Psychopharmacology Flashcards
Examples of SSRIs
sertraline, fluoxetine, paroxetine, citalopram, escitalopram
FLUOXETINE in UNDER 18
Indications for SSRIs
depression, anxiety, OCD, bulimia nervosa
SSRIs MOA
inhibit the reuptake of serotonin from presynaptic serotonin pumps
Side effects of SSRIs
GI symptoms, anxiety/agitation, insomnia, sweating, sex (anorgasmia)
Associated with:
- Increased suicidality,
- cytochrome-mediated interactions (fluoxetine)
Can cause hyponatraemia
SSRI withdrawal Sx
dizziness, headache, tremor, agitation, GI issues ~
esp paroxetine and sertraline
MOAI
Inhibit the enzymes: Monoamine oxidase A + B
Indicated for use in depression
MOAI SE
- Overdose
- TYRAMINE CHEESE REACTION (hypertensive crisis)
SNRIs
Venelafaxine, Duloxetine
- indicated for depression and anxiety
SNRI MOA
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
SNRIs SE
dizziness, dry mouth, constipation, hot flushes (muscarinic?)
NaSSAs
Noradrenergic and Specific Serotonergic Antidepressants
- Mirtazapine
Indicated for use in: depression, anxiety (off license)
NaSSAs (Mirtazapine) MOA
presynaptic alpha2 blockage -> increased noradrenaline and
serotonin from presynaptic neurons;
histamine antagonist
Mirtazapine (NaSSA) SE
- SEDATION + Wight gain (from histamine blocking)
- Headache
- Postural hypotension
- Dizziness
- Tremor
Tricyclics
AMITRYPTYLINE
Indicated in:
- Depression
- Anxiety
- OCD
- Chronic pain (lower dose)
- Nocturnal enuresis
Tricyclic MOA
blockade of both noradrenaline and serotonin reuptake pumps (alsodopamine to a small extent).
Muscarinic, histaminergic, alpha-adrenergic
When are tricyclics contraindicated
- IHD
- Arrhythmias
- Severe liver disease
- RIsk of OVERDOSE
Tricyclic SE
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
Lithium indications
- MANIA (acute and prophylaxis)
- Tx RESISTANT depression
- Agression + Impulsivity
- MOOD STABILISATION
What monitoring is required for lithium
- Pre starting BASELINE:
- FBC, U+E, Ca2+, PO4^3-, TFTs, ECG, PREGNANCY - WEEKLY BLOODS till levels stable -> then 3 MONTHLY
- Including renal + TFTs
What is the theraputic index range of lithium
0.5. - 1
1.5-2 = toxicity
> 2 = severly toxic
Lithium SE
- 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)
Which meds is it inadvisiable to have alongside lithium
NSAIDs, ACEi and Duiretics (anything that alters kidney function)
Lithium is renally excreted
Sodium valproate
Indicated as: MOOD STABILISER, ANTICONVULSANT, for Migraine prophylaxis
Sodium valproate SE
weight gain, dizziness, hair loss, n+v, tremor, deranged LFTs
TERATOGENIC
Benzodiazepines
- lorazepam (short acting),
- diazepam (longer acting),
- midazolam,
- chlordiazepoxide
Benzodiazepams indications
- anxiety (short term in extreme cases only),
- mania, psychosis,
- alcohol withdrawal,
- insomnia,
- acute agitation/aggression,
- epilepsy,
- acute back pain
Benzodiazepine MOA
bind to GABA receptor -> neuronal inhibition
Benzodiazepine SE
- Addiction
- Resp / CNS DEPRESSANT EFFECTS (so can’t take any other cns depressants at same time)
- avoid in neuro / severe resp disease
Methylphenidate
ADHD
MOA: Dopamine + Noradrenaline reuptake
- Modified slow realse OR fast relaease
Methylphenidate SE
anxiety, increased BP, arrhythmias, appetite loss
Acetylecholinesterase Inhib
- DONEPEZIL, RIVASTIGMINE, Galantamine
for MILD-MOD ALZHEIMER’S
AChE Inhib SE
- Fatigue
- GI issues
- BRADYCARDIA
- Need to check BASLINE ECG + PR before starting
Z-drugs
SLEEPING PILLS etc ZOPICLONE
- Stimulate GABA receptor
- RIsk of Dependancy
- Careful in neuro / resp disease
Antipsychotics indications
- PSYCHOSIS
- MANIA
- Depresssion
- Refractory anxiety
- PTSD
- Behavioural challenges in dementia
- Tourettes
- Rapid tranquilisation
Antipsychotics SE
- ANTICHOLINERGIC
- ANTIHISTAMINERGIC
- ANTI-ALPHA ADRENERGIC
- Lower seizure thershold
- QT PROLONGATION
Extrapyramidal (more common in typical APs):
- Parkinsonism
- Acute dystonia
- Tradive dyskinesia after years (permenant)
MOA of Typical Antipsychotics + examples
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
MOA of Atypical antipsychotics + examples
BLOCKS 5HT2 receptor -> METABOLIC SE (weight gain,
impaired glycaemic control, lipid elevation)
E.g. RISPERIDONE, OLANZEPINE, CLOZAPINE, Quetiapine, Aripiprazole (these can be given IM)
When is clozapine used and why is it not commonly used
Tx RESISTANT SCHIZOPHRENIA
Has lots of SE:
- Hypersalivation
- Constipation
- Myocarditis
- Cardiomyopathy
- NEUTROPENIA + AGRANULOCYOTOSIS
Methadone
- Used as oral substitution therapy
in addictions - Opiate receptor agonist
- Risk of respiratory depression
Buprenorphine
- Oral substitution in opiate dependence
- Partial opiate receptor agonist
- Patient needs to be in state of withdrawal before starting or will cause withdrawal
Examples of liver enzyme inducing drugs
- Rifampicin
- Phenytoin
- Carbamazepine
- St John’s Wort
- Chronic alcohol use
Important as more at risk from paracetamol overdose
