Psychopharmacology Flashcards
What are the barriers to adherence?
Side effects
Lack of insight
Not believing that drugs will work
Goes against their beliefs
Formulation or mode of administration
Fear of addiction
Fear of changing self
What are the levels of insight?
Knowledge that there is something wrong
Knowledge of the nature and cause of the disorder
Knowledge that the treatment will help and willingness to help
What are the considerations when prescribing medication?
Contraindications
Drug interactions
Effects on current conditions (epilepsy, Parkinson’s etc)
Pharmacokinetics (weight, ethnicity, endogenous enzymes)
What are the first line medications for depression?
SSRIs
What connections/parts of the brain might cognitive dysfunction in depression be related to?
Ventral tegmental area to the DLPFC (attention, working memory, decision making)
What connections/parts of the brain might anhedonia in depression be related to?
Ventral tegmental area to nucleus accumbens (pleasure and reward)
What connections/parts of the brain might cognitive dysfunction in depression be related to?
Ventral tegmental area to ventral PFC
What connections/parts of the brain might depressed mood and suicidal ideation in depression be related to?
Raphe nucleus to ventral prefrontal cortex (serotonergic)
What connections/parts of the brain might somatic symptoms (sleep and appetite) in depression be related to?
Raphe nucleus to hypothalamus (serotonergic)
How would you dose someone over 75yo?
Half of standard adult dose
How soon would it be expected to see side effects?
10-14 days
How does half life length affect SSRI discontinuation syndrome?
Shorter half life increases risk
How does half life length affect benzodiazepine addictiveness?
Shorter half life increases addiction risk
What is a NaSSA (like mirtazapine?)
Noradrenergic and specific serotonergic antidepressant - block is receptors to increase noradrenaline and serotonin release
What would be a somatic side effect of an SNRI?
Increased blood pressure from noradrenergic activity
What is a short term first line for anxiety?
Benzodiazepines
What are the issues with first generation antipsychotics?
They bind to dopamine receptors across pathways and for a long time, causing side effects such as apathy, anhedonia, extrapyramidal symptoms
What pathways is dopamine implicated in?
Nigrostriatal - motor (EPS)
Mesocortical - cognition, socialisation
Mesolimbic- arousal, memory behaviour
Tuberoinfundibular - prolactin release
What are examples of first generation antipsychotics?
Chlorpromazine, haloperidol
What are examples of second generation (atypical) antipsychotics?
Olanzapine
Risperidone (dementia)
Quetiapine
Aripiprazole
Lurasidone
What medication is used for treatment resistant psychosis?
Clozapine
What are the risks of clozapine?
Increased risk of seizures
Agranulocytosis (<2%) which can be fatal
Monitoring by blood test is necessary
How would you counter agranulocytosis from clozapine?
Growth colony stimulating factor (cancer treatment)
How would you monitor someone on Olanzapine?
Glucose at baseline? One month, and 4-6 months. Lipids every quarter for one year, then yearly.
How do you monitor patients on any antipsychotics?
Baseline FBC, urea and electrolytes, liver function, ECG, BP
How would you monitor patients on Risperidone, Amisulpride, or Sulpiride?
Prolactin: baseline, 6 months, and annual