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Phase 3a > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

Examples of SSRIs

A

sertraline, fluoxetine, paroxetine, citalopram, escitalopram

FLUOXETINE in UNDER 18

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2
Q

Indications for SSRIs

A

depression, anxiety, OCD, bulimia nervosa

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3
Q

SSRIs MOA

A

inhibit the reuptake of serotonin from presynaptic serotonin pumps

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4
Q

Side effects of SSRIs

A

GI symptoms, anxiety/agitation, insomnia, sweating, sex (anorgasmia)

Associated with:

  • Increased suicidality,
  • cytochrome-mediated interactions (fluoxetine)

Can cause hyponatraemia

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5
Q

SSRI withdrawal Sx

A

dizziness, headache, tremor, agitation, GI issues ~
esp paroxetine and sertraline

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6
Q

MOAI

A

Inhibit the enzymes: Monoamine oxidase A + B

Indicated for use in depression

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7
Q

MOAI SE

A
  • Overdose
  • TYRAMINE CHEESE REACTION (hypertensive crisis)
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8
Q

SNRIs

A

Venelafaxine, Duloxetine

  • indicated for depression and anxiety
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9
Q

SNRI MOA

A

Presynaptic blockade of both noradrenaline and serotonin reuptake pumps
(in high doses also blocks dopamine reuptake);

low effects on muscarinic,
histaminergic and alpha-adrenergic receptors

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10
Q

SNRIs SE

A

dizziness, dry mouth, constipation, hot flushes (muscarinic?)

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11
Q

NaSSAs

A

Noradrenergic and Specific Serotonergic Antidepressants

  • Mirtazapine

Indicated for use in: depression, anxiety (off license)

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12
Q

NaSSAs (Mirtazapine) MOA

A

presynaptic alpha2 blockage -> increased noradrenaline and
serotonin from presynaptic neurons;

histamine antagonist

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13
Q

Mirtazapine (NaSSA) SE

A
  • SEDATION + Wight gain (from histamine blocking)
  • Headache
  • Postural hypotension
  • Dizziness
  • Tremor
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14
Q

Tricyclics

A

AMITRYPTYLINE

Indicated in:

  • Depression
  • Anxiety
  • OCD
  • Chronic pain (lower dose)
  • Nocturnal enuresis
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15
Q

Tricyclic MOA

A

blockade of both noradrenaline and serotonin reuptake pumps (alsodopamine to a small extent).

Muscarinic, histaminergic, alpha-adrenergic

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16
Q

When are tricyclics contraindicated

A
  • IHD
  • Arrhythmias
  • Severe liver disease
  • RIsk of OVERDOSE
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17
Q

Tricyclic SE

A

Remember: Triple A

  • Anticholinergic
    - Dry mouth; constipation; blurred vision; urinary retention
  • Antiadrenergic
    - Postural hypotension
  • Antihistaminergic
    - Sedation + weight gain

+ CARDIAC -> LONG QT; HEART BLOCK; ARRHYTHMIAS; PALPITATIONS

18
Q

Lithium indications

A
  • MANIA (acute and prophylaxis)
  • Tx RESISTANT depression
  • Agression + Impulsivity
  • MOOD STABILISATION
19
Q

What monitoring is required for lithium

A
  • Pre starting BASELINE:
    - FBC, U+E, Ca2+, PO4^3-, TFTs, ECG, PREGNANCY
  • WEEKLY BLOODS till levels stable -> then 3 MONTHLY
    - Including renal + TFTs
20
Q

What is the theraputic index range of lithium

A

0.5. - 1

1.5-2 = toxicity

> 2 = severly toxic

21
Q

Lithium SE

A
  • Polyuria, Polydipsia
  • Weight gain
  • Oedema
  • Fine tremor -> coarse when more serious

QT ECG changes
Arrhythmias
Nystagmus
Dysarthria
Brisk reflexes
Impaired consiousness
TERATOGENIC (Ebstein’s abnormality of tricuspid)

22
Q

Which meds is it inadvisiable to have alongside lithium

A

NSAIDs, ACEi and Duiretics (anything that alters kidney function)

Lithium is renally excreted

23
Q

Sodium valproate

A

Indicated as: MOOD STABILISER, ANTICONVULSANT, for Migraine prophylaxis

24
Q

Sodium valproate SE

A

weight gain, dizziness, hair loss, n+v, tremor, deranged LFTs

TERATOGENIC

25
Q

Benzodiazepines

A
  • lorazepam (short acting),
  • diazepam (longer acting),
  • midazolam,
  • chlordiazepoxide
26
Q

Benzodiazepams indications

A
  • anxiety (short term in extreme cases only),
  • mania, psychosis,
  • alcohol withdrawal,
  • insomnia,
  • acute agitation/aggression,
  • epilepsy,
  • acute back pain
27
Q

Benzodiazepine MOA

A

bind to GABA receptor -> neuronal inhibition

28
Q

Benzodiazepine SE

A
  • Addiction
  • Resp / CNS DEPRESSANT EFFECTS (so can’t take any other cns depressants at same time)
    - avoid in neuro / severe resp disease
29
Q

Methylphenidate

A

ADHD

MOA: Dopamine + Noradrenaline reuptake

  • Modified slow realse OR fast relaease
30
Q

Methylphenidate SE

A

anxiety, increased BP, arrhythmias, appetite loss

31
Q

Acetylecholinesterase Inhib

A
  • DONEPEZIL, RIVASTIGMINE, Galantamine

for MILD-MOD ALZHEIMER’S

32
Q

AChE Inhib SE

A
  • Fatigue
  • GI issues
  • BRADYCARDIA
    - Need to check BASLINE ECG + PR before starting
33
Q

Z-drugs

A

SLEEPING PILLS etc ZOPICLONE

  • Stimulate GABA receptor
  • RIsk of Dependancy
  • Careful in neuro / resp disease
34
Q

Antipsychotics indications

A
  • PSYCHOSIS
  • MANIA
  • Depresssion
  • Refractory anxiety
  • PTSD
  • Behavioural challenges in dementia
  • Tourettes
  • Rapid tranquilisation
35
Q

Antipsychotics SE

A
  • ANTICHOLINERGIC
  • ANTIHISTAMINERGIC
  • ANTI-ALPHA ADRENERGIC
  • Lower seizure thershold
  • QT PROLONGATION

Extrapyramidal (more common in typical APs):

  • Parkinsonism
  • Acute dystonia
  • Tradive dyskinesia after years (permenant)
36
Q

MOA of Typical Antipsychotics + examples

A

ANTAGONISE D2 RECEPTORS - involved in:

  • Mesolimbic (delusions / hallucinations)
  • Mesocortical (Negative Sx)
  • Substantia Nigra (Movement - blocking -> Extrapyramidal SE)
  • Tuberoinfundibular (blocks dopamine inhib of pit gland -> prolactin secretion -> improved sexual function + libido)
  • Chemoreceptor trigger zone (N+V)

HALOPERIDOL (injectable), CHLORPROMAZINE, FLUPENTIXOL

37
Q

MOA of Atypical antipsychotics + examples

A

BLOCKS 5HT2 receptor -> METABOLIC SE (weight gain,
impaired glycaemic control, lipid elevation)

E.g. RISPERIDONE, OLANZEPINE, CLOZAPINE, Quetiapine, Aripiprazole (these can be given IM)

38
Q

When is clozapine used and why is it not commonly used

A

Tx RESISTANT SCHIZOPHRENIA

Has lots of SE:

  • Hypersalivation
  • Constipation
  • Myocarditis
  • Cardiomyopathy
  • NEUTROPENIA + AGRANULOCYOTOSIS
39
Q

Methadone

A
  • Used as oral substitution therapy
    in addictions
  • Opiate receptor agonist
  • Risk of respiratory depression
40
Q

Buprenorphine

A
  • Oral substitution in opiate dependence
  • Partial opiate receptor agonist
  • Patient needs to be in state of withdrawal before starting or will cause withdrawal
41
Q

Examples of liver enzyme inducing drugs

A
  • Rifampicin
  • Phenytoin
  • Carbamazepine
  • St John’s Wort
  • Chronic alcohol use

Important as more at risk from paracetamol overdose

42
Q
A

Phase 3a (26 decks)

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