdrawal symptoms

27
Q

Classification of benzos drugs is based on the duration of action/half-life. Name one drug in each class and their half-life

A

Remember the order and names of the drugs by the mnemonic MOLD & remember that there is just a doubling pattern in ther elimination half-live
M→ midozalam (ultra short-acting) - less than 6 hours
O→ Oxazepam (short-acting) - 6-12 hours
L→ Lorazepam (intermediate-acting) - 12-24 hours
D→ Diazepam (long-acting) - 24 hours

Note that short acting agents have greater tendency to cause overt dependency and withdrawal

28
Q

Explain the difference between short- and rapid-acting drugs

A

Short acting→ the effects last for a short period

Rapid acting→ the effects occur rapidly

29
Q

Indications for bonzos

A

Acute aggressive behaviours - Lorazepam (sedating restless patient who can move around) and diazepam (for the restless patient who needs to be restrained)
- Always ensure that resuscitation equipment and flumazenil (antidote is present) because sedation can cause respiratory failure

Epilepsy – status epilepticus (state of having one seizure that lasts more than 5 minutes or having more than 1 seizure within 5 minutes without going back to normal level of consciousness between episodes)

Anaesthesia

Alcohol withdrawal syndrome/delirium tremens.

Muscle tone disorders such as acute dystonia.

Serotonin syndrome

Anxiety disorders (not favoured at all, rather use antidepressant medication like SSRIs and SNRIs)

Other - Quick relief of hypertension in drug overdoses, Treating tachycardia caused by stimulants like cocaine

30
Q

What is used in dystonia

A

Dystonia- give biperidine

- Treatment of EPSE caused by antipsychotics

31
Q

Explain the dependence mechanism

A

The main problem with dependency is that it can occur even after several weeks of treatment with therapeutic doses.

Without benzodiazepines, you see that GABA plays an inhibitory role on the VTA (Ventral tegmental area) where dopamine is produced. However, when benzodiazepines are used over time, you get neuroadaptation where there is decrease GABA activity in order to maintain homeostasis and overcome the drug effects. This results in disinhibition of dopamine producing neurons

32
Q

How could you avoid dependence

A

Treatment should be kept to a minimum, reviewed regularly and discontinued as soon as possible.
Do NOT use for anxiety states
Longstanding anxiety disorders and panic disorders should be managed with counselling and low-dose antidepressants.
Although the benzodiazepines have hypnotic properties, it is not desirable to use them in the routine management of insomnia

Therapeutic relationship between client and doctor is very important:
- Patients often do not view Benzo dependence as an addiction because their doctor prescribed the medication = denial is a big problem

33
Q

What are antipsychotic drugs?

A

Antipsychotic drugs are a class of medicines used to treat psychosis and other mental and emotional conditions

34
Q

Name the two classes of antipsychotics and give examples of each

A 
Typicals:
•Chlorpromazine 
•Haloperidol 
•Flupentixol 
•Fluphenazine 
•Thioridazine 
Atypicals:
•Clozapine 
•Olanzapine 
•Risperidone 
•Aripiprazole 
•Lurasidone
35
Q

MOA of typical antipsychotic

A

First generation antipsychotics act by blocking D2 receptors.
They are non-selective and therefore block D2 receptors in all areas of the brain.
They also block histaminic, noradrenergic and cholinergic receptors.

36
Q

What are typical antipsychotics used for

A 
•Schizophrenia 
•Schizoaffective disorder 
•Bipolar disorder
•Severe agitation
•Dementia 
•Delirium 
•Major depressive disorder with psychotic features 
Non-psychiatric indications: nausea, vomiting,  Tourette's' syndrome, Huntington 'disease, intractable hiccups
37
Q

EPSEs from typical antipsychotics

A

Parkinsonism, Acute dystonic reactions, Tardive dyskinesia ,Akathisia ,Neuroleptic malignant syndrome

38
Q

Possible other affects of antipsychotics

A 
Endocrine system 
Gastrointestinal system 
Cognition 
Seizure threshold 
Cardiovascular system 
Other side effects include blurred vision, hot flushes and weight gain
39
Q

Contra-indications of antipsychotics

A 
Known hypersensitivity
Cardiac abnormalities 
Previous EPSEs
Parkinson's disease 
Renal or hepatic insufficiency
40
Q

Atypical antipsychotics MOA

A

Second-generation antipsychotics work by blocking D2 receptors as well as serotonin receptors.
5-HT2A and 5-HT2C subtypes of serotonin receptors are the most involved

41
Q

Atypical antipsychotics uses

A
  • Treatment resistant schizophrenia
  • Bipolar mood disorder – mania or mixed
  • Major depressive disorder
  • Agitation
42
Q

Atypical antipsychotics contra-indications

A 
Prolactinoma
Parkinsonism 
Tardive dyskinesia 
Severe neutropenia 
Bone marrow depression 
Previous neuroleptic syndrome
43
Q

Atypical antipsychotics contra-indications

A 
Prolactinoma
Parkinsonism 
Tardive dyskinesia 
Severe neutropenia 
Bone marrow depression 
Previous neuroleptic syndrome
44
Q

Side-effects of atypical antipsychotics

A

Weight gain , agranulocytosis, constipation, Hyperprolactinemia, Myocarditis, pericarditis, Convulsions

Psychiatry (13 decks)

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